Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension.

Détails

ID Serval
serval:BIB_293F4F03C6C7
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension.
Périodique
Journal of Neurology, Neurosurgery, and Psychiatry
Auteur(s)
Oddo M., Levine J.M., Frangos S., Carrera E., Maloney-Wilensky E., Pascual J.L., Kofke W.A., Mayer S.A., LeRoux P.D.
ISSN
1468-330X[electronic]
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Volume
80
Numéro
8
Pages
916-920
Langue
anglais
Résumé
BACKGROUND: The impact of osmotic therapies on brain oxygen has not been extensively studied in humans. We examined the effects on brain tissue oxygen tension (PbtO(2)) of mannitol and hypertonic saline (HTS) in patients with severe traumatic brain injury (TBI) and refractory intracranial hypertension. METHODS: 12 consecutive patients with severe TBI who underwent intracranial pressure (ICP) and PbtO(2) monitoring were studied. Patients were treated with mannitol (25%, 0.75 g/kg) for episodes of elevated ICP (>20 mm Hg) or HTS (7.5%, 250 ml) if ICP was not controlled with mannitol. PbtO(2), ICP, mean arterial pressure, cerebral perfusion pressure (CPP), central venous pressure and cardiac output were monitored continuously. RESULTS: 42 episodes of intracranial hypertension, treated with mannitol (n = 28 boluses) or HTS (n = 14 boluses), were analysed. HTS treatment was associated with an increase in PbtO(2) (from baseline 28.3 (13.8) mm Hg to 34.9 (18.2) mm Hg at 30 min, 37.0 (17.6) mm Hg at 60 min and 41.4 (17.7) mm Hg at 120 min; all p<0.01) while mannitol did not affect PbtO(2) (baseline 30.4 (11.4) vs 28.7 (13.5) vs 28.4 (10.6) vs 27.5 (9.9) mm Hg; all p>0.1). Compared with mannitol, HTS was associated with lower ICP and higher CPP and cardiac output. CONCLUSIONS: In patients with severe TBI and elevated ICP refractory to previous mannitol treatment, 7.5% hypertonic saline administered as second tier therapy is associated with a significant increase in brain oxygenation, and improved cerebral and systemic haemodynamics.
Mots-clé
Adult, Brain Chemistry/drug effects, Brain Injuries/complications, Brain Injuries/drug therapy, Data Interpretation, Statistical, Diuretics/pharmacology, Female, Glasgow Coma Scale, Hemodynamics/drug effects, Humans, Intracranial Hypertension/drug therapy, Intracranial Hypertension/etiology, Intracranial Pressure/physiology, Male, Mannitol/pharmacology, Oxygen Consumption/drug effects, Recurrence, Saline Solution, Hypertonic/pharmacology
Pubmed
Web of science
Création de la notice
09/12/2009 13:29
Dernière modification de la notice
20/08/2019 14:08
Données d'usage