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https://www.readbyqxmd.com/read/28478873/the-use-of-mannitol-and-hypertonic-saline-therapies-in-patients-with-elevated-intracranial-pressure-a-review-of-the-evidence
#1
REVIEW
Briana Witherspoon, Nathan E Ashby
Patients with increased intracranial pressure generally require pharmacologic therapies and often more definitive treatments, such as surgical intervention. The overall goal of these interventions is to maintain or re-establish adequate cerebral blood flow and prevent herniation. Regardless of the cause of increased intracranial pressure, osmotherapy is considered the mainstay of medical therapy, and should be administered as soon as possible. This article reviews the history of hyperosmolar and hypertonic therapies, the Monro-Kellie hypothesis, and types of cerebral edema...
June 2017: Nursing Clinics of North America
https://www.readbyqxmd.com/read/28471928/complication-rates-of-3-hypertonic-saline-infusion-through-peripheral-intravenous-access
#2
Claudia Andira Perez, Stephen A Figueroa
INTRODUCTION: Hyperosmolar therapy with hypertonic saline (HTS) is a cornerstone in the management of intracranial hypertension and hyponatremia in the neurological intensive care unit. Theoretical safety concerns remain for infiltration, thrombophlebitis, tissue ischemia, and venous thrombosis associated with continuous 3% HTS administered via peripheral intravenous (pIV) catheters. It is common practice at many institutions to allow only central venous catheter infusion of 3% HTS. METHODS: Hospital policy was changed to allow the administration of 3% HTS via 16- to 20-gauge pIVs to a maximum infusion rate of 50 mL/h in patients without central venous access...
June 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28431870/the-effect-of-hypertonic-saline-and-mannitol-on-coagulation-in-moderate-traumatic-brain-injury-patients
#3
Haifeng Wang, Hongshi Cao, Xiaohong Zhang, Liang Ge, Li Bie
BACKGROUND: Hyperosmolar therapy, using either hypertonic saline (HTS) or mannitol (MT), is considered the treatment of choice for intracranial hypertension, a disorder characterized by high intracranial pressure (ICP). However, hyperosmolar agents have been postulated to impair coagulation and platelet function. The aim of this study was to identify whether HTS and MT could affect coagulation in moderate traumatic brain injury (TBI) patients. METHODS: In this prospective and randomized double-blind study, we included adult patients with moderate TBI...
April 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28372715/management-of-hyperglycemic-crises-diabetic-ketoacidosis-and-hyperglycemic-hyperosmolar-state
#4
REVIEW
Maya Fayfman, Francisco J Pasquel, Guillermo E Umpierrez
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most serious and life-threatening hyperglycemic emergencies in diabetes. DKA is more common in young people with type 1 diabetes and HHS in adult and elderly patients with type 2 diabetes. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Both are characterized by insulinopenia and severe hyperglycemia. Early diagnosis and management are paramount. Treatment is aggressive rehydration, insulin therapy, electrolyte replacement, and treatment of underlying precipitating events...
May 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28245347/autologous-serum-eye-drops-for-dry-eye
#5
REVIEW
Qing Pan, Adla Angelina, Michael Marrone, Walter J Stark, Esen K Akpek
BACKGROUND: Theoretically, autologous serum eye drops (AS) offer a potential advantage over traditional therapies on the assumption that AS not only serve as a lacrimal substitute to provide lubrication but contain other biochemical components that allow them to mimic natural tears more closely. Application of AS has gained popularity as second-line therapy for patients with dry eye. Published studies on this subject indicate that autologous serum could be an effective treatment for dry eye...
February 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28122469/dexmedetomidine-for-refractory-intracranial-hypertension
#6
Kendra J Schomer, Christian M Sebat, Jason Y Adams, Jeremiah J Duby, Kiarash Shahlaie, Erin L Louie
Dexmedetomidine (DEX) is a selective α2 adrenergic agonist that is commonly used for sedation in the intensive care unit (ICU). The role of DEX for adjunctive treatment of refractory intracranial hypertension is poorly defined. The primary objective of this study was to determine the effect of DEX on the need for rescue therapy (ie, hyperosmolar boluses, extraventricular drain [EVD] drainages) for refractory intracranial hypertension. Secondary objectives included the number of intracranial pressure (ICP) excursions, bradycardic, hypotensive, and compromised cerebral perfusion pressure episodes...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28107262/suspected-cerebral-edema-in-diabetic-ketoacidosis-is-there-still-a-role-for-head-ct-in-treatment-decisions
#7
Carmen L Soto-Rivera, Lisa A Asaro, Michael S D Agus, Danielle D DeCourcey
OBJECTIVES: Neurologic deterioration associated with cerebral edema in diabetic ketoacidosis is typically sudden in onset, progresses rapidly, and requires emergent treatment. The utility of brain imaging by head CT in decisions to treat for cerebral edema has not been previously studied. The objective of this study was to describe the characteristics of pediatric patients with diabetic ketoacidosis who develop altered mental status and evaluate the role of head CT in this cohort. DESIGN: Retrospective analysis of clinical, biochemical, and radiologic data...
March 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28046026/comparison-of-in-vitro-and-ex-vivo-wound-healing-assays-for-the-investigation-of-diabetic-wound-healing-and-demonstration-of-a-beneficial-effect-of-a-triterpene-extract
#8
Christopher Ueck, Thomas Volksdorf, Pia Houdek, Sabine Vidal-Y-Sy, Susanne Sehner, Bernhard Ellinger, Ralf Lobmann, Axel Larena-Avellaneda, Konrad Reinshagen, Ina Ridderbusch, Klaas Kohrmeyer, Ingrid Moll, Rolf Daniels, Philipp Werner, Irmgard Merfort, Johanna M Brandner
Diabetes mellitus is a frequent cause for chronic, difficult-to-treat wounds. New therapies for diabetic wounds are urgently needed and in-vitro or ex-vivo test systems are essential for the initial identification of new active molecules. The aim of this study is to compare in-vitro and ex-vivo test systems for their usability for early drug screening and to investigate the efficacy of a birch bark triterpene extract (TE) that has been proven ex-vivo and clinically to accelerate non-diabetic wound healing (WH), in a diabetic context...
2017: PloS One
https://www.readbyqxmd.com/read/27798539/pediatric-minor-traumatic-brain-injury-with-intracranial-hemorrhage-identifying-low-risk-patients-who-may-not-benefit-from-icu-admission
#9
Erin Comer Burns, Beech Burns, Craig D Newgard, Amber Laurie, Rongwei Fu, Theresa Graif, Casey S Ward, Abbie Bauer, David Steinhardt, Laura M Ibsen, David M Spiro
BACKGROUND: Pediatric patients with any severity of traumatic intracranial hemorrhage (tICH) are often admitted to intensive care units (ICUs) for early detection of secondary injury. We hypothesize that there is a subset of these patients with mild injury and tICH for whom ICU care is unnecessary. OBJECTIVES: To quantify tICH frequency and describe disposition and to identify patients at low risk of inpatient critical care intervention (CCI). METHODS: We retrospectively reviewed patients aged 0 to 17 years with tICH at a single level I trauma center from 2008 to 2013...
October 28, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27695597/continuous-qualitative-electroencephalography-as-a-noninvasive-neuromonitor
#10
Zachary D Threlkeld, Mohan Kottapally, Aimee Aysenne, Nerissa Ko
Intracranial pressure (ICP) monitoring frequently guides key decisions in the management of diseases causing intracranial hypertension. Although typically measured by invasive means, contraindications may leave the clinician with little recourse for dynamic ICP evaluation-particularly when the patient's mental status is compromised. We describe here a healthy 18-year-old woman who subacutely progressed to coma due to diffuse cerebral venous sinus thrombosis. Heparinization precluded the use of invasive ICP monitoring, and electroencephalography (EEG) was used novelly as a surrogate ICP monitor...
October 2016: Neurohospitalist
https://www.readbyqxmd.com/read/27690659/intracerebral-laser-interstitial-thermal-therapy-followed-by-tumor-resection-to-minimize-cerebral-edema
#11
Sindhura Pisipati, Kyle A Smith, Kushal Shah, Koji Ebersole, Roukoz B Chamoun, Paul J Camarata
OBJECTIVE Laser interstitial thermal therapy (LITT) is used in numerous neurosurgical applications including lesions that are difficult to resect. Its rising popularity can be attributed to its minimally invasive approach, improved accuracy with real-time MRI guidance and thermography, and enhanced control of the laser. One of its drawbacks is the possible development of significant edema, which contributes to extended hospital stays and often necessitates hyperosmolar or steroid therapy. Here, the authors discuss the use of minimally invasive craniotomy to resect tissue ablated with LITT in attempt to minimize cerebral edema...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27632060/intracranial-pressure-monitoring-in-infants-and-young-children-with-traumatic-brain-injury
#12
Rebecca R Dixon, Maryalice Nocera, Adam J Zolotor, Heather T Keenan
OBJECTIVE: To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000-2001. DESIGN: Prospective, observational cohort study. SETTING: Twelve PICUs in North Carolina. PATIENTS: All children 24 months old or younger with traumatic brain injury, admitted to an included PICU...
November 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27625237/is-intracranial-pressure-monitoring-useful-in-children-with-severe-traumatic-brain-injury
#13
Sekar Arunkumar, Bhagavatula Indira Devi, Dhaval Shukla, Madhusudhan Reddy
BACKGROUND: Intracranial pressure monitoring (ICP) is considered as optional for management of severe traumatic brain injury (TBI) in children. AIMS: This study was performed to determine whether ICP monitoring is beneficial in the managing severe TBI in children. SETTINGS AND DESIGN: Neurosurgical intensive care unit (ICU) of a tertiary care referral center; prospective observational study. MATERIALS AND METHODS: Children aged 16 years or less with severe TBI defined as "postresuscitation Glasgow Coma Scale (GCS) score of 8 or less admitted to an ICU" were enrolled...
September 2016: Neurology India
https://www.readbyqxmd.com/read/27581233/acute-peritoneal-dialysis-in-a-jehovah-s-witness-post-laparotomy
#14
Usha Devi Appalsawmy, Habib Akbani
A 56-year-old man who was a Jehovah's Witness with an advanced directive against autologous procedures developed acute kidney injury needing renal replacement therapy while he was intubated and ventilated on the intensive care unit. He was being treated for hyperosmolar hyperglycaemic state. He also had a healing laparotomy wound, having undergone a splenectomy less than a month ago following a road traffic accident. His hyperkalaemia and metabolic acidosis were refractory to medical treatment. As he became oligoanuric, decision was taken to carry out acute peritoneal dialysis (PD) by inserting a Tenckhoff catheter in his abdomen using peritoneoscopic technique...
August 31, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27568371/hyperosmolar-therapy-in-pediatric-traumatic-brain-injury-a-retrospective-study
#15
Nadia Roumeliotis, Christian Dong, Géraldine Pettersen, Louis Crevier, Guillaume Emeriaud
OBJECTIVES: The objectives of the study are to describe the use of hyperosmolar therapy in pediatric traumatic brain injury (TBI) and examine its effect on intracranial pressure (ICP) and cerebral perfusion pressure (CPP). DESIGN: A retrospective review of patients with severe TBI admitted to the pediatric intensive care unit (PICU) was conducted. Inclusion criteria were ICP monitoring and administration of a hyperosmolar agent (20 % mannitol or 3 % hypertonic saline) within 48 h of PICU admission; for which dose and timing were recorded...
December 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/27536206/immunomodulation-on-the-ocular-surface-a-review
#16
REVIEW
Anna M Ambroziak, Jerzy Szaflik, Jacek P Szaflik, Maciej Ambroziak, Jan Witkiewicz, Piotr Skopiński
The increasing understanding of immune mechanisms changed our perception of the ocular surface, which is now considered a compartment of the common mucosal immune system. It offered the possibility to alter the physiological immune response on the ocular surface and effectively combat inflammation, which impairs stability of the tear film and causes tear hyperosmolarity, causing symptoms of dry eye disease. The paper provides an overview of ocular surface anatomy and physiology, explains the underlying mechanisms of dry eye disease and discusses novel and promising treatment modalities, such as cyclosporine A, biological therapies using autologous serum and various growth factors as well as experimental treatment methods which are currently being investigated...
2016: Central-European Journal of Immunology
https://www.readbyqxmd.com/read/27521606/role-of-tear-osmolarity-in-dry-eye-symptoms-after-cataract-surgery
#17
Ana González-Mesa, Javier Paz Moreno-Arrones, Daniele Ferrari, Miguel A Teus
PURPOSE: To analyze changes in tear osmolarity and the Ocular Surface Disease Index (OSDI) in patients after cataract surgery. DESIGN: Prospective, observational cohort study. METHODS: setting: Institutional. PATIENT POPULATION: Fifty-two patients with a unilateral cataract (study eye) scheduled for surgery and good visual function in the fellow (control eye). Patients were excluded who were receiving chronic topical therapy, such as glaucoma medications, or had a history of previous ocular surgery...
October 2016: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/27486749/in-vitro-inhibition-of-nfat5-mediated-induction-of-ccl2-in-hyperosmotic-conditions-by-cyclosporine-and-dexamethasone-on-human-hela-modified-conjunctiva-derived-cells
#18
Elise Warcoin, Christophe Baudouin, Carole Gard, Françoise Brignole-Baudouin
PURPOSE: To investigate the pro-inflammatory intracellular mechanisms induced by an in vitro model of dry eye disease (DED) on a Hela-modified conjunctiva-derived cells in hyperosmolarity (HO) stress conditions. This study focused on CCL2 induction and explored the implications of the nuclear factor of activated T-cells 5 (NFAT5) as well as mitogen-activated protein kinases (MAPK) and nuclear factor kappa B (NFĸB). This work was completed by an analysis of the effects of cyclosporine A (CsA), dexamethasone (Dex) and doxycycline (Dox) on HO-induced CCL2 and NFAT5 induction...
2016: PloS One
https://www.readbyqxmd.com/read/27399574/376%C3%A2-the-salt-versus-sugar-debate-urinary-sodium-losses-following-hypertonic-saline-administration-curtails-its-superior-osmolar-effect-in-comparison-to-mannitol-in-severe-traumatic-brain-injury
#19
Aniruddha Tekkatte Jagannatha, Sriganesh Kamath, Indira Devi, Umamaheswara G S Rao
INTRODUCTION: Osmotherapy forms an integral part in the management of patients with severe traumatic brain injury (TBI). An ideal choice between mannitol and hypertonic saline (HTS) remains to be conclusively proven. More importantly, attention has not been paid to the long-term osmolarity changes during the therapy. The current prospective randomized study aims at evaluating the effect of serum and urine osmolarity and sodium achieved with mannitol and HTS on intracranial pressure (ICP) and outcome...
August 2016: Neurosurgery
https://www.readbyqxmd.com/read/27043279/dornase-alfa-for-cystic-fibrosis
#20
REVIEW
Connie Yang, Mark Chilvers, Mark Montgomery, Sarah J Nolan
BACKGROUND: Dornase alfa is currently used as a mucolytic to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis. It reduces mucus viscosity in the lungs, promoting improved clearance of secretions. This is an update of a previously published review. OBJECTIVES: To determine whether the use of dornase alfa in cystic fibrosis is associated with improved mortality and morbidity compared to placebo or other medications that improve airway clearance, and to identify any adverse events associated with its use...
April 4, 2016: Cochrane Database of Systematic Reviews
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