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Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury.
Ann N Y Acad Sci. 2015 May; 1345:83-8.AN

Abstract

Hyperosmolar agents are commonly used as an initial treatment for the management of raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). They have an excellent adverse-effect profile compared to other therapies, such as hyperventilation and barbiturates, which carry the risk of reducing cerebral perfusion. The hyperosmolar agent mannitol has been used for several decades to reduce raised ICP, and there is accumulating evidence from pilot studies suggesting beneficial effects of hypertonic saline (HTS) for similar purposes. An ideal therapeutic agent for ICP reduction should reduce ICP while maintaining cerebral perfusion (pressure). While mannitol can cause dehydration over time, HTS helps maintain normovolemia and cerebral perfusion, a finding that has led to a large amount of pilot data being published on the benefits of HTS, albeit in small cohorts. Prophylactic therapy is not recommended with mannitol, although it may be beneficial with HTS. To date, no large clinical trial has been performed to directly compare the two agents. The best current evidence suggests that mannitol is effective in reducing ICP in the management of traumatic intracranial hypertension and carries mortality benefit compared to barbiturates. Current evidence regarding the use of HTS in severe TBI is limited to smaller studies, which illustrate a benefit in ICP reduction and perhaps mortality.

Authors+Show Affiliations

Division of Stroke and Critical Care, Department of Neurology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25726965

Citation

Mangat, Halinder S., and Roger Härtl. "Hypertonic Saline for the Management of Raised Intracranial Pressure After Severe Traumatic Brain Injury." Annals of the New York Academy of Sciences, vol. 1345, 2015, pp. 83-8.
Mangat HS, Härtl R. Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury. Ann N Y Acad Sci. 2015;1345:83-8.
Mangat, H. S., & Härtl, R. (2015). Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury. Annals of the New York Academy of Sciences, 1345, 83-8. https://doi.org/10.1111/nyas.12704
Mangat HS, Härtl R. Hypertonic Saline for the Management of Raised Intracranial Pressure After Severe Traumatic Brain Injury. Ann N Y Acad Sci. 2015;1345:83-8. PubMed PMID: 25726965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury. AU - Mangat,Halinder S, AU - Härtl,Roger, Y1 - 2015/02/27/ PY - 2015/3/3/entrez PY - 2015/3/3/pubmed PY - 2015/9/22/medline KW - hyperosmotics KW - hypertonic saline KW - intracranial hypertension KW - intracranial pressure KW - mannitol KW - traumatic brain injury SP - 83 EP - 8 JF - Annals of the New York Academy of Sciences JO - Ann. N. Y. Acad. Sci. VL - 1345 N2 - Hyperosmolar agents are commonly used as an initial treatment for the management of raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). They have an excellent adverse-effect profile compared to other therapies, such as hyperventilation and barbiturates, which carry the risk of reducing cerebral perfusion. The hyperosmolar agent mannitol has been used for several decades to reduce raised ICP, and there is accumulating evidence from pilot studies suggesting beneficial effects of hypertonic saline (HTS) for similar purposes. An ideal therapeutic agent for ICP reduction should reduce ICP while maintaining cerebral perfusion (pressure). While mannitol can cause dehydration over time, HTS helps maintain normovolemia and cerebral perfusion, a finding that has led to a large amount of pilot data being published on the benefits of HTS, albeit in small cohorts. Prophylactic therapy is not recommended with mannitol, although it may be beneficial with HTS. To date, no large clinical trial has been performed to directly compare the two agents. The best current evidence suggests that mannitol is effective in reducing ICP in the management of traumatic intracranial hypertension and carries mortality benefit compared to barbiturates. Current evidence regarding the use of HTS in severe TBI is limited to smaller studies, which illustrate a benefit in ICP reduction and perhaps mortality. SN - 1749-6632 UR - https://www.unboundmedicine.com/medline/citation/25726965/Hypertonic_saline_for_the_management_of_raised_intracranial_pressure_after_severe_traumatic_brain_injury_ L2 - https://doi.org/10.1111/nyas.12704 DB - PRIME DP - Unbound Medicine ER -