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Osmotherapy in brain edema: a questionable therapy.

Grände, Per-Olof LU and Romner, Bertil LU (2012) In Journal of Neurosurgical Anesthesiology 24(4). p.407-412
Abstract
Despite the fact that it has been used since the 1960s in diseases associated with brain edema and has been investigated in >150 publications on head injury, very little has been published on the outcome of osmotherapy. We can only speculate whether osmotherapy improves outcome, has no effect on outcome, or leads to worse outcome. Here we describe the action and potentially beneficial and adverse effects of the 2 most commonly used osmotic solutions, mannitol and hypertonic saline, and present some critical aspects of their use. There is a well-documented transient intracranial pressure (ICP)-reducing effect of osmotherapy, but an adverse rebound increase in ICP after its withdrawal has been discussed extensively in the literature and... (More)
Despite the fact that it has been used since the 1960s in diseases associated with brain edema and has been investigated in >150 publications on head injury, very little has been published on the outcome of osmotherapy. We can only speculate whether osmotherapy improves outcome, has no effect on outcome, or leads to worse outcome. Here we describe the action and potentially beneficial and adverse effects of the 2 most commonly used osmotic solutions, mannitol and hypertonic saline, and present some critical aspects of their use. There is a well-documented transient intracranial pressure (ICP)-reducing effect of osmotherapy, but an adverse rebound increase in ICP after its withdrawal has been discussed extensively in the literature and is an expected pathophysiological phenomenon. From side effects related to renal and pulmonary failure, electrolyte disturbances, and a rebound increase in ICP, osmotherapy can be negative for outcome, which may explain why we lack scientific support for its use. These drawbacks, and the fact that the most recent Cochrane meta-analyses of osmotherapy in brain edema and stroke could not find any beneficial effects on outcome, make routine use of osmotherapy in brain edema doubtful. Nevertheless, the use of osmotherapy as a temporary measure may be justified to acutely prevent brain stem compression until other measures, such as evacuation of space-occupying lesions or decompressive craniotomy, can be performed. This article is the Con part in a Pro-Con debate in the present journal on the general routine use of osmotherapy in brain edema. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
renal failure, traumatic brain injury, phenomenon, rebound, osmotherapy, hypertonic saline, brain edema, mannitol
in
Journal of Neurosurgical Anesthesiology
volume
24
issue
4
pages
407 - 412
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000309294400023
  • pmid:22955195
  • scopus:84866360493
ISSN
1537-1921
DOI
10.1097/01.ana.0000419730.29492.8b
language
English
LU publication?
yes
id
065666ba-71df-4f05-b40a-9a017287343d (old id 3124220)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22955195?dopt=Abstract
date added to LUP
2012-10-04 15:57:45
date last changed
2017-08-27 04:50:08
@article{065666ba-71df-4f05-b40a-9a017287343d,
  abstract     = {Despite the fact that it has been used since the 1960s in diseases associated with brain edema and has been investigated in >150 publications on head injury, very little has been published on the outcome of osmotherapy. We can only speculate whether osmotherapy improves outcome, has no effect on outcome, or leads to worse outcome. Here we describe the action and potentially beneficial and adverse effects of the 2 most commonly used osmotic solutions, mannitol and hypertonic saline, and present some critical aspects of their use. There is a well-documented transient intracranial pressure (ICP)-reducing effect of osmotherapy, but an adverse rebound increase in ICP after its withdrawal has been discussed extensively in the literature and is an expected pathophysiological phenomenon. From side effects related to renal and pulmonary failure, electrolyte disturbances, and a rebound increase in ICP, osmotherapy can be negative for outcome, which may explain why we lack scientific support for its use. These drawbacks, and the fact that the most recent Cochrane meta-analyses of osmotherapy in brain edema and stroke could not find any beneficial effects on outcome, make routine use of osmotherapy in brain edema doubtful. Nevertheless, the use of osmotherapy as a temporary measure may be justified to acutely prevent brain stem compression until other measures, such as evacuation of space-occupying lesions or decompressive craniotomy, can be performed. This article is the Con part in a Pro-Con debate in the present journal on the general routine use of osmotherapy in brain edema.},
  author       = {Grände, Per-Olof and Romner, Bertil},
  issn         = {1537-1921},
  keyword      = {renal failure,traumatic brain injury,phenomenon,rebound,osmotherapy,hypertonic saline,brain edema,mannitol},
  language     = {eng},
  number       = {4},
  pages        = {407--412},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Neurosurgical Anesthesiology},
  title        = {Osmotherapy in brain edema: a questionable therapy.},
  url          = {http://dx.doi.org/10.1097/01.ana.0000419730.29492.8b},
  volume       = {24},
  year         = {2012},
}