Application and research of osmotic therapy in children with intracranial hypertension syndrome

Abstract

Pediatric intracranial hypertension (ICH) syndrome is a critical and severe pathogenic disorder. An appropriate and effective treatment can reduce its mortality, and decrease incidences of secondary brain injuries and neurologic complications. Timely treatment of intracranial pressure is the key measure in the acute stage of pediatric ICH syndrome, and osmotic therapy is considered as the most common measure to reduce intracranial pressure. Osmotic drugs used in the acute stage of pediatric ICH syndrome include urea, glycerin, sorbitol, mannitol, and hypertonic saline, etc.. Since urea, glycerin and sorbitol are associated with numerous side effects, they are no longer used clinically. Mannitol as the traditionally used osmotic medication has a definitive effect on reducing intracranial pressure, thus it is still widely administrated in clinical practices. Despite that hypertonic saline has a similar effect on reduction of intracranial pressure as mannitol, continuous studies have shown that administration of hypertonic saline yields even better outcomes for reducing intracranial pressure and better maintenance of cerebral perfusion pressure (CPP) compared with the use of mannitol. Moreover, the administration of hypertonic saline may provide protection for brain functions through various mechanisms. From the perspective of protection for brain functions, new studies and guidelines increasingly suggest and pay attention to the application of hypertonic saline in reduction of intracranial pressure, especially, recommend it as the first-line osmotic medcine for traumatic brain injury (TBI)-induced pediatric ICH syndrome. As of today, questions are still remained: could hypertonic saline replace mannitol as the first-line osmotic medcine in reducing intracranial pressure or in which cases should hypertonic saline be preferably selected? This article focuses on the historical and current research progresses of osmotic therapy in reduction of intracranial pressure in the acute stage for children with ICH syndrome, and explores the mechanisms of reduction of intracranial pressure for mannitol and hypertonic saline, and discovers recent clinical status of using mannitol and hypertonic saline as well as comparison between these two medications in treatment of children with ICH syndrome. Key words: Intracranial hypertension; Intracranial pressure; Brain injuries; Mannitol; Saline solution, hypertonic; Osmotic therapy; Side effect; Child