Abstract
The use of hyperosmolar agents for intracranial hypertension was introduced in the early 20th century and remains a mainstay of therapy for patients with cerebral edema. Both animal and human studies have demonstrated the efficacy of two hyperosmolar agents, mannitol and hypertonic saline, in reducing intracranial pressure via volume redistribution, plasma expansion, rheologic modifications, and anti-inflammatory effects. However, because of physician and institutional variation in therapeutic practices, lack of standardized protocols for initiation and administration of therapy, patient heterogeneity, and a paucity of randomized controlled trials have yielded little Class I evidence on which clinical decisions can be based, most current evidence regarding the use of hyperosmolar therapy is derived from retrospective analyses (Class III) and case series (Class IV). In this review, we summarize the available evidence regarding the use of hyperosmolar therapy with mannitol or hypertonic saline for the medical management of intracranial hypertension and present a comprehensive discussion of the evidence associated with various theoretical and practical concerns related to initiation, dosage, and monitoring of therapy.
- Content Type Journal Article
- Category Review
- Pages 1-14
- DOI 10.1007/s12028-011-9649-x
- Authors
- Andrew Torre-Healy, Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
- Nicholas F. Marko, Cancer Research UK Cambridge Cancer Research Institute, Robinson Way, Cambridge, CB2 0RE UK
- Robert J. Weil, Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
- Journal Neurocritical Care
- Online ISSN 1556-0961
- Print ISSN 1541-6933
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