Hyperosmolar solutions for management of raised intracranial pressure: new concepts

Abstract

Background The hyperosmolar solutions are an effective therapy for raised intracranial pressure(＞20 mmHg)(1 mmHg=0.133 kPa).The two commonly used hyperosmolar solutions are mannitoli and hypertonic saline in clinical practice.However,there is controversy on how to select hyperosmolar solutions to manage raised intracranial pressure.Objective To promote people to deeply understand the effect of hyperosmolar solutions on the raised intracranial pressure.Content In this paper the pharmacologic mechanisms,clinical applications and adverse effects of the two hyperosmolar solutions in recent researches are reviewed.Recent published meta-analysis failed to confirm which hyperosmolar solution is better in management of intracranial hypertension and cerebral perfusion pressure,however,maintaining plasma osmolality ＜320 mOsm/L and sodium level between 145 mmol/L-155 mmol/L is appropriate during hyperosmolar therapy.Trend The studies on indications,timing and optimal dose of those hyperosmolar solutions will be helpful in clinical management of patients with intracranial hypertension. Key words: Hyperosmolar solutions; Intracranial pressure; Mannitoli; Hypertonic saline; Neurophysiological effects