Manitol versus solución salina hipertónica en neuroanestesia It appears that a low dose of mannitol acts as a renal vasodilator while high-dose mannitol is. Randomized, controlled trial on the effect of a 20% mannitol solution and a % saline/6% dextran solution on increased intracranial pressure. Introduction Hyperosmolar therapy with mannitol or hypertonic saline (HTS) is the primary medical management strategy for elevated intracranial pressure (ICP).

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InThe Neurocritical Care Society sent an online survey to its members in order to determine the usual management for the treatment of IH.

Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned?

Hypertonic saline in critical care: These two conditions worsen neurological outcomes and are the major cause of mortality in neurological patients. A potential role in the pathophysiology of vascular changes following traumatic brain injury.

Global brain water increases after experimental focal cerebral ischemia: The authors chose to measure efficacy against cumulative and daily ICP burden as opposed to discrete events. The rebound phenomenon, seen also with mannitol, has a similar mechanism of action, but both the escape as well as the rebound phenomenon is less, due to the reflection coefficient. The most commonly utilized hyperosmolar agents are mannitol and HTS. Indications include lowering ICP in patients with TBI, sub-arachnoid haemorrhage, stroke, 50,51 liver failure, 52 and also as adjunct therapy with mannitol, either sequentially or in combination.

Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned?

Mannitol for acute traumatic brain injury. Hypertonic fluid resuscitation from subarachnoid hemorrhage in rats.

Cerebral effects of isovolemic hemodilution with hypertonic saline solution. It is still to be determined whether HTS should be administered in the form of a drip or infusion; both are effective but there are more results, and none of them worse, with the use of bolus doses.


Elevated ICP may occur in TBI in the presence of haematomas or cerebral oedema, and continues to be an important focus of patient care. They did not find significant differences between the two agents, but the sample size is very small to allow a definitive conclusion.

In67 one study showed the worst mortality rate with the use of infusion, while no study using bolus doses showed these poor results.

Effects of hypertonic saline solution and mannitol in acute intracranial hypertension in rabbits

In contrast, those who preferred mannitol mentioned longer experience with the drug and ease of use because no central venous access is required. Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. A hundred years of hard-earned lessons.

Out of the 17 patients who were randomized in each group, 9 patients received only mannitol, 12 received only sodium lactate, and 13 patients crossed over and received both mannitol and sodium lactate. Conclusions A single dose of hypertonic isoncotic saline solution [7. Early insults to the injured brain. The lund concept for severe traumatic brain injury. Cited 37 Source Add To Collection. While mannitol induces an osmotic diuresis, the initial rapid increase in intravascular volume can paradoxically cause acute hypervolemia which could precipitate heart failure or pulmonary edema in susceptible patients.

While simplifying the therapeutic strategy to a single optimal agent, that is, universally applicable is attractive from an algorithmic perspective, it is more likely that distinct hyperosmolar agents exert optimal therapeutic effects in different clinical contexts. They found varying degrees of increased CBF in the contralateral hemisphere of patients with ischaemic stroke after osmotic mannitol, apparently mediated by blood pressure.


Brain tumours Cerebral oedema rarely presents in a pure form, and the two types of oedema are found together in many clinical situations, making clinical distinction difficult. Solucoonit has been published every two months.

Recently, the Cochrane collaborative reviewed the evidence that supports the Lund concept to treat patients with severe TBI. There are no firm recommendations as to which of the two agents should be used, but mannitol is used more frequently as first-line therapy for TBI-associated IH, followed by HTS as second-line therapy when there is no response to mannitol.

Regardless of its aetiology, intracranial hypertension creates a secondary lesion because it lowers CPP, predisposing the brain hopertonica ischaemia and triggering brain tissue displacement with the risk of compressing vital structures. Hyperosmolar therapy for raised intracranial pressure. In solucionn, they evaluated these potential complications with HTS and 0. In a meta-analysis of 36 articles carried out inMortazavi found 16 on TBI, including 4 prospective randomized, 1 prospective non-randomized, 7 prospective observational, and 4 retrospective studies.

Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. Osmotic demyelination syndrome following correction of hyponatremia. Trials should also test equiosmolar agents infused over the same time period as to mitigate the effects of molarity and infusion time.

Support Center Support Center. The Brain Trauma Foundation in its management guidelines for TBI is clear in stating that hypotension must be avoided because it is an isolated parameter of poor prognosis. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure.