Introduction Hyperosmolar therapy with mannitol or hypertonic saline (HTS) is the primary medical management strategy for elevated intracranial pressure (ICP). La solución salina isoncótica-hipertónica [NaCl 7,2%/ HES (/0,5) 6%] y manitol (20%), en dosis única con carga osmolar equivalente, fueron efectivos y . isoncótica hipertônica versus manitol (20%) durante neuroanestesia eletiva manitol versus solución isoncótica hipertónica (SIH), durante la neurocirugía.
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Such trials are only necessary if the manifol na tion of mannitol as the gold standard is appro-priate and if current evidence suggests hipfrtonica therapeutic equipoise with HTS. Confl icts of interestThe author declares that he has no competing interests. Data availability is limited because of small sample sizes, inconsistent methods and few prospective randomized comparative studies, although both agents are effective and have a reasonable risk profile for the treatment of cerebral oedema and IH.
It has a low probability of anaphylactic reactions or of transmitting infectious agents, and it easily controlled by serum Na levels. Hyperosmolar therapy for intracranial hypertension. However, 9 comparative studies, hipertnica of which were randomized prospective controlled studies, showed that HTS was better at controlling ICP than mannitol.
Hyperosmolar Therapy for Intracranial Hypertension. Hypertonic saline, not mannitol, should be considered gold-standard medical therapy for intracranial hypertension. Revisamos la eficacia de los datos para SSH frente a manitol hablando sobre sus consideraciones clinicas. Intracranial hypertension occurs during the acute phase of ICH and it is a predictor of poor prognosis in these patients. No sufficient data were found on the effectiveness of pre-hospital use of mannitol. Agar Sal y Manitol Documents.
Solucion Hipertonica vs Manitol en HEC
These two conditions worsen neurological outcomes and are the major cause of mortality in neurological patients. Kamel, 61 in that same year, carried out a meta-analysis of all randomized trials comparing mannitol and HTS for the treatment sklucion IH.
The effects of mannitol on blood viscosity. Regardless of the aetiology of IH, osmotherapy is one of the pillars in the management of this disorder.
There is current evidence in the experimental and the aolucion literature in the sense that HTS is an effective alternative to conventional osmotic agents in neurocritical patients with different aetiologies. This favourable result is associated with improved cerebral tissue oxygenation for more than min.
Reacciones en Solucion Acuosa Documents. Two comprehensive reviews have summarized this evidence. Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: En el presente articulo mostramos la evidencia actual que soporta a la SSH y al manitol y cual se considera la mejor opcion como terapia medica en el tratamiento de la HIC. Mannitol is a sugar alcohol with a molecular weight of kDa. In contrast, of the 26 studies in which HTS boluses were administered, 7 were prospective randomized studies, and 6 support bolus use.
Finally, I discuss additional clinical considera tions for appropriate designation of a gold standard.
A total of 36 studies describe HTS treatment of IH in adults and children from etiologies including trauma, stroke, tumor, infec-tion, and intracranial and subarachnoid hemorrhage. Experimental alteration of brain bulk. There are no pharmacokinetic data on HTS, but Lazaridis suggests that the onset of the effects is similar to that of mannitol.
Of those 3 studies, only 2 suggest infusion administration. In a study in rodents inBhardwaj et al. They did not find evidence to support the theory that osmotic agents reduce CBV, arguing against the theory that they reduce ICP by creating cerebral vasoconstriction 89 The AHA guidelines still in force show that osmotherapy is among other aggressive medical measures for the treatment of critically ill patients with malignant cerebral oedema after a large cerebral infarction.
Frequency and predictors of stroke death in 5, participants in the Cardiovascular Health Study.
With regard to sample size, the number of patients reported in high-quality trials of HTS actually exceeds the comparable number Marko Critical Care Two of these four studies directly compare outcomes in patients receiving mannitol with those of control patients treated with phenobarbital or placebo. I make this argument fi rst by examining the evidence on which the apparent designation of mannitol as the current gold standard is based.
It is filtered in the glomeruli and reabsorbed in the nephron as an osmotic diuretic, it is hardly metabolized, and it is excreted unchanged. Hypertonic fluid resuscitation from subarachnoid hemorrhage in rats.
Hypertonic saline versus mannitol for the treatment intracranial pressure: De Vivo et al. They showed a low potential of complications with the use of HHS in the clinical setting during almost one decade. 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 Hipertonicaa IH, followed by HTS as second-line therapy when there is no response to mannitol.
Vasogenic oedema is usually the result of increased capillary permeability due to breakdown of the BBB from trauma, tumours, abscesses, white matter usually being the most affected.
Brain myelinolysis following hypernatremia in rats. An equiosmolar dose is 0. Are you looking for A large prospective randomized study is needed in order to answer this question. Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: Mannitol versus hypertonic saline solution in neuroanaesthesia colombian journal of anesthesiology.
Services on Demand Article. Of the 36, 12 compared mannitol with HTS: Weed 15 Estimated H-index: These changes persisted for a period of min.
Solucion Hipertonica vs Manitol en HEC
ConclusionsMannitol is often considered the gold-standard therapy for medical management of IH, primarily because of its long history.
Mannitol is an effective way to lower ICP elevation Class II 19 and it is indicated in acute intracranial hypertension as a measure to be assessed when there are signs and solicion of active or impending transtentorial herniation Class III. Although the study grouped the patients for the majority of the characteristics measured, and although it is the largest zolucion conducted in humans until in supratentorial tumours, it is worth nothing that it did not measure ICP routinely and it excluded patients with signs of IH.
Resuscitation with hypertonic saline-dextran reduces serum biomarker levels and correlates with outcome in severe traumatic brain injury patients.