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Hyperosmolar Therapy for Intracranial Hypertension

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Abstract

The use of hyperosmolar agents for intracranial hypertension was introduced in the early 20th century and remains a mainstay of therapy for patients with cerebral edema. Both animal and human studies have demonstrated the efficacy of two hyperosmolar agents, mannitol and hypertonic saline, in reducing intracranial pressure via volume redistribution, plasma expansion, rheologic modifications, and anti-inflammatory effects. However, because of physician and institutional variation in therapeutic practices, lack of standardized protocols for initiation and administration of therapy, patient heterogeneity, and a paucity of randomized controlled trials have yielded little Class I evidence on which clinical decisions can be based, most current evidence regarding the use of hyperosmolar therapy is derived from retrospective analyses (Class III) and case series (Class IV). In this review, we summarize the available evidence regarding the use of hyperosmolar therapy with mannitol or hypertonic saline for the medical management of intracranial hypertension and present a comprehensive discussion of the evidence associated with various theoretical and practical concerns related to initiation, dosage, and monitoring of therapy.

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Authors and Affiliations

  1. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Andrew Torre-Healy & Robert J. Weil

  2. Cancer Research UK Cambridge Cancer Research Institute, Robinson Way, Cambridge, CB2 0RE, UK

    Nicholas F. Marko

  3. The Department of Applied Mathematics and Theoretical Physics, Cambridge University, Cambridge, UK

    Nicholas F. Marko

  4. Brain Tumor and Neuro-Oncology Center, The Neurological Institute, Cleveland Clinic, ND4-40 LRI, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Robert J. Weil

Authors
  1. Andrew Torre-Healy
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  2. Nicholas F. Marko
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  3. Robert J. Weil
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Correspondence to Nicholas F. Marko.

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Andrew Torre-Healy and Nicholas F. Marko contributed equally to this study and are considered co-first authors.

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Torre-Healy, A., Marko, N.F. & Weil, R.J. Hyperosmolar Therapy for Intracranial Hypertension. Neurocrit Care 17, 117–130 (2012). https://doi.org/10.1007/s12028-011-9649-x

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