Anest. intenziv. Med. 2010;21(1):18-22

Osmotherapy in neurosurgery - hyperosmolar mannitol or hypertonic saline?Intesive Care Medicine - Review Article

Dostálová Vlasta*, Dostál Pavel, Schreiberová Jitka, Černý Vladimír
Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové

Hyperosmolar solutions of mannitol and hypertonic saline (HS) have been both used to treat elevated intracranial pressure in critically ill patients and during neurosurgery interventions. The hyperosmolarity of mannitol and HS, combined with the impermeability of the blood - brain barrier to mannitol and sodium, provides favourable conditions for moving water from the brain to the intravascular compartment. However, a number of prospective clinical trials comparing the effects of mannitol and HS on intracranial pressure have suggested that HS is at least as effective as, if not better than, mannitol in the treatment of intracranial hypertension and perifocal oedema.

Keywords: osmotherapy; mannitol; hypertonic solution; sodium chloride; osmotic reflexion cofficient; vasogennic oedema

Received: October 23, 2009; Accepted: November 1, 2009; Published: February 1, 2010  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Vlasta D, Dostál P, Schreiberová J, Černý V. Osmotherapy in neurosurgery - hyperosmolar mannitol or hypertonic saline? Anest. intenziv. Med. 2010;21(1):18-22.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Fenstermacher, J. D., Johnson, J. A. Filtration and reflection coefficients of the rabbit blood-brain barrier. Am. J. Physiol., 1966, 211, p. 341-346. Go to original source... Go to PubMed...
    2. Zornow, M. H. Hypertonic saline as a safe and efficacious treatment of intracranial hypertension. J. Neurosurg. Anesthesiol., 1996, 8, p. 175-177. Go to original source... Go to PubMed...
    3. Qureshi, A. I., Suarez, J. I. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit. Care Med., 2000, 28, p. 3301-3313. Go to original source... Go to PubMed...
    4. Borgnia, M., Nielsen, S., Engel, A., Agre, P. Cellular and molecular biology of aquaporin water channels. Annu. Rev. Biochem., 1999, 68, p. 425. Go to original source... Go to PubMed...
    5. Munar, F. et al. Cerebral hemodynamic effects of 7.2 % hypertonic saline in patients with head injury and raised intracranial pressure. J. Neurotrauma, 2000, 17, p. 41-51. Go to original source... Go to PubMed...
    6. Berger, S., Schurer, L., Hartl, R., Messmer, K., Baethmann, A. Reduction of posttraumatic intracranial hypertension by hypertonic/hyperoncotic saline/dextran and hypertonic mannitol. Neurosurgery, 1995, 37, p. 98-107. Go to original source... Go to PubMed...
    7. Weed, L. H., McKibben, P. S. Experimental alteration of brain bulk. Am. J. Physiol., 1919, 48, p. 531-558. Go to original source...
    8. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons Guidelines for the management of severe traumatic brain injury. Hyperosmolar therapy. J. Neurotrauma, 2007, 24, p. 14-20.
    9. Nakayama, S., Sibley, L., Gunther, R. A., Holcroft, J. W., Kramer, G. C. Small-volume resuscitation with hypertonic saline (2400 mOsm/liter) during hemorrhagic shock. Circ. Shock, 1984, 13, p. 149-159. Go to PubMed...
    10. Rocha-e-Silva, M., Negraes, G. A., Soares, A. M., Pontieri, V., Loppnow, L. Hypertonic resuscitation from severe hemorrhagic shock: patterns of regional circulation. Circ. Shock, 1986, 19, p. 165-175. Go to PubMed...
    11. Maningas, P. A. Resuscitation with 7.5% NaCl in 6% dextran-70 during hemorrhagic shock in swine: effects on organ blood flow. Crit. Care Med., 1987, 15, p. 1121-1126. Go to original source... Go to PubMed...
    12. Cooper, D. J., Myles, P. S., McDermott, F. T. et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA, 2004, 291, p. 1350-1357. Go to original source... Go to PubMed...
    13. Kempski, O., Obert, C., Mainka, T., Heimann, A., Strecker, U. "Small volume resuscitation" as treatment of cerebral blood flow disturbances and increased ICP in trauma and ischemia. Acta Neurochir. Suppl., 1996, 66, p. 114-117. Go to original source... Go to PubMed...
    14. Muizelaar, J. P., Wei, E. P., Kontos, H. A., Becker, D. P. Cerebral blood flow is regulated by changes in blood pressure and in blood viscosity alike. Stroke, 1986, 17, p. 44-48. Go to original source... Go to PubMed...
    15. Shackford, S. R., Bourguignon, P. R., Wald, S. L., Rogers, F. B., Osler, T. M., Clark, D. E. Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. J. Trauma, 1998, 44, p. 50-58. Go to original source... Go to PubMed...
    16. Harutjunyan, L., Holz, C., Rieger, A., Menzel, M., Grond, S., Soukup, J. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients: A randomized clinical trial. Crit. Care, 2005, 9, p. 530-540. Go to original source... Go to PubMed...
    17. Gross, J. S., Gruber, D. P., Gann, S. et al. Hypertonic saline attenuates the hormonal response to injury. Ann. Surg., 1989, 209, p. 684-691. Go to original source... Go to PubMed...
    18. Hartl, R., Medary, M. B., Ruge, M. et al. Hypertonic/hyperoncotic saline attenuates microcirculatory disturbances after traumatic brain injury. J. Trauma, 1997, 42, p. 41-47. Go to original source... Go to PubMed...
    19. Hartl, R., Schurer, L., Schmid-Schonbein, G. W., del Zoppo, G. J. Experimental antileukocyte interventions in cerebral ischemia. J. Cereb. Blood Flow Metab., 1996, 16, p. 1108-1119. Go to original source... Go to PubMed...
    20. Kempski, O. Cerebral edema. Semin. Nephrol., 2001, 21, p. 303-307. Go to original source... Go to PubMed...
    21. Kempski, O., Seiwert, T., Otsuka, H. et al. Modeling of the ischemic penumbra. Acta Neurochir. Suppl., 1999, 73, p. 41-44. Go to original source... Go to PubMed...
    22. Zornow, M. H. Hypertonic saline as a safe and efficacious treatment of intracranial hypertension. J. Neurosurg. Anesthesiol., 1996, 8, p. 175-177. Go to original source... Go to PubMed...
    23. Qureshi, A. I., Wilson, D. A., Traystman, R. J. Treatment of elevated intracranial pressure in experimental intracerebral hemorrhage: comparison between mannitol and hypertonic saline. Neurosurgery, 1999, 44, p. 1055-1063. Go to original source... Go to PubMed...
    24. Paterna, S. et al. Changes in Brain Natriuretic Peptide Levels and Bioelectrical Impedance Measurements After Treatment With High-Dose Furosemide and Hypertonic Saline Solution Versus High-Dose Furosemide Alone in Refractory Congestive Heart Failure. J. Am. Coll. Cardiol., 2005, 45, p. 1997-2003. Go to original source... Go to PubMed...
    25. Krausz, M. M. Controversies in shock research: hypertonic resuscitation: pros and cons. Shock, 1995, 3, p. 69-72. Go to original source... Go to PubMed...
    26. Dorman, H. R., Sondheimer, J. H., Cadnapaphornchai, P. Mannitol-induced acute renal failure. Med., 1990, 69, p. 153-159. Go to original source... Go to PubMed...
    27. Qureshi, A. I., Suarez, J. I., Bhardwaj, A. Malignant cerebral edema in patients with hypertensive intracerebral hemorrhage associated with hypertonic saline infusion: a rebound phenomenon? J. Neurosurg. Anesthesiol., 1998, 10, p. 188-192. Go to original source... Go to PubMed...
    28. De Vivo, P., Del Gaudio, A., Ciritella, P., Puopolo, M., Chiarotti, F., Mastronardi, E. Hypertonic saline solution: a safe alternative to mannitol 18% in neurosurgery. Minerva Anestesiol., 2001, 67, p. 603-611. Go to PubMed...
    29. Toung, T. J. K. et al. Hypertonic saline ameliorates cerebral edema associated with experimental brain tumor. Journal of neurosurgical anesthesiology, 2002, 14, p. 187-193. Go to original source... Go to PubMed...
    30. Erard, A. C., Walder, B., Ravussin, P. Effects of equiosmolar load of 20% mannitol, 7.5% saline and 0.9% saline on plasma osmolarity, haemodynamics and plasma concentrations of electrolytes. Ann. Fr. Anesth. Reanim., 2003, 22, p.18-24. Go to original source... Go to PubMed...
    31. Vialet, R., Albanese, J., Thomachot, L. et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit. Care Med., 2003, 31, p. 1683-1687. Go to original source... Go to PubMed...
    32. Toung, T. J., Chang, Y., Lin, J., Bhardwaj, A. Increases in lung and brain water following experimental stroke: effect of mannitol and hypertonic saline. Crit. Care Med., 2005, 33, s. 203-208. Go to original source... Go to PubMed...
    33. Yildizdas, D., Altunbasak, S., Celik, U., Herguner, O. Hypertonic saline treatment in children with cerebral edema. Indian Pediatr., 2006, 43, s. 771-779. Go to PubMed...
    34. Khanna, S., Davis, D., Peterson, B. et al. Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury. Crit. Care Med., 2000, 28, p. 1144-1151. Go to original source... Go to PubMed...
    35. Adelson, P. D., Bratton, S. L., Carney, N. A. et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Use of hyperosmolar therapy in the management of severe pediatric traumatic brain injury. Pediatr Crit. Care Med., 2003, 4, p. 40-44. Go to original source... Go to PubMed...
    36. Rozet, I. et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology, 2007, 107, p. 697-704. Go to original source... Go to PubMed...
    37. Battison, C., Andrews, P. J., Graham, C., Petty, T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit. Care Med., 2005, 33, p. 196-202. Go to original source... Go to PubMed...
    38. Francony, G. et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Crit. Care Med., 2008, 36, p. 795-800. Go to original source... Go to PubMed...
    39. Suarez, J. I., Qureshi, A. I., Bhardwaj, A. et al. Treatment of refractory intracranial hypertension with 23.4% saline. Crit. Care Med., 1998, 26, p. 1118-1122. Go to original source... Go to PubMed...
    40. Tseng, M. Y., Al-Rawi, P. G., Pickard, J. D., Rasulo, F. A., Kirkpatrick, P. J. Effect of hypertonic saline on cerebral blood flow in poor grade patients with subarachnoid hemorrhage. Stroke, 2003, 34, p. 1389-1396. Go to original source... Go to PubMed...
    41. Heimann, A., Takeshima, T., Alessandri, B. et al. Effects of hypertonic/hyperoncotic treatment after rat cortical vein occlusion. Crit. Care Med., 2003, 31, p. 2495-2501. Go to original source... Go to PubMed...
    42. Berger, S., Schurer, L., Hartl, R., Messmer, K., Baethmann, A. Reduction of post-traumatic intracranial hypertension by hypertonic/hyperoncotic saline/dextran and hypertonic mannitol. Neurosurgery, 1995, 37, p. 98-107. Go to original source... Go to PubMed...
    43. Prough, D. S., Whitley, J. M., Taylor, C. L., Deal, D. D., DeWitt, D. S. Rebound intracranial hypertension in dogs after resuscitation with hypertonic solutions from hemorrhagic shock accompanied by an intracranial mass lesion. J. Neurosurg. Anesthesiol., 1999, 11, p. 102-111. Go to original source... Go to PubMed...
    44. Horn, P., Munch, E., Vajkoczy, P., Hermann, P., Quintel, M., Schilling, L., Schmiedek, P., Schurer, L. Hypertonic saline solution for control of elevated intracranial pressure in patients with exhausted response to mannitol and barbiturates. Neurol. Res., 1999, 21, p. 758-764. Go to original source... Go to PubMed...
    45. Toung, T. J., Tyler, B., Brem, H., Traystman, R. J., Hurn, P. D., Bhardwaj, A.: Hypertonic saline ameliorates cerebral edema associated with experimental brain tumor. J. Neurosurg. Anesthesiol., 2002, 14, p. 187-193. Go to original source... Go to PubMed...

    Return to the content


    Anesteziologie a intenzivní medicína

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.