Document Detail

Superior effect of hypertonic saline over mannitol to attenuate cerebral edema in a rabbit bacterial meningitis model.
MedLine Citation:
PMID:  21336112     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Adjunctive therapies that reduce the cerebral edema in bacterial meningitis include osmotic agents. There is a lack of information comparing mannitol vs. hypertonic saline as an osmotic agent for adjunctive therapy of bacterial meningitis. We attempted to elucidate the impact of hypertonic saline in cerebral edema in the setting of bacterial meningitis as well as to explore potential mechanisms of action.
DESIGN: Randomized controlled in vivo study.
SETTING: University research laboratory.
SUBJECTS: Rabbits.
INTERVENTIONS: A rabbit model of bacterial meningitis was used comparing 3% hypertonic saline with 20% mannitol as adjunctive therapy.
MEASUREMENTS AND MAIN RESULTS: Adjunctive 3% hypertonic saline treatment persistently elevated mean arterial pressure as compared with the model or ampicillin group (p < .01). Although both 20% mannitol and 3% hypertonic saline efficiently elevated serum osmolality for almost 5 hrs (p < .01), 20% mannitol lowered intracranial pressure for only a short time (<2 hrs) and did not elevate cerebral perfusion pressure. Three percent hypertonic saline treatment efficiently lowered intracranial pressure and elevated cerebral perfusion pressure for almost 5 hrs (p < .01). Furthermore, 3% hypertonic saline treatment efficiently elevated serum Na+ concentration for >5 hrs (p < .01). Three percent hypertonic saline treatment was superior to 20% mannitol in lowering leukocyte number and protein content in cerebrospinal fluid (p < .01). Three percent hypertonic saline treatment reduced water content and Evans blue incorporation in the brain (p < .01). Three percent hypertonic saline treatment inhibited aquaporin 4 expression (p < .01) and attenuated pathologic brain damage more efficiently compared with adjuvant 20% mannitol treatment (p < .01).
CONCLUSIONS: Adjunctive 3% hypertonic saline treatment significantly elevated mean arterial pressure, reduced intracranial pressure, greatly improved cerebral perfusion pressure, inhibited brain aquaporin 4 expression, reduced cerebral edema, and attenuated brain damage with a superior effect over 20% mannitol in a rabbit bacterial meningitis model.
Shuang Liu; Lian Li; ZiQiang Luo; MingJie Wang; Hua She; Xiaohe Yu; XiaoDan Deng; FuRong Huang; LiHong Shang; ChangE Jian; GengZhong Ji; ShaoJie Yue
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-25     Completed Date:  2011-08-11     Revised Date:  2012-05-25    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1467-73     Citation Subset:  AIM; IM    
Department of Pediatrics, Xiangya Hospital, [corrected] Central South University, Changsha, China.
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MeSH Terms
Ampicillin / therapeutic use
Anti-Bacterial Agents / therapeutic use
Brain Edema / microbiology*,  prevention & control*
Chemotherapy, Adjuvant
Disease Models, Animal
Diuretics, Osmotic / therapeutic use*
Mannitol / therapeutic use*
Meningitis, Escherichia coli / complications*,  therapy
Saline Solution, Hypertonic / therapeutic use*
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Diuretics, Osmotic; 0/Saline Solution, Hypertonic; 69-53-4/Ampicillin; 69-65-8/Mannitol
Comment In:
Crit Care Med. 2011 Jun;39(6):1592-3   [PMID:  21610643 ]
Erratum In:
Crit Care Med. 2012 May;40(5):1697

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