Treatment of elevated intracranial pressure with hyperosmolar therapy in patients with renal failure.

Neurocritical Care
Karen G HirschRomergryko G Geocadin

Abstract

To evaluate the use of hyperosmolar therapy in the management of elevated intracranial pressure (ICP) and transtentorial herniation (TTH) in patients with renal failure and supratentorial lesions. Patients with renal failure undergoing renal replacement therapy treated with 23.4% saline (30-60 mL) and/or mannitol for high ICP or clinical evidence of TTH were analyzed in a retrospective cohort. The primary outcome measure was reversal of TTH or ICP crisis. Secondary outcome measures were modified Rankin scale on hospital discharge, survival to hospital discharge, and adverse effects. Of 254 subjects over 7 years, 6 patients with end-stage renal disease had 11 events. All patients received a 23.4% saline bolus, along with mannitol (91%), hypertonic saline (HS) maintenance fluids (82%), and surgical interventions (n = 2). Reversal occurred in 6/11 events (55%); 2 of 6 patients survived to discharge. ICP recording of 6 TTH events showed a reduction from ICP of 41 ± 3.8 mmHg (mean ± SEM) with TTH to 20.8 ± 3.9 mmHg (p = 0.05) 1 h after the 23.4% saline bolus. Serum sodium increased from 141.4 to 151.1 mmol/L 24 h after 23.4% saline bolus (p = 0.001). No patients were undergoing hemodialysis at the time of the event. There were no ca...Continue Reading

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Citations

Dec 26, 2012·Advances in Chronic Kidney Disease·Karen G Hirsch, S Andrew Josephson
Apr 15, 2017·Case Reports in Critical Care·Anton LundKirsten Møller
May 1, 2021·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Sara Stern-Nezer
Oct 8, 2021·Continuum : Lifelong Learning in Neurology·Eric M Liotta

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