Christopher R Pasarikovski1, Naif M Alotaibi2, Fawaz Al-Mufti3, R Loch Macdonald4. 1. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 2. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: naif.alotaibi@mail.utoronto.ca. 3. Endovascular Surgical Neuroradiology Program, Rutgers University-New Jersey Medical School, Newark, New Jersey, USA. 4. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre for Biomedical Research and Li Ka Shing Knowledge Institute, Department of Surgery, University of Toronto, Canada.
Abstract
BACKGROUND: The use of hyperosmolar agents, such as mannitol or hypertonic saline (HTS), to control high intracranial pressure (ICP) in patients with traumatic brain injury has been well studied. However, the role of HTS in the management of aneurysmal subarachnoid hemorrhage (aSAH)-associated increased ICP is still unclear. METHODS: We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of this review is to quantify ICP reduction produced by HTS and its effect on clinical outcomes defined by any standardized functional score. Secondary outcomes included HTS versus mannitol in ICP reduction, HTS effects on cerebral vasospasm, and HTS dose concentration, infusion rate, infusion volume, frequency of redosing, and serum sodium/osmolality limits for repeat dosing. RESULTS: Five studies were included in the review encompassing 175 patients. Studies on aSAH included mostly poor grade patients (defined as World Federation of Neurosurgical Societies grade 4 and 5). HTS concentrations ranged from 3%-23.5%. Most studies found that HTS decreased ICP when compared with either baseline or placebo. The mean decrease in ICP from HTS administration was 8.9 mm Hg (range: 3.3-12.1 mm Hg). Only 1 study showed possible improvement in poor grade aSAH outcomes. CONCLUSIONS: The current evidence suggests that HTS is as effective as mannitol at reducing increased ICP in aSAH. However, there is not enough data to recommend the optimal and safest dose concentration or whether HTS significantly improves outcomes in aSAH.
BACKGROUND: The use of hyperosmolar agents, such as mannitol or hypertonic saline (HTS), to control high intracranial pressure (ICP) in patients with traumatic brain injury has been well studied. However, the role of HTS in the management of aneurysmal subarachnoid hemorrhage (aSAH)-associated increased ICP is still unclear. METHODS: We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of this review is to quantify ICP reduction produced by HTS and its effect on clinical outcomes defined by any standardized functional score. Secondary outcomes included HTS versus mannitol in ICP reduction, HTS effects on cerebral vasospasm, and HTS dose concentration, infusion rate, infusion volume, frequency of redosing, and serum sodium/osmolality limits for repeat dosing. RESULTS: Five studies were included in the review encompassing 175 patients. Studies on aSAH included mostly poor grade patients (defined as World Federation of Neurosurgical Societies grade 4 and 5). HTS concentrations ranged from 3%-23.5%. Most studies found that HTS decreased ICP when compared with either baseline or placebo. The mean decrease in ICP from HTS administration was 8.9 mm Hg (range: 3.3-12.1 mm Hg). Only 1 study showed possible improvement in poor grade aSAH outcomes. CONCLUSIONS: The current evidence suggests that HTS is as effective as mannitol at reducing increased ICP in aSAH. However, there is not enough data to recommend the optimal and safest dose concentration or whether HTS significantly improves outcomes in aSAH.
Authors: Melissa M J Chua; Alejandro Enríquez-Marulanda; Santiago Gomez-Paz; Yosuke Akamatsu; Mohamed M Salem; Georgios A Maragkos; Luis C Ascanio; Khalid A Hanafy; Corey R Fehnel; Christopher S Ogilvy; Justin Moore; Ajith J Thomas Journal: J Stroke Cerebrovasc Dis Date: 2021-11-05 Impact factor: 2.136
Authors: Fawaz Al-Mufti; Stephan A Mayer; Gurmeen Kaur; Daniel Bassily; Boyi Li; Matthew L Holstein; Jood Ani; Nicole E Matluck; Haris Kamal; Rolla Nuoman; Christian A Bowers; Faizan S Ali; Hussein Al-Shammari; Mohammad El-Ghanem; Chirag Gandhi; Krishna Amuluru Journal: Neuroradiol J Date: 2021-09-03