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Osmotherapy

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https://www.readbyqxmd.com/read/29123907/endoscopic-hematoma-evacuation-for-acute-subdural-hematoma-in-a-young-patient-a-case-report
#1
Atsushi Kuge, Daisuke Tsuchiya, Shigeki Watanabe, Mitsuya Sato, Toshihiko Kinjo
Case: The standard treatment for acute subdural hematoma (ASDH) is large craniotomy; decompressive craniectomy may also be carried out, if needed, to prevent secondary brain damage. Recently, an endoscopic procedure for elderly patients with ASDH was carried out and reported; its safety and effectiveness were emphasized because of minimal invasiveness. We report a young case and discuss its difficulties and tips.A 31-year-old man was found to be in a state of general convulsion. At the time of admission, we observed severe consciousness disturbance, anisocoria, and left hemiparesis...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/28762591/ean-consensus-review-on-prevention-diagnosis-and-management-of-tick-borne-encephalitis
#2
REVIEW
P Taba, E Schmutzhard, P Forsberg, I Lutsar, U Ljøstad, Å Mygland, I Levchenko, F Strle, I Steiner
BACKGROUND AND PURPOSE: Tick-borne encephalitis (TBE) is an infection of the central nervous system (CNS) caused by tick-borne encephalitis virus (TBEV) and transmitted by ticks, with a variety of clinical manifestations. The incidence of TBE in Europe is increasing due to an extended season of the infection and the enlargement of endemic areas. Our objectives are to provide recommendations on the prevention, diagnosis and management of TBE, based on evidence or consensus decisions. METHODS: For systematic evaluation, the literature was searched from 1970 to 2015 (including early online publications of 2016), and recommendations were based on evidence or consensus decisions of the Task Force when evidence-based data were not available...
August 1, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28725211/critical-evaluation-of-the-lund-concept-for-treatment-of-severe-traumatic-head-injury-25%C3%A2-years-after-its-introduction
#3
REVIEW
Per-Olof Grände
When introduced in 1992, the Lund concept (LC) was the first complete guideline for treatment of severe traumatic brain injury (s-TBI). It was a theoretical approach, based mainly on general physiological principles-i.e., of brain volume control and optimization of brain perfusion and oxygenation of the penumbra zone. The concept gave relatively strict outlines for cerebral perfusion pressure, fluid therapy, ventilation, sedation, nutrition, the use of vasopressors, and osmotherapy. The LC strives for treatment of the pathophysiological mechanisms behind symptoms rather than just treating the symptoms...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28629456/comparison-of-the-effects-of-7-2-hypertonic-saline-and-20-mannitol-on-whole-blood-coagulation-and-platelet-function-in-dogs-with-suspected-intracranial-hypertension-a-pilot-study
#4
RANDOMIZED CONTROLLED TRIAL
Ivayla D Yozova, Judith Howard, Diana Henke, Daniel Dirkmann, Katja N Adamik
BACKGROUND: Hyperosmolar therapy with either mannitol or hypertonic saline (HTS) is commonly used in the treatment of intracranial hypertension (ICH). In vitro data indicate that both mannitol and HTS affect coagulation and platelet function in dogs. The aim of this study was to compare the effects of 20% mannitol and 7.2% HTS on whole blood coagulation using rotational thromboelastometry (ROTEM®) and platelet function using a platelet function analyzer (PFA®) in dogs with suspected ICH...
June 19, 2017: BMC Veterinary Research
https://www.readbyqxmd.com/read/28509350/high-sodium-continuous-veno-venous-hemodialysis-with-regional-citrate-anticoagulation-and-online-dialysate-generation-in-patients-with-acute-liver-failure-and-cerebral-edema
#5
Tamim Hamdi, Lenar Yessayan, Jerry Yee, Balazs Szamosfalvi
INTRODUCTION: Acute liver failure is associated with a high mortality rate. Induction of plasma hypertonicity with mannitol or hypertonic saline remains the cornerstone in the management of resultant cerebral edema. Significant disadvantages of this approach include poor or unpredictable control of serum sodium concentration and volume expansion, among others. METHODS: We used high sodium continuous veno-venous hemodialysis with regional citrate anticoagulation and online dialysate generation to accurately control the serum sodium in eleven patients with acute liver failure, renal failure, and cerebral edema...
May 16, 2017: Hemodialysis International
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
#6
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/28338505/effects-of-hypertonic-saline-and-sodium-lactate-on-cortical-cerebral-microcirculation-and-brain-tissue-oxygenation
#7
Vlasta Dostalova, Jitka Schreiberova, Vlasta Dostalova, Jiri Paral, Jaroslav Kraus, Alena Ticha, Vera Radochova, Pavel Dostal
BACKGROUND: Hyperosmolar solutions have been used in neurosurgery to modify brain bulk. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of hypertonic saline (HTS) and sodium lactate (HTL) on cerebral cortical microcirculation and brain tissue oxygenation in a rabbit craniotomy model. METHODS: Rabbits (weight, 1.5 to 2.0 kg) were anesthetized, ventilated mechanically, and subjected to a craniotomy. The animals were allocated randomly to receive a 3...
March 23, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28299023/the-effect-of-osmotherapy-and-tight-control-of-acidosis-on-early-graft-function-among-deceased-donor-kidney-transplant-recipients-a-randomized-controlled-trial
#8
F Etezadi, A H Najafi Abrandabadi, J Motaharinia, M Mojtahedzadeh, P Pourfakhr, M R Khajavi, S Gooran, R Shariat Moharari, S Dehghani
BACKGROUND: Reperfusion injury and the acid-base status of the transplant are important factors affecting post-transplantation graft function. OBJECTIVE: We hypothesized that infusing hypertonic saline (HS) or tight control of acid-base status of the blood rushing through renal graft using sodium bicarbonate may have beneficial effects on early graft function. METHODS: Candidates for deceased-donor kidney transplant were randomized into three groups...
2017: International Journal of Organ Transplantation Medicine
https://www.readbyqxmd.com/read/28171804/hemodynamic-and-neuro-monitoring-for-neurocritically-ill-patients-an-international-survey-of-intensivists
#9
Sanjeev Sivakumar, Fabio S Taccone, Mohammed Rehman, Holly Hinson, Neeraj Naval, Christos Lazaridis
PURPOSE: To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among "neurointensivists" (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI). METHODS: Anonymous 22-question Web-based survey among physician members of SCCM and ESICM. RESULTS: Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI...
June 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28000133/association-of-early-hemodynamic-profile-and-the-development-of-systolic-dysfunction-following-traumatic-brain-injury
#10
Vijay Krishnamoorthy, Ali Rowhani-Rahbar, Nophanan Chaikittisilpa, Edward F Gibbons, Frederick P Rivara, Nancy R Temkin, Alex Quistberg, Monica S Vavilala
BACKGROUND: While systolic dysfunction has been observed following traumatic brain injury (TBI), the relationship between early hemodynamics and the development of systolic dysfunction has not been investigated. Our study aimed to determine the early hemodynamic profile that is associated with the development of systolic dysfunction after TBI. METHODS: We conducted a prospective cohort study among patients under 65 years old without cardiac comorbidities who sustained moderate-severe TBI...
June 2017: Neurocritical Care
https://www.readbyqxmd.com/read/27907954/today-s-approach-to-treating-brain-swelling-in-the-neuro-intensive-care-unit
#11
Shreyansh Shah, W Taylor Kimberly
Brain swelling is an urgent clinical problem that frequently accompanies ischemic stroke, brain hemorrhage, and traumatic brain injury; it increases morbidity and mortality associated with them. It occurs due to failure of membrane transporters and leakage of the blood-brain barrier (BBB), resulting in combination of cytotoxic, ionic, and vasogenic edema. Currently, decompressive craniectomy and osmotherapy are the mainstays of management, but these therapies do not halt the underlying molecular cascade leading to brain swelling...
December 2016: Seminars in Neurology
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
#12
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/27261957/pre-trauma-center-management-of-intracranial-pressure-in-severe-pediatric-traumatic-brain-injury
#13
Gregory Hansen, Patrick J McDonald, Doug Martin, Jeff K Vallance
OBJECTIVES: Pre-trauma center care is a critical component in severe pediatric traumatic brain injury (TBI). For geographically large trauma catchment areas, optimizing increased intracranial pressure (ICP) management may potentially improve outcomes. This retrospective study examined ICP management in nontrauma centers and during interfacility transport to the trauma center. METHODS: Charts from a pediatric level I trauma center were reviewed for admissions between 2008 and 2013...
June 2, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27068929/outcome-of-a-cohort-of-severe-cerebral-venous-thrombosis-in-intensive-care
#14
Benjamin Soyer, Marco Rusca, Anne-Claire Lukaszewicz, Isabelle Crassard, Jean-Pierre Guichard, Damien Bresson, Joaquim Mateo, Didier Payen
BACKGROUND: Severity of cerebral venous thrombosis (CVT) may require the transfer to intensive care unit (ICU). This report described the context for CVT transfer to ICU, the strategy of care and the outcome after 1 year. METHODS: Monocentric cohort of 41 consecutive CVT admitted in a French ICU tertiary hospital (National Referent Center for CVT). Data collected are as follows: demographic data, clinical course, incidence of craniectomy and/or endovascular procedures and outcome in ICU, after 3 and 12 months...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27035238/osmotherapy-with-hypertonic-saline-attenuates-global-cerebral-edema-following-experimental-cardiac-arrest-via-perivascular-pool-of-aquaporin-4
#15
Shin Nakayama, Elton Migliati, Mahmood Amiry-Moghaddam, Ole P Ottersen, Anish Bhardwaj
OBJECTIVES: We tested the hypothesis that osmotherapy with hypertonic saline attenuates cerebral edema following experimental cardiac arrest and cardiopulmonary resuscitation by exerting its effect via the perivascular pool of aquaporin-4. We used mice with targeted disruption of the gene encoding α-syntrophin (α-Syn) that demonstrate diminished perivascular aquaporin-4 pool but retain the non-endfoot and ependymal pools. DESIGN: Laboratory animal study. SETTING: University animal research laboratory...
August 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/26948324/progress-in-drug-treatment-of-cerebral-edema
#16
REVIEW
Y Y Deng, F C Shen, D Xie, Q P Han, M Fang, C B Chen, H K Zeng
Cerebral edema causes intracranial hypertension (ICH) which leads to severe outcome of patients in the clinical setting. Effective anti-edema therapy may significantly decrease the mortality in a variety of neurological conditions. At present drug treatment is a cornerstone in the management of cerebral edema. Osmotherapy has been the mainstay of pharmacologic therapy. Mannitol and hypertonic saline (HS) are the most commonly used osmotic agents. The relative safety and efficacy of HS and mannitol in the treatment of cerebral edema and reduction of enhanced ICP have been demonstrated in the past decades...
2016: Mini Reviews in Medicinal Chemistry
https://www.readbyqxmd.com/read/26874842/treatment-of-edema-associated-with-intracerebral-hemorrhage
#17
Audrey Leasure, W Taylor Kimberly, Lauren H Sansing, Kristopher T Kahle, Golo Kronenberg, Hagen Kunte, J Marc Simard, Kevin N Sheth
Cerebral edema (i.e., "brain swelling") is a common complication following intracerebral hemorrhage (ICH) and is associated with worse clinical outcomes. Perihematomal edema (PHE) accumulates during the first 72 h after hemorrhage, and during this period, patients are at risk of clinical deterioration due to the resulting tissue shifts and brain herniation. First-line medical therapies for patients symptomatic of PHE include osmotic agents, such as mannitol in low- or high-dose bolus form, or boluses of hypertonic saline (HTS) at varied concentrations with or without subsequent continuous infusion...
February 2016: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/26655973/-half-molar-sodium-lactate-the-osmotic-agent-we-are-looking-for
#18
I Aramendi, W Manzanares, A Biestro
Intracranial hypertension (ICH) is the most important modifiable factor with predictive negative value in brain injury patients. Osmotherapy is the most important first level specific measure in the treatment of ICH. Mannitol 20%, and 3, 7.5, 10, and 23% hypertonic sodium chloride are the most commonly used osmotic agents in the neurocritical care setting. Currently, controversy about the best osmotic agent remains elusive. Therefore, over the past few years, half-molar sodium lactate has been introduced as a new osmotic agent to be administered in the critically ill...
March 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/26444221/hypothermia-for-intracranial-hypertension-after-traumatic-brain-injury
#19
RANDOMIZED CONTROLLED TRIAL
Peter J D Andrews, H Louise Sinclair, Aryelly Rodriguez, Bridget A Harris, Claire G Battison, Jonathan K J Rhodes, Gordon D Murray
BACKGROUND: In patients with traumatic brain injury, hypothermia can reduce intracranial hypertension. The benefit of hypothermia on functional outcome is unclear. METHODS: We randomly assigned adults with an intracranial pressure of more than 20 mm Hg despite stage 1 treatments (including mechanical ventilation and sedation management) to standard care (control group) or hypothermia (32 to 35°C) plus standard care. In the control group, stage 2 treatments (e.g...
December 17, 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/26293166/bacterial-meningitis-an-update-of-new-treatment-options
#20
REVIEW
Roland Nau, Marija Djukic, Annette Spreer, Sandra Ribes, Helmut Eiffert
The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case-control study...
2015: Expert Review of Anti-infective Therapy
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