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Effects of mannitol bolus administration on intracranial pressure, cerebral extracellular metabolites, and tissue oxygenation in severely head-injured patients.
J Trauma 2007; 62(2):292-8JT

Abstract

BACKGROUND

Osmotic agents are widely used to lower elevated intracranial pressure (ICP). However, little data are available regarding cerebral oxygenation and metabolism in the traumatized brains studied under clinical conditions. The present prospective, open-labeled clinical study was designed to investigate whether administration of mannitol, with the aim of reducing moderate intracranial hypertension, improves cerebral metabolism and oxygenation in patients after severe traumatic brain injury (TBI).

METHODS

Multimodal cerebral monitoring (MCM), consisting of intraparenchymal ICP, tissue oxygenation (ptiO2), and micro dialysis measurements was initiated in six male TBI patients (mean age 45 years; Glasgow Coma Scale score <9). A total of 14 mannitol boli (20%, 0.5g/kg, 20 minutes infusion time) were administered to treat ICP exceeding 20 mm Hg (2.7 kPa). Temporal alterations determined by MCM after mannitol infusions were recorded for 120 minutes. Microdialysates were assayed immediately for extracellular glucose, lactate, pyruvate, and glutamate concentrations.

RESULTS

Elevated ICP was successfully treated in all cases. This effect was maximal 40 minutes after start of infusion (25 +/- 6 mm Hg [3.3 +/- 0.8 kPa] to 17 +/- 3 mm Hg [2.3 +/- 0.4 kPa], p < 0.05) and lasted up to 100 minutes. Cerebral ptiO2 remained unaffected (21 +/- 5 mm Hg [2.8 +/- 0.7 kPa] to 23 +/- 6 mm Hg [3.1 +/- 0.8 kPa], n.s.). Microdialysate concentrations of all analytes rose unspecifically by 10% to 40% from baseline, reaching maximum concentrations 40 to 60 minutes after start of the infusion.

CONCLUSIONS

Mannitol efficiently reduces increased ICP. At an ICP of up to 30 mm Hg [4 kPa] it does not affect cerebral oxygenation. Unspecific increases of extracellular fluid metabolites can be explained by transient osmotic dehydration. Additional mechanisms, such as increased cerebral perfusion and blood volume, might explain an accelerated return to baseline.

Authors+Show Affiliations

Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany. oliver.sakowitz@med.uni-heidelberg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17297315

Citation

Sakowitz, Oliver W., et al. "Effects of Mannitol Bolus Administration On Intracranial Pressure, Cerebral Extracellular Metabolites, and Tissue Oxygenation in Severely Head-injured Patients." The Journal of Trauma, vol. 62, no. 2, 2007, pp. 292-8.
Sakowitz OW, Stover JF, Sarrafzadeh AS, et al. Effects of mannitol bolus administration on intracranial pressure, cerebral extracellular metabolites, and tissue oxygenation in severely head-injured patients. J Trauma. 2007;62(2):292-8.
Sakowitz, O. W., Stover, J. F., Sarrafzadeh, A. S., Unterberg, A. W., & Kiening, K. L. (2007). Effects of mannitol bolus administration on intracranial pressure, cerebral extracellular metabolites, and tissue oxygenation in severely head-injured patients. The Journal of Trauma, 62(2), pp. 292-8.
Sakowitz OW, et al. Effects of Mannitol Bolus Administration On Intracranial Pressure, Cerebral Extracellular Metabolites, and Tissue Oxygenation in Severely Head-injured Patients. J Trauma. 2007;62(2):292-8. PubMed PMID: 17297315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of mannitol bolus administration on intracranial pressure, cerebral extracellular metabolites, and tissue oxygenation in severely head-injured patients. AU - Sakowitz,Oliver W, AU - Stover,John F, AU - Sarrafzadeh,Asita S, AU - Unterberg,Andreas W, AU - Kiening,Karl L, PY - 2007/2/14/pubmed PY - 2007/3/16/medline PY - 2007/2/14/entrez SP - 292 EP - 8 JF - The Journal of trauma JO - J Trauma VL - 62 IS - 2 N2 - BACKGROUND: Osmotic agents are widely used to lower elevated intracranial pressure (ICP). However, little data are available regarding cerebral oxygenation and metabolism in the traumatized brains studied under clinical conditions. The present prospective, open-labeled clinical study was designed to investigate whether administration of mannitol, with the aim of reducing moderate intracranial hypertension, improves cerebral metabolism and oxygenation in patients after severe traumatic brain injury (TBI). METHODS: Multimodal cerebral monitoring (MCM), consisting of intraparenchymal ICP, tissue oxygenation (ptiO2), and micro dialysis measurements was initiated in six male TBI patients (mean age 45 years; Glasgow Coma Scale score <9). A total of 14 mannitol boli (20%, 0.5g/kg, 20 minutes infusion time) were administered to treat ICP exceeding 20 mm Hg (2.7 kPa). Temporal alterations determined by MCM after mannitol infusions were recorded for 120 minutes. Microdialysates were assayed immediately for extracellular glucose, lactate, pyruvate, and glutamate concentrations. RESULTS: Elevated ICP was successfully treated in all cases. This effect was maximal 40 minutes after start of infusion (25 +/- 6 mm Hg [3.3 +/- 0.8 kPa] to 17 +/- 3 mm Hg [2.3 +/- 0.4 kPa], p < 0.05) and lasted up to 100 minutes. Cerebral ptiO2 remained unaffected (21 +/- 5 mm Hg [2.8 +/- 0.7 kPa] to 23 +/- 6 mm Hg [3.1 +/- 0.8 kPa], n.s.). Microdialysate concentrations of all analytes rose unspecifically by 10% to 40% from baseline, reaching maximum concentrations 40 to 60 minutes after start of the infusion. CONCLUSIONS: Mannitol efficiently reduces increased ICP. At an ICP of up to 30 mm Hg [4 kPa] it does not affect cerebral oxygenation. Unspecific increases of extracellular fluid metabolites can be explained by transient osmotic dehydration. Additional mechanisms, such as increased cerebral perfusion and blood volume, might explain an accelerated return to baseline. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/17297315/Effects_of_mannitol_bolus_administration_on_intracranial_pressure_cerebral_extracellular_metabolites_and_tissue_oxygenation_in_severely_head_injured_patients_ L2 - http://Insights.ovid.com/pubmed?pmid=17297315 DB - PRIME DP - Unbound Medicine ER -