Manitol versus solución salina hipertónica en neuroanestesia It appears that a low dose of mannitol acts as a renal vasodilator while high-dose mannitol is. Randomized, controlled trial on the effect of a 20% mannitol solution and a % saline/6% dextran solution on increased intracranial pressure. Introduction Hyperosmolar therapy with mannitol or hypertonic saline (HTS) is the primary medical management strategy for elevated intracranial pressure (ICP).
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As far as dose is concerned, ICP reduction and longer lasting responses have been observed when a dose between 0. Mannitol is a sugar alcohol with a molecular weight of kDa. Nicholls D, Attwell D.
Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned?
However, in the past few decades there has been growing interest in HTS as an alternative to mannitol in treating elevated ICP. Metabolic acidosis in the critically ill: Kamel, 61 in that same year, carried out a meta-analysis of all randomized trials comparing mannitol and HTS for fs treatment of IH. Wise BL, Chater N. Wien Klin Wochenschr,pp. In particular, hyperosmolar therapy, which includes mannitol or hypertonic saline HTSis frequently administered to reduce ICP.
Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: The mean reduction in ICP for mannitol was 7.
L -1 and 5. InWeed and McKibben first described the effect of osmotherapy in laboratory animals by showing that hypertonic fluids reduced brain bulk and ICP.
Fluid resuscitation in patients with TBI is of critical importance because of the need to avoid hypotension and secondary neurological injury, which result in increased mortality in these patients. Management of physiological variables in neuroanaesthesia: The abbreviation of its title is Rev. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.
Best Pract Res Clin Anaesthesiol, 21pp. The benefit of HTS relative to long-term neurological out-comes compared to that of mannitol is yet unclear. None of the three treatment regimens influenced cerebral blood flow or brain metabolism. Other problems include ARF, arrhythmias, haemolysis, acute lung oedema and pontine myelinolysis. It is not yet clear if it must be a bolus dose or an infusion. The lund concept for severe traumatic brain injury.
The authors concluded that when the same osmotic load is administered, mannitol and HTS are equally effective in treating intracranial hypertension in patients with severe TBI. N Engl J Med. Hypertonic saline resuscitation attenuates neutrophil lung sequestration and transmigration by diminishing leukocyte-endothelial interactions in a two-hit model of sv shock and infection.
The concept of guiding treatment by ICP monitoring was recently challenged in a study by Chesnut et al. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. No statistically significant difference in either maximum reduction nor in duration of ICP was observed.
Solycion search strategy yielded seven articles for inclusion that were analyzed from the full manuscript. Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension[ 19 ] This is a prospective, nonrandomized, and cross-over study that compares the effects on brain tissue hipretonica tension PbtO 2 of mannitol and HTS.
We review the efficacy data for HTS compared with mannitol in terms of clinical considerations.
Treatment failures occurred in 7 out of 10 patients in the mannitol group versus 1 out of 10 in the HTS group. L -1and the increase in chloride, mean of 5. One limitation to this study was the osmolar difference between ,anitol solutions; the patients in HTS arm received a higher osmolar load than the mannitol arm mOsm vs.
Other Papers By First Author. A new therapy of post-trauma brain oedema based on haemodynamic principles for brain volume regulation. Anesthesiol Clin, 25pp. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure.
Services on Demand Article. Download PDF Cite this paper. The study included 40 elective patients, the majority ASA-III, taken to surgery for supratentorial tumours, posterior fossa procedures, AVM and aneurisms, with and without subarachnoid haemorrhage.
HTS treatment was associated with an increase in PbtO 2 from baseline Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. soluclon
Characterizing the dose-response relationship between mannitol and intracranial pressure in traumatic brain injury patients using a high-frequency physiological data collection system.
We included both prospective and retrospective randomized controlled studies of adult patients with intracranial hypertension as a result of severe TBI who received hyperosmolar therapy.