Mannitol for acute traumatic brain injury

Wakai, Abel; McCabe, Aileen; Roberts, Ian; Schierhout, Gill

doi:10.1002/14651858.cd001049.pub5

Cited by 141 publications

(56 citation statements)

References 17 publications

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“…The efficacy of existing neuroprotective treatments for high ICP after TBI remains uncertain. There is insufficient data supporting pre-hospital administration of mannitol for treatment of high ICP after TBI [28]. Mass lesions and an increase in brain water content (edema) and cerebral blood volume contribute to raised ICP in TBI [29].…”

Section: Current Status Of Treatments For Tbimentioning

confidence: 99%

Investigational agents for treatment of traumatic brain injury

Xiong

Zhang

Mahmood

et al. 2015

Expert Opinion on Investigational Drugs

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Introduction Traumatic brain injury (TBI) is a major cause of death and disability worldwide. To date, there are no pharmacologic agents proven to improve outcomes from TBI because all the Phase III clinical trials in TBI have failed. Thus, there is a compelling need to develop treatments for TBI. Areas covered The aim of this review is to provide an overview of select cell-based and pharmacological therapies under early development for the treatment of TBI, which seek to enhance cognitive and neurological functional recovery through neuroprotective and neurorestorative strategies. Expert’s opinion TBI elicits both complex degenerative and regenerative tissue responses in the brain. TBI can lead to cognitive, behavioral, and motor deficits. Although numerous promising neuroprotective treatment options have emerged from preclinical studies that mainly target the lesion, translation of preclinical effective neuroprotective drugs to clinical trials has proven challenging. Accumulating evidence indicates that the mammalian brain has a significant, albeit limited, capacity for both structural and functional plasticity as well as regeneration essential for spontaneous functional recovery after injury. A new therapeutic approach is to stimulate neurovascular remodeling by enhancing angiogenesis, neurogenesis, oligodendrogenesis, and axonal sprouting, which in concert, may improve neurological functional recovery after TBI.

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Section: Current Status Of Treatments For Tbimentioning

confidence: 99%

Investigational agents for treatment of traumatic brain injury

Xiong

Zhang

Mahmood

et al. 2015

Expert Opinion on Investigational Drugs

View full text Add to dashboard Cite

show abstract

“…While mannitol has been widely adopted in the hospital setting, there are no data supporting its effectiveness in the prehospital setting (Sayre et al, 1996;Wakai et al, 2013) and it may actually be harmful in pediatric patients (White et al, 2001). The classic hyperosmolar fluid used in the empiric treatment of cerebral herniation is mannitol.…”

Section: Brain-directed Hyperosmolar Fluid Therapymentioning

confidence: 99%

The prehospital management of traumatic brain injury

Goldberg

Rojanasarntikul

Jagoda

2015

Handbook of Clinical Neurology

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“…A recent Cochrane Review concluded that mannitol has a beneficial effect on mortality after TBI when compared to pentobarbital treatment but may have a detrimental effect on mortality when compared to HTS. 64 There are differences in the results from various studies on the duration of ICP reduction, as well as on the improvement in brain oxygenation with HTS. These differences may be related to the concentration of HTS used.…”

Section: Shortcomingsmentioning

confidence: 99%

Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury

Mangat

Härtl

2015

Annals of the New York Academy of Sciences

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Hyperosmolar agents are commonly used as an initial treatment for the management of raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). They have an excellent adverse-effect profile compared to other therapies, such as hyperventilation and barbiturates, which carry the risk of reducing cerebral perfusion. The hyperosmolar agent mannitol has been used for several decades to reduce raised ICP, and there is accumulating evidence from pilot studies suggesting beneficial effects of hypertonic saline (HTS) for similar purposes. An ideal therapeutic agent for ICP reduction should reduce ICP while maintaining cerebral perfusion (pressure). While mannitol can cause dehydration over time, HTS helps maintain normovolemia and cerebral perfusion, a finding that has led to a large amount of pilot data being published on the benefits of HTS, albeit in small cohorts. Prophylactic therapy is not recommended with mannitol, although it may be beneficial with HTS. To date, no large clinical trial has been performed to directly compare the two agents. The best current evidence suggests that mannitol is effective in reducing ICP in the management of traumatic intracranial hypertension and carries mortality benefit compared to barbiturates. Current evidence regarding the use of HTS in severe TBI is limited to smaller studies, which illustrate a benefit in ICP reduction and perhaps mortality.

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Mannitol for acute traumatic brain injury

Abstract: Cochrane Database of Systematic Reviews Analysis 1.2. Comparison 1 ICP-directed mannitol ('treatment') compared to mannitol according to neurological signs ('control'), Outcome 2 Death or severe disability.

Cited by 141 publications

References 17 publications

Investigational agents for treatment of traumatic brain injury

Investigational agents for treatment of traumatic brain injury

The prehospital management of traumatic brain injury

Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury

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