Intra-Ocular and Intracranial Pressure

Hypertonic saline: First-line therapy for cerebral edema?

“…These sets of observations have constituted the first description of osmotherapy in the medical literature. In 1927, intravenous administration of concentrated urea was brought into clinical use by Fremont-Smith and Forbes [9] and investigated further by Javid and Settlage [10,11] in the 1950s. About the same time the use of concentrated solutions of human plasma proteins by Hughes et al [12] was attempted, although this was abandoned quickly due to high cost and concern for allergic reactions.…”

Cerebral resuscitation: role of osmotherapy

“…This set of observations, detailing the effects of changes in plasma osmolality on brain parenchyma, has formed the basis of osmotherapy [13,17]. The first agent to be utilized formally as an osmotic agent was concentrated urea [18]. Interest in the use of concentrated human plasma proteins to raise oncotic pressure as a means of alleviating elevated ICP was dampened by the high cost of preparation and the potential for allergic reactions [13].…”

Osmotherapy in neurocritical care

“…IV delivery of osmotic agents (eg, urea) in clinical practice was formalized in 1927 [11]. Subsequently, interest in increasing plasma oncotic pressure with delivery of concentrated human plasma proteins as a strategy for ameliorating cerebral edema was short lived due to concerns of allergic reactions and expense of these solutions [12].…”