Dose–response relationship of mannitol and intracranial pressure: a metaanalysis

Sorani, Marco D.; Manley, Geoffrey T.

doi:10.3171/jns/2008/108/01/0080

Cited by 62 publications

(30 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4,8 Continuous infusions of mannitol take longer to lower ICP and have not been found to have any benefit over bolus administration. 4 Therefore, the most potentially harmful and also most common type of error in this study is underdosing, which occurred in 8% of cases in this study.…”

Section: 69mentioning

confidence: 99%

Mannitol dosing error during interfacility transfer for intracranial emergencies

Elliott

MacKenzie

O’Kelly

2015

JNS

View full text Add to dashboard Cite

OBJECT Mannitol is commonly used to treat elevated intracranial pressure (ICP). The authors analyzed mannitol dosing errors at peripheral hospitals prior to or during transport to tertiary care facilities for intracranial emergencies. They also investigated the appropriateness of mannitol use based on the 2007 Brain Trauma Foundation guidelines for severe traumatic brain injury. METHODS The authors conducted a retrospective review of the Shock Trauma Air Rescue Society (STARS) electronic patient database of helicopter medical evacuations in Alberta, Canada, between 2004 and 2012, limited to patients receiving mannitol before transfer. They extracted data on mannitol administration and patient characteristics, including diagnosis, mechanism, Glasgow Coma Scale score, weight, age, and pupil status. RESULTS A total of 120 patients with an intracranial emergency received a mannitol infusion initiated at a peripheral hospital (median Glasgow Coma Scale score 6; range 3–13). Overall, there was a 22% dosing error rate, which comprised an underdosing rate (< 0.25 g/kg) of 8.3% (10 of 120 patients), an overdosing rate (> 1.5 g/kg) of 7.5% (9 of 120), and a nonbolus administration rate (> 1 hour) of 6.7% (8 of 120). Overall, 72% of patients had a clear indication to receive mannitol as defined by meeting at least one of the following criteria based on Brain Trauma Foundation guidelines: neurological deterioration (11%), severe traumatic brain injury (69%), or pupillary abnormality (25%). CONCLUSIONS Mannitol administration at peripheral hospitals is prone to dosing error. Strategies such as a pretransport checklist may mitigate this risk.

show abstract

Section: 69mentioning

confidence: 99%

Mannitol dosing error during interfacility transfer for intracranial emergencies

Elliott

MacKenzie

O’Kelly

2015

JNS

View full text Add to dashboard Cite

show abstract

“…5,6,10,11 Manitol merupakan diuretika osmotika utama yang digunakan untuk mengurangi edema serebri. 4 Manitol menurunkan tekanan intrakranial dengan cara memindahkan cairan dari intraselular ke ruang intravaskular. 4 Pemindahan cairan tersebut karena menaikkan gradient osmotik antara otak dan darah.…”

Section: Pendahuluanunclassified

“…4 Manitol menurunkan tekanan intrakranial dengan cara memindahkan cairan dari intraselular ke ruang intravaskular. 4 Pemindahan cairan tersebut karena menaikkan gradient osmotik antara otak dan darah. 6 Efek cepat manitol didapat dari perubahan keenceran darah yang akan menaikkan aliran darah otak serta oksigenasi otak yang menyebabkan vasokontriksi yang berujung pada penurunan tekanan intrakranial.…”

Section: Pendahuluanunclassified

“…6 Efek cepat manitol didapat dari perubahan keenceran darah yang akan menaikkan aliran darah otak serta oksigenasi otak yang menyebabkan vasokontriksi yang berujung pada penurunan tekanan intrakranial. 4,6 Efek samping manitol dapat menyebabkan diuresis cairan dan elektrolit sehingga terjadi hipotensi intravaskular yang dapat meningkatkan mortalitas penderita cedera kepala. 12 Pemberian manitol jangka panjang dapat menyebabkan dehidrasi intravaskular, hipotensi, serta azotemia prerenal yang dapat berkembang menjadi gagal ginjal.…”

Section: Pendahuluanunclassified

See 1 more Smart Citation

Perbandingan Efektivitas Natrium Laktat dengan Manitol untuk Menurunkan Tekanan Intrakranial Penderita Cedera Kepala Berat

Arifin¹,

Risdianto²

2012

mkb

View full text Add to dashboard Cite

AbstrakPeningkatan tekanan intrakranial masih menjadi penyebab utama kematian pada penderita cedera kepala. Penggunaan obat baru sebagai terapi osmosis diharapkan mampu menurunkan tekanan intrakranial. Penelitian prospektif, samar ganda, acak dilakukan terhadap 20 penderita cedera kepala berat di Unit Gawat Darurat (UGD) Rumah Sakit Dr. Hasan Sadikin Bandung selama bulan Februari-Juli 2009. Penderita dikelompokkan dalam 2 kelompok yang mendapat terapi manitol atau natrium laktat. Dilakukan pengukuran tekanan intrakranial, kadar laktat, kadar natrium, serta kalium sebelum dan sesudah terapi osmosis dengan uji Shapiro-Wilk untuk analisis distribusi dan uji t berpasangan atau uji Wilcoxon untuk perbandingan rata-rata mempergunakan program statistical products and solution services (SPSS). Kelompok natrium laktat mengalami penurunan tekanan intrakranial (p<0,001) serta kenaikan kadar laktat (p=0,035). Kelompok manitol mengalami penurunan tekanan intrakranial (p=0,005) dan perubahan kadar laktat (p=0,135). Kadar natrium dan kalium pada kedua kelompok tidak terdapat perubahan yang bermakna. Penurunan tekanan intrakranial kelompok manitol dan natrium laktat tidak berbeda bermakna (p=0,417). Kadar laktat antara kelompok natrium laktat dan manitol berbeda bermakna (p=0,016), yaitu kenaikan kadar laktat yang lebih tinggi pada kelompok natrium laktat. Simpulan, pemberian natrium laktat dan manitol sama efektifnya menurunkan tekanan intrakranial pada penderita cedera kepala berat. Pemberian natrium laktat meningkatkan kadar laktat secara bermakna dibandingkan dengan pemberian manitol. Tidak terdapat perbedaan bermakna kadar natrium dan kalium pada kedua kelompok penelitian. [MKB. 2012;44 (1)

show abstract

“…5 Mannitol is more effective when given in a high dose (1.4 gm/kg) as a bolus rather than by continuous infusion. 21,32,142 Mannitol also reduces blood viscosity and improves the rheology of blood flow. 24 There is evidence to suggest that mannitol also acts through vasoconstriction in response to these changes in blood viscosity.…”

Section: Management Of Suspected Raised Icpmentioning

confidence: 99%

Prehospital management of traumatic brain injury

Stiver¹,

Manley²

2008

FOC

Self Cite

View full text Add to dashboard Cite

The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

show abstract

Dose–response relationship of mannitol and intracranial pressure: a metaanalysis

Abstract: Despite its clinical importance, the determination of the mannitol dose-response curve continues to be challenging for many reasons. This metaanalysis highlights the need for a consensus of methods and results required to determine this important relationship.

Cited by 62 publications

References 35 publications

Mannitol dosing error during interfacility transfer for intracranial emergencies

Mannitol dosing error during interfacility transfer for intracranial emergencies

Perbandingan Efektivitas Natrium Laktat dengan Manitol untuk Menurunkan Tekanan Intrakranial Penderita Cedera Kepala Berat

Prehospital management of traumatic brain injury

Contact Info

Product

Resources

About