The Use of Mannitol and Hypertonic Saline Therapies in Patients with Elevated Intracranial Pressure

Witherspoon, Briana; Ashby, Nathan E.

doi:10.1016/j.cnur.2017.01.002

Cited by 44 publications

(21 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, the majority of studies on the efficacy of mannitol therapy have been conducted in this cohort and generalised to other patient cohorts and there is little evidence for its use in the management of stroke patients with elevated ICP. The use of mannitol is contraindicated where there is clear evidence of BBB breakdown [ 81 ] and repeated dosing may lead to mannitol accumulation within the brain parenchyma, reversing the osmotic drive and increasing intra-parenchymal fluid accumulation, further elevating ICP and leading to neurological deterioration [ 70 , 82 , 83 ]. HTS is also used to manage elevated ICP.…”

Section: Current Treatments For Cerebral Oedema Following Acute Cnmentioning

confidence: 99%

The Role of Neurogenic Inflammation in Blood-Brain Barrier Disruption and Development of Cerebral Oedema Following Acute Central Nervous System (CNS) Injury

Sorby-Adams

Marcoionni

Dempsey

et al. 2017

IJMS

105

View full text Add to dashboard Cite

Acute central nervous system (CNS) injury, encompassing traumatic brain injury (TBI) and stroke, accounts for a significant burden of morbidity and mortality worldwide, largely attributable to the development of cerebral oedema and elevated intracranial pressure (ICP). Despite this, clinical treatments are limited and new therapies are urgently required to improve patient outcomes and survival. Originally characterised in peripheral tissues, such as the skin and lungs as a neurally-elicited inflammatory process that contributes to increased microvascular permeability and tissue swelling, neurogenic inflammation has now been described in acute injury to the brain where it may play a key role in the secondary injury cascades that evolve following both TBI and stroke. In particular, release of the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP) appear to be critically involved. In particular, increased SP expression is observed in perivascular tissue following acute CNS injury, with the magnitude of SP release being related to both the frequency and degree of the insult. SP release is associated with profound blood-brain barrier disruption and the subsequent development of vasogenic oedema, as well as neuronal injury and poor functional outcomes. Inhibition of SP through use of a neurokinin 1 (NK1) antagonist is highly beneficial following both TBI and ischaemic stroke in pre-clinical models. The role of CGRP is more unclear, especially with respect to TBI, with both elevations and reductions in CGRP levels reported following trauma. However, a beneficial role has been delineated in stroke, given its potent vasodilatory effects. Thus, modulating neuropeptides represents a novel therapeutic target in the treatment of cerebral oedema following acute CNS injury.

show abstract

Section: Current Treatments For Cerebral Oedema Following Acute Cnmentioning

confidence: 99%

The Role of Neurogenic Inflammation in Blood-Brain Barrier Disruption and Development of Cerebral Oedema Following Acute Central Nervous System (CNS) Injury

Sorby-Adams

Marcoionni

Dempsey

et al. 2017

IJMS

105

View full text Add to dashboard Cite

show abstract

“…Mannitol, 6-carbon natural alditol, is a hyperosmolar solution and osmotherapeutic agent only scarcely metabolized and mainly excreted rapidly via the kidneys [ 4 ]. To this day, it is widely used in many fields of medicine due to its beneficial effects on the kidney [ 5 ], brain [ 6 , 7 , 8 ] and heart [ 4 , 9 ]. One main clinical indication is treatment of elevated intracranial pressure (ICP), as the osmotherapeutic agent is thought to decrease brain volume by reducing overall water content and thus blood volume by its osmotic and vasoconstrictive effect [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cardioprotective Properties of Mannitol—Involvement of Mitochondrial Potassium Channels

Feige,

Rubbert,

Raupach

et al. 2021

IJMS

View full text Add to dashboard Cite

Cardiac preconditioning (PC) and postconditioning (PoC) are powerful measures against the consequences of myocardial ischemia and reperfusion (I/R) injury. Mannitol—a hyperosmolar solution—is clinically used for treatment of intracranial and intraocular pressure or promotion of diuresis in renal failure. Next to these clinical indications, different organ-protective properties—e.g., perioperative neuroprotection—are described. However, whether Mannitol also confers cardioprotection via a pre- and/or postconditioning stimulus, possibly reducing consequences of I/R injury, remains to be seen. Therefore, in the present study we investigated whether (1) Mannitol-induced pre- and/or postconditioning induces myocardial infarct size reduction and (2) activation of mitochondrial ATP-sensitive potassium (mKATP) channels is involved in cardioprotection by Mannitol. Experiments were performed on isolated hearts of male Wistar rats via a pressure controlled Langendorff system, randomized into 7 groups. Each heart underwent 33 min of global ischemia and 60 min of reperfusion. Control hearts (Con) received Krebs–Henseleit buffer as vehicle only. Pre- and postconditioning was achieved by administration of 11 mmol/L Mannitol for 10 min before ischemia (Man-PC) or immediately at the onset of reperfusion (Man-PoC), respectively. In further groups, the mKATP channel blocker 5HD, was applied with and without Mannitol, to determine the potential underlying cardioprotective mechanisms. Primary endpoint was infarct size, determined by triphenyltetrazolium chloride staining. Mannitol significantly reduced infarct size both as a pre- (Man-PC) and postconditioning (Man-PoC) stimulus compared to control hearts (Man-PC: 31 ± 4%; Man-PoC: 35 ± 6%, each p < 0.05 vs. Con: 57 ± 9%). The mKATP channel inhibitor completely abrogated the cardioprotective effect of Mannitol-induced pre- (5HD-PC-Man-PC: 59 ± 8%, p < 0.05 vs. Man-PC) and postconditioning (5HD-PoC-Man-PoC: 59 ± 10% vs. p <0.05 Man-PoC). Infarct size was not influenced by 5HD itself (5HD-PC: 60 ± 14%; 5HD-PoC: 54 ± 14%, each ns vs. Con). This study demonstrates that Mannitol (1) induces myocardial pre- and postconditioning and (2) confers cardioprotection via activation of mKATP channels.

show abstract

“…A stroke consists of a series of processes starting with the rupture of brain blood vessels causing blood to leak into the brain parenchyma tissue, the cerebrospinal fluid spaces around the brain, or a combination of both. At the onset of a stroke within a few minutes to several hours, cytotoxic edema occurs then develops into vasogenic edema due to the displacement of intravascular fluid into the interstitial space (6) .…”

Section: Introductionmentioning

confidence: 99%

Changes of Consciousness Level and Blood Pressure of Acute Stroke Patients Administering Mannitol Therapy

2021

IJPHRD

View full text Add to dashboard Cite

Objects:To analyze changes in consciousness level and blood pressure of acute stoke patients administering mannitol therapy. Methods:The study was a descriptive cohort. Thirty-four respondents were applied to selecting by purposive sampling. Data were analyzed by descriptive. Results:The results showed that there was an improvement in consciousness level (GCS). The improvement in the patient's level of consciousness occurred after more than twenty-four hours of getting mannitol therapy. While the blood pressure until the third day, there were still suffering from hypertension. Conclusion:Improvements in consciousness level after administering mannitol therapy indicate loss of cerebral edema, improvement in cerebral blood flow (CBF) and brain perfusion pressure (CPP), and repair of damaged nerve cells.

show abstract

The Use of Mannitol and Hypertonic Saline Therapies in Patients with Elevated Intracranial Pressure

Cited by 44 publications

References 38 publications

The Role of Neurogenic Inflammation in Blood-Brain Barrier Disruption and Development of Cerebral Oedema Following Acute Central Nervous System (CNS) Injury

The Role of Neurogenic Inflammation in Blood-Brain Barrier Disruption and Development of Cerebral Oedema Following Acute Central Nervous System (CNS) Injury

Cardioprotective Properties of Mannitol—Involvement of Mitochondrial Potassium Channels

Changes of Consciousness Level and Blood Pressure of Acute Stroke Patients Administering Mannitol Therapy

Contact Info

Product

Resources

About