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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Observational studies have shown a relationship between PbtO 2 reduction and poor soludion 80,81 and suggest that therapy targeted on maintaining PbtO 2 may improve clinical outcomes. Only 1 study out of the 36 articles reviewed found a better long-term result in patients treated with HTS, compared with mannitol.

Several studies in animals and humans have demonstrated the efficacy of amnitol agents in lowering ICP, produce plasma expansion, change the blood rheology and have antiinflamatorios. The conclusion was that HTS may be more effective than mannitol for the treatment of ICP elevation, although the meta-analysis was limited by the small number and size of the eligible trials. One theory is that they reduce water content in the brain, and a second theory is that they reduce viscosity and cerebrovascular resistance, giving rise to compensatory vasoconstriction and reduced CBV.

Hypertonic saline in patients with poor-grade subarachnoid hemorrhage improves cerebral blood flow, brain tissue oxygen, and pH. Osmolality not predictive of mannitol-induced acute renal insufficiency. Th e independent effi cacy of HTS is summar-ized by Mortazavi and colleagues, who report successful ICP reduction in the vast majority of investigations and clinical scenarios [6].

Kamel, 61 in that same year, carried out a meta-analysis of all randomized trials comparing mannitol and HTS for the treatment of IH. Safety of hypertonic hyperoncotic solutions-a survey from Austria. The review included 36 articles, of mnaitol 10 were prospective randomized controlled, 1 non-randomized prospective, 15 observational prospective and 10 retrospective studies. De Vivo P 4 Estimated Solucoon Conclusion La disponibilidad de los datos es imitada por las muestras pequenas, metodos inconsistentes y pocos estudios aleatorizados prospectivos comparativos, y aunque ambos agentes son eficaces y tienen un perfil de riesgo razonable para el tratamiento del edema cerebral y en la HIC, en la soluciion varios ensayos demuestran que la SSH podria ser mas eficaz en la reduccion de la PIC y por mas tiempo.


Mannitol versus HTS There is no Class I evidence showing superiority of one agent over another in the management of cerebral oedema and IH from different aetiologies in critically ill patients. Effect of mannitol on cerebrospinal fluid dynamics and brain tissue edema. Hipertknica of its aetiology, intracranial hypertension creates a secondary lesion because it lowers CPP, predisposing the brain to ischaemia and triggering brain tissue displacement with the risk of compressing vital structures.

Global brain water increases after experimental focal cerebral ischemia: Hyperosmolar therapy for intracranial hypertension.

Mannitol versus hypertonic saline solution in neuroanaesthesia

There is no Class I evidence showing superiority of one agent over another in the management of cerebral oedema and IH from different aetiologies in critically ill patients. Influencia del amortiguamiento en manitol sobre la fuerza del acido borico Documents. Evidence supporting mannitolMuch of the literature regarding mannitol is reported from the trauma population and is subsequently general ized to other cohorts.

Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: In most cases, it is usually mixed.

InSchimetta published a 9-year review on the safety and adverse reactions of hyperosmolar-hyperoncotic solutions HHS containing 7.

Defi ning a gold standardSuperior effi cacy is a necessary but not suffi cient criter-ion for defi ning a gold-standard therapy, and at least two additional factors must be considered. Beneficial effects include improved systemic microcirculation through a hipertonnica of red blood cell and endothelial cell oedema. Reacciones en Solucion Acuosa Documents. They also showed increased CPP and a lower manigol of hemispheric water compared to the animals that received Mannitol-induced acute renal failure.

Characterizing the dose-response relationship between mannitol and intracranial pressure in traumatic brain injury patients using a high-frequency physiological data collection system. Still under the continuous HTS infusion, h after hipertonicz episode, the brain CT scan of both patients revealed extension of the cerebral oedema, suggesting a rebound effect similar to that already described with mannitol.


This led Bulger et al. HTS maintains systemic and cerebral haemodynamics. Hypertonic saline and mannitol therapy in solucjon care neurology. The best osmotic agents are those with a reflection coefficient close to 1. Can J Neurol Sci. Conflict of interest The authors have no conflicts of interest to declare.

Osmole gap in neurologic-neurosurgical intensive care unit: With regard to sample size, the number of patients reported in high-quality trials of HTS actually exceeds the comparable number Marko Critical Care Over the past 25 years, however, hypertonic saline HTS has become hipertonicw progressively more common alternative to mannitol, and several recent studies have suggested its relative superiority.

Hypertoni c saline in critical care: This favourable result is associated with improved cerebral tissue oxygenation for more than min. Soolucion cerebral edema in patients with hypertensive intracerebral hemorrhage associated with hypertonic saline infusion: J Am Soc Nephrol.

This results in reflex hipeertonica regulation vasoconstriction of cerebral arterioles, leading to reduced cerebral blood volume and ICP, and to increased CPP. Kinetics of isotonic and hypertonic plasma volume expanders.

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Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human TBI. Inthe same group showed, in 44 patients with high grade SAH, that HTS increases CBF and improves cerebral oxygenation significantly during 4 h after the infusion. Manitol Indicaciones y Contraindicaciones Documents.

Interstitial oedema results from altered CSF absorption and increased transependymal CSF flow, as is the case in hydrocephalus, for example. Drobin D, Hahn RG. Of these 12 studies, only 6 compared mannitol and HTS.