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Hypertonic saline more efficacious than mannitol in lethal intracranial hypertension model.
Neurol Res 2010; 32(2):139-43NR

Abstract

BACKGROUND

Medical management of brain edema and elevated intracranial pressure (ICP) is a crucial challenge in neurosurgical practice. Depending on the cause, the treatments for brain edema fall into three categories: stabilization of the blood-brain barrier, depletion of brain water and surgical decompression. Although mannitol is the mainstay of hyperosmolar therapy, hypertonic saline (HS) is emerging as an effective alternative to traditional osmotic agents.

METHODS

Experimental elevated ICP (50 mmHg) was induced in rabbits using an intracranial balloon. The effects of mannitol and HS (10% NaCl) were compared in this specific physiopathological model. Twelve animals were divided into three groups (control, HS and mannitol) according to intravenous administration of 0.9% NaCl, 10% NaCl or 20% mannitol 5 minutes after the elevation of ICP. The doses of 10% NaCl and 20% mannitol were iso-osmolar. During 90 minutes, continuous recording of ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) was realized.

RESULTS

The control group had a median survival of only 53 minutes, significantly lower than the treated groups (p=0.0002). There was statistical difference between mannitol and HS; the 10% NaCl group had lower values of ICP (p=0.0116) and higher values of MAP (p<0.0001) and CPP (p<0.0001).

CONCLUSION

The findings demonstrate higher efficacy of the 10% NaCl treatment in this comparison with 20% mannitol. Further efforts should be directed toward development of clinical studies using iso-osmotic doses of mannitol and HS in specific etiologies of intracranial hypertension.

Authors+Show Affiliations

Department of Neurosurgery, Hospital da Restauração, Agamenon Magalhães, SN, Recife, Pernambuco 51021-110, Brazil. joacil_carlos@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19309542

Citation

da Silva, Joacil Carlos, et al. "Hypertonic Saline More Efficacious Than Mannitol in Lethal Intracranial Hypertension Model." Neurological Research, vol. 32, no. 2, 2010, pp. 139-43.
da Silva JC, de Lima Fde M, Valença MM, et al. Hypertonic saline more efficacious than mannitol in lethal intracranial hypertension model. Neurol Res. 2010;32(2):139-43.
da Silva, J. C., de Lima, F. d. e. . M., Valença, M. M., & de Azevedo Filho, H. R. (2010). Hypertonic saline more efficacious than mannitol in lethal intracranial hypertension model. Neurological Research, 32(2), pp. 139-43. doi:10.1179/174313209X405119.
da Silva JC, et al. Hypertonic Saline More Efficacious Than Mannitol in Lethal Intracranial Hypertension Model. Neurol Res. 2010;32(2):139-43. PubMed PMID: 19309542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertonic saline more efficacious than mannitol in lethal intracranial hypertension model. AU - da Silva,Joacil Carlos, AU - de Lima,Frederico de Melo Tavares, AU - Valença,Marcelo Moraes, AU - de Azevedo Filho,Hildo Rocha Cirne, Y1 - 2009/03/23/ PY - 2009/3/25/entrez PY - 2009/3/25/pubmed PY - 2010/9/23/medline SP - 139 EP - 43 JF - Neurological research JO - Neurol. Res. VL - 32 IS - 2 N2 - BACKGROUND: Medical management of brain edema and elevated intracranial pressure (ICP) is a crucial challenge in neurosurgical practice. Depending on the cause, the treatments for brain edema fall into three categories: stabilization of the blood-brain barrier, depletion of brain water and surgical decompression. Although mannitol is the mainstay of hyperosmolar therapy, hypertonic saline (HS) is emerging as an effective alternative to traditional osmotic agents. METHODS: Experimental elevated ICP (50 mmHg) was induced in rabbits using an intracranial balloon. The effects of mannitol and HS (10% NaCl) were compared in this specific physiopathological model. Twelve animals were divided into three groups (control, HS and mannitol) according to intravenous administration of 0.9% NaCl, 10% NaCl or 20% mannitol 5 minutes after the elevation of ICP. The doses of 10% NaCl and 20% mannitol were iso-osmolar. During 90 minutes, continuous recording of ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) was realized. RESULTS: The control group had a median survival of only 53 minutes, significantly lower than the treated groups (p=0.0002). There was statistical difference between mannitol and HS; the 10% NaCl group had lower values of ICP (p=0.0116) and higher values of MAP (p<0.0001) and CPP (p<0.0001). CONCLUSION: The findings demonstrate higher efficacy of the 10% NaCl treatment in this comparison with 20% mannitol. Further efforts should be directed toward development of clinical studies using iso-osmotic doses of mannitol and HS in specific etiologies of intracranial hypertension. SN - 1743-1328 UR - https://www.unboundmedicine.com/medline/citation/19309542/Hypertonic_saline_more_efficacious_than_mannitol_in_lethal_intracranial_hypertension_model_ L2 - http://www.tandfonline.com/doi/full/10.1179/174313209X405119 DB - PRIME DP - Unbound Medicine ER -