Document Detail

New trends in hyperosmolar therapy?
MedLine Citation:
PMID:  23385373     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: To discuss trends in the use of osmotic therapy.
RECENT FINDINGS: Use of osmotic therapy has evolved from bolus administration of mannitol to routine use of hypertonic saline as a bolus as well as in continuous infusions to creating a sustained hyperosmolar state.In a survey of neurointensivists 55% favored hypertonic saline over mannitol. Retrospective studies suggest better intracranial pressure (ICP) control with hypertonic saline. Whereas a prospective study in adults with head injury compared alternating doses of mannitol and hypertonic saline and found no difference in change in ICP control or outcome, two meta-analyses, which did not include this study, favored hypertonic saline for ICP control (although the absolute difference of 2 mmHg is of little clinical value) with no difference in outcome.Hypertonic saline has also been administered by infusions to creating a sustained stable hyperosmolar state. Two studies, using historical controls, suggested benefit of hypertonic saline infusions. In a prospective, randomized study, in children with severe head injury Lactated Ringer's solution was compared to hypertonic saline. Although ICP control was similar, the hypertonic saline group required fewer other interventions.
SUMMARY: The existing data do not support favoring boluses of hypertonic saline over mannitol in terms of ICP control, let alone outcome. The rationale for continuous infusions to create a sustained hyperosmolar state is open to discussion and use of this approach should be curtailed pending further research.
Michael N Diringer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current opinion in critical care     Volume:  19     ISSN:  1531-7072     ISO Abbreviation:  Curr Opin Crit Care     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-05     Completed Date:  2013-10-21     Revised Date:  2014-04-02    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  77-82     Citation Subset:  IM    
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MeSH Terms
Brain Ischemia / drug therapy*,  physiopathology
Cerebral Hemorrhage / drug therapy*,  physiopathology
Craniocerebral Trauma / drug therapy*,  physiopathology
Critical Care / methods,  trends*
Diuretics, Osmotic / pharmacology,  therapeutic use*
Intracranial Hypertension / drug therapy*,  physiopathology
Mannitol / pharmacology,  therapeutic use*
Osmolar Concentration
Practice Guidelines as Topic
Saline Solution, Hypertonic / pharmacology,  therapeutic use*
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Diuretics, Osmotic; 0/Saline Solution, Hypertonic; 3OWL53L36A/Mannitol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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