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Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension.
J Neurol Neurosurg Psychiatry 2009; 80(8):916-20JN

Abstract

BACKGROUND

The impact of osmotic therapies on brain oxygen has not been extensively studied in humans. We examined the effects on brain tissue oxygen tension (PbtO(2)) of mannitol and hypertonic saline (HTS) in patients with severe traumatic brain injury (TBI) and refractory intracranial hypertension.

METHODS

12 consecutive patients with severe TBI who underwent intracranial pressure (ICP) and PbtO(2) monitoring were studied. Patients were treated with mannitol (25%, 0.75 g/kg) for episodes of elevated ICP (>20 mm Hg) or HTS (7.5%, 250 ml) if ICP was not controlled with mannitol. PbtO(2), ICP, mean arterial pressure, cerebral perfusion pressure (CPP), central venous pressure and cardiac output were monitored continuously.

RESULTS

42 episodes of intracranial hypertension, treated with mannitol (n = 28 boluses) or HTS (n = 14 boluses), were analysed. HTS treatment was associated with an increase in PbtO(2) (from baseline 28.3 (13.8) mm Hg to 34.9 (18.2) mm Hg at 30 min, 37.0 (17.6) mm Hg at 60 min and 41.4 (17.7) mm Hg at 120 min; all p<0.01) while mannitol did not affect PbtO(2) (baseline 30.4 (11.4) vs 28.7 (13.5) vs 28.4 (10.6) vs 27.5 (9.9) mm Hg; all p>0.1). Compared with mannitol, HTS was associated with lower ICP and higher CPP and cardiac output.

CONCLUSIONS

In patients with severe TBI and elevated ICP refractory to previous mannitol treatment, 7.5% hypertonic saline administered as second tier therapy is associated with a significant increase in brain oxygenation, and improved cerebral and systemic haemodynamics.

Authors+Show Affiliations

Neurointensive Care Unit, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

19293171

Citation

Oddo, M, et al. "Effect of Mannitol and Hypertonic Saline On Cerebral Oxygenation in Patients With Severe Traumatic Brain Injury and Refractory Intracranial Hypertension." Journal of Neurology, Neurosurgery, and Psychiatry, vol. 80, no. 8, 2009, pp. 916-20.
Oddo M, Levine JM, Frangos S, et al. Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. J Neurol Neurosurg Psychiatry. 2009;80(8):916-20.
Oddo, M., Levine, J. M., Frangos, S., Carrera, E., Maloney-Wilensky, E., Pascual, J. L., ... LeRoux, P. D. (2009). Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. Journal of Neurology, Neurosurgery, and Psychiatry, 80(8), pp. 916-20. doi:10.1136/jnnp.2008.156596.
Oddo M, et al. Effect of Mannitol and Hypertonic Saline On Cerebral Oxygenation in Patients With Severe Traumatic Brain Injury and Refractory Intracranial Hypertension. J Neurol Neurosurg Psychiatry. 2009;80(8):916-20. PubMed PMID: 19293171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. AU - Oddo,M, AU - Levine,J M, AU - Frangos,S, AU - Carrera,E, AU - Maloney-Wilensky,E, AU - Pascual,J L, AU - Kofke,W A, AU - Mayer,S A, AU - LeRoux,P D, Y1 - 2009/03/16/ PY - 2009/3/19/entrez PY - 2009/3/19/pubmed PY - 2009/7/31/medline SP - 916 EP - 20 JF - Journal of neurology, neurosurgery, and psychiatry JO - J. Neurol. Neurosurg. Psychiatry VL - 80 IS - 8 N2 - BACKGROUND: The impact of osmotic therapies on brain oxygen has not been extensively studied in humans. We examined the effects on brain tissue oxygen tension (PbtO(2)) of mannitol and hypertonic saline (HTS) in patients with severe traumatic brain injury (TBI) and refractory intracranial hypertension. METHODS: 12 consecutive patients with severe TBI who underwent intracranial pressure (ICP) and PbtO(2) monitoring were studied. Patients were treated with mannitol (25%, 0.75 g/kg) for episodes of elevated ICP (>20 mm Hg) or HTS (7.5%, 250 ml) if ICP was not controlled with mannitol. PbtO(2), ICP, mean arterial pressure, cerebral perfusion pressure (CPP), central venous pressure and cardiac output were monitored continuously. RESULTS: 42 episodes of intracranial hypertension, treated with mannitol (n = 28 boluses) or HTS (n = 14 boluses), were analysed. HTS treatment was associated with an increase in PbtO(2) (from baseline 28.3 (13.8) mm Hg to 34.9 (18.2) mm Hg at 30 min, 37.0 (17.6) mm Hg at 60 min and 41.4 (17.7) mm Hg at 120 min; all p<0.01) while mannitol did not affect PbtO(2) (baseline 30.4 (11.4) vs 28.7 (13.5) vs 28.4 (10.6) vs 27.5 (9.9) mm Hg; all p>0.1). Compared with mannitol, HTS was associated with lower ICP and higher CPP and cardiac output. CONCLUSIONS: In patients with severe TBI and elevated ICP refractory to previous mannitol treatment, 7.5% hypertonic saline administered as second tier therapy is associated with a significant increase in brain oxygenation, and improved cerebral and systemic haemodynamics. SN - 1468-330X UR - https://www.unboundmedicine.com/medline/citation/19293171/Effect_of_mannitol_and_hypertonic_saline_on_cerebral_oxygenation_in_patients_with_severe_traumatic_brain_injury_and_refractory_intracranial_hypertension_ L2 - http://jnnp.bmj.com/cgi/pmidlookup?view=long&amp;pmid=19293171 DB - PRIME DP - Unbound Medicine ER -