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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
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
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
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
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
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
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
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
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
Chun-Ling Chi, Dong-Fang Shen, Peng-Jun Wang, Hu-Lun Li, Li Zhang
Ginkgolide B, a diterpene, is an herbal constituent isolated from the leaves of Ginkgo biloba tree. The present study demonstrates the effect of ginkgolide B in osmotherapy on brain metabolism and tissue oxygenation. Multimodality monitoring including intracranial pressure (ICP), cerebral perfusion pressure (CPP), partial pressure of brain tissue oxygen (PbtO2), lactate/pyruvate ratio (LPR) and microdialysis were employed to study the effect of ginkgolide B osmotherapy. The results demonstrated that administration of 15% solution of ginkgolide B to the comatose patients with raised ICP (> 20 mm Hg) and resistant to standard therapy led to a significant decrease in ICP...
2015: International Journal of Clinical and Experimental Medicine
Pavel Dostal, Jitka Schreiberova, Vlasta Dostalova, Vlasta Dostalova, Tomas Tyll, Jiri Paral, Islam Abdo, Miroslav Cihlo, David Astapenko, Zdenek Turek
BACKGROUND: Hyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of mannitol and hypertonic saline (HTS) on cerebral cortical microcirculation in a rabbit craniotomy model. METHODS: Rabbits (weight, 2.0-3.0 kg) were anesthetized, ventilated mechanically, and subjected to a craniotomy. The animals were allocated randomly to receive a 3...
2015: BMC Anesthesiology
A Raghava, Prasanna Udupi Bidkar, M V S Satya Prakash, B Hemavathy
BACKGROUND: Osmotherapy is the frequently used for the treatment of intracranial pressure. The purpose of the study was to compare the effect of equiosmolar solution of 3% hypertonic saline and 20% mannitol on brain relaxation in supratentorial tumor surgery. METHODS: After institutional review board approval and written informed consent, 50 patients aged >18, Glasgow Coma Scale (GCS) >13 with ASA physical status 1, 2, and 3 scheduled to undergo craniotomy for supratentorial tumors were enrolled in this prospective, randomized study...
2015: Surgical Neurology International
Neetika Garg, Anand Venkatraman, Ambarish Pandey, Nilay Kumar
AIM: End-stage renal disease is a prevalent and growing health problem worldwide. With increasing Internet use, video-sharing websites could potentially serve as a powerful platform for dissemination of information on dialysis. We conducted a cross-sectional study to assess the accuracy, content and viewership of YouTube videos on dialysis. METHODS: YouTube videos identified using the search term 'dialysis' were classified independently by two physicians as 'useful,' 'misleading' and 'patient's personal experiences'...
May 2015: Nephrology
Dhuleep S Wijayatilake, Chiraag Talati, Selvakumar Panchatsharam
BACKGROUND: To survey the current practice of monitoring and management of severe traumatic brain injury (TBI) patients in the critical care units across the United Kingdom. METHODS: A structured telephone interview was conducted with senior medical or nursing staff of all the adult neurocritical care units. Thirty-one neurocritical care units that managed adult patients with severe TBI were identified from the Risk Adjustment in Neurocritical Care (RAIN) study and the Society of British Neurological Surgeons...
July 2015: Journal of Neurosurgical Anesthesiology
Susanne Muehlschlegel, Raphael Carandang, Wiley Hall, Nisha Kini, Saef Izzy, Bridget Garland, Cynthia Ouillette, Imramsjah M J van der Bom, Thomas F Flood, Matthew J Gounis, John P Weaver, Bruce Barton, Ajay K Wakhloo
BACKGROUND: Dantrolene is neuroprotective in animal models and may attenuate cerebral vasospasm (cVSP) in human aneurysmal subarachnoid haemorrhage (aSAH). We evaluated safety, feasibility and tolerability of intravenous dantrolene (IV-D) in patients with aSAH. METHODS: In this single-centre, randomised, double blind, placebo-controlled trial, 31 patients with aSAH were randomised to IV-D 1.25 mg every 6 h for 7 days (n=16) or equiosmolar free water/5% mannitol (placebo; n=15)...
September 2015: Journal of Neurology, Neurosurgery, and Psychiatry
Sang-Beom Jeon, Younsuck Koh, H Alex Choi, Kiwon Lee
Malignant cerebral edema following ischemic stroke is life threatening, as it can cause inadequate blood flow and perfusion leading to irreversible tissue hypoxia and metabolic crisis. Increased intracranial pressure and brain shift can cause herniation syndrome and finally brain death. Multiple randomized clinical trials have shown that preemptive decompressive hemicraniectomy effectively reduces mortality and morbidity in patients with malignant middle cerebral artery infarction. Another life-saving decompressive surgery is suboccipital craniectomy for patients with brainstem compression by edematous cerebellar infarction...
September 2014: Journal of Stroke
Kenichiro Kumasaka, Joshua A Marks, Rachel Eisenstadt, Mohammad A Murcy, Davoud Samadi, Shengjie Li, Victoria Johnson, Kevin D Browne, Douglas H Smith, C William Schwab, Jose L Pascual
BACKGROUND: Mannitol, hypertonic saline, and progesterone may blunt leukocyte recruitment after traumatic brain injury (TBI). We hypothesized that progesterone reduces pericontusional recruitment of leukocytes to a greater extent than either osmotherapy a day after TBI. METHODS: CD1 mice underwent controlled cortical impact and were treated with osmotherapy (mannitol and hypertonic saline) or progesterone. Thirty-two hours after TBI, live pial microscopy was used to evaluate leukocyte-endothelial interactions and immunohistochemistry was used for the detection of pericontusional tissue polymorphonuclear neutrophils...
December 2014: American Journal of Surgery
Marcey Osgood, Rebecca Compton, Raphael Carandang, Wiley Hall, Glenn Kershaw, Susanne Muehlschlegel
INTRODUCTION: We aim to raise awareness for the potential for rapid brain edema and herniation in acutely brain-injured patients undergoing renal replacement therapy (RRT), including one case undergoing continuous veno-venous hemofiltration. Dialysis disequilibrium syndrome (DDS) may have been a possible cause for the brain edema. METHODS: We retrospectively reviewed four consecutive neurocritically ill patients in acute renal failure undergoing RRT between 2011 and 2013...
April 2015: Neurocritical Care
Luke Kim, James Schuster, Daniel N Holena, Carrie A Sims, Joshua Levine, Jose L Pascual
BACKGROUND: Venous thromboembolic prophylaxis (VTEp) is often delayed following traumatic brain injury (TBI), yet animal data suggest that it may reduce cerebral inflammation and improve cognitive recovery. We hypothesized that earlier VTEp initiation in severe TBI patients would result in more rapid neurologic recovery and reduced progression of brain injury on radiologic imaging. STUDY DESIGN: Medical charts of severe TBI patients admitted to a level 1 trauma center in 2009-2010 were queried for admission Glasgow Coma Scale (GCS), head Abbreviated Injury Scale, Injury Severity Score (ISS), osmotherapy use, emergency neurosurgery, and delay to VTEp initiation...
July 2014: Journal of Emergencies, Trauma, and Shock
Tareq Kheirbek, Jose L Pascual
Intracranial hypertension is caused by brain edema generated by different disorders, the commonest of which is traumatic brain injury. The treatment of brain edema focuses on drawing water out of brain tissue into the intravascular space. This is typically accomplished with osmolar therapy, most commonly mannitol and hypertonic saline. Recent human trials suggest that hypertonic saline may have a more profound and long-lasting effect in reducing intracranial hypertension following traumatic brain injury when compared with mannitol...
September 2014: Current Neurology and Neuroscience Reports
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