Toxic Effects of Nutritional Support in the Severely Head Injured Patient

Rosner, Michael J.; Rosner, Sheila D.

doi:10.1007/978-3-642-77789-9_152

Cited by 3 publications

(1 citation statement)

References 7 publications

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“…By this way we would be stabilizing CPP and indirectly would be controlling ICR c) Glycerol infusion could also be a way to solve the problem of nutritional support of the brain injured patients [35]. It is recognized that caloric load via glucose during the early recovery period of brain injury is related to higher ICP and worst outcome [38]. Glycerol has been demonstrated as a viable fuel source with properties very suitable to this condition: reduction of glycaemia and energetic expenditure and spare of protein [43].…”

Section: Discussionmentioning

confidence: 99%

Osmotherapy for increased intracranial pressure: Comparison between mannitol and glycerol

et al. 1997

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Osmotic agents are still the most common treatment for controlling intracranial hypertension (ICH). Mannitol, glycerol, sorbitol, and hypertonic serum saline are the agents currently available. This work was designed to compare mannitol and glycerol in a similar population of brain injured patients, randomly divided into two groups of eight. The following mean day parameters were obtained: number of infusions, hydric balance, mean arterial pressure (MAP), and intracranial pressure (ICP). Cerebral perfusion pressure (CPP) was calculated. Brain computed tomographies (CT) were obtained on arrival, at follow-up whenever justified and at discharge. For comparison of both groups a modified therapeutic intensity level (mTIL) was used. Both agents induced a statistically equally effective decrease on ICP and increase on CPP evaluated at one and two hours post infusion but the mean day mTIL showed a statistically significant difference in favour of glycerol. The possible explanations of this difference are discussed. According to our results mannitol would be most indicated as a bolus to control sudden rises in ICP whereas glycerol would be most indicated as a basal treatment.

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Section: Discussionmentioning

confidence: 99%

Osmotherapy for increased intracranial pressure: Comparison between mannitol and glycerol

et al. 1997

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Traitement de l’œdème cérébral

Minassian

2003

Annales Françaises d'Anesthésie et de Réanimation

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Cerebral perfusion pressure: management protocol and clinical results

Rosner¹,

Rosner²,

Johnson³

1995

Journal of Neurosurgery

891

377

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Early results using cerebral perfusion pressure (CPP) management techniques in persons with traumatic brain injury indicate that treatment directed at CPP is superior to traditional techniques focused on intracranial pressure (ICP) management. The authors have continued to refine management techniques directed at CPP maintenance. One hundred fifty-eight patients with Glasgow Coma Scale (GCS) scores of 7 or lower were managed using vascular volume expansion, cerebrospinal fluid drainage via ventriculostomy, systemic vasopressors (phenylephrine or norepinephrine), and mannitol to maintain a minimum CPP of at least 70 mm Hg. Detailed outcomes and follow-up data bases were maintained. Barbiturates, hyperventilation, and hypothermia were not used. Cerebral perfusion pressure averaged 83 +/- 14 mm Hg; ICP averaged 27 +/- 12 mm Hg; and mean systemic arterial blood pressure averaged 109 +/- 14 mm Hg. Cerebrospinal fluid drainage averaged 100 +/- 98 cc per day. Intake (6040 +/- 4150 cc per day) was carefully titrated to output (5460 +/- 4000 cc per day); mannitol averaged 188 +/- 247 g per day. Approximately 40% of these patients required vasopressor support. Patients requiring vasopressor support had lower GCS scores than those not requiring vasopressors (4.7 +/- 1.3 vs. 5.4 +/- 1.2, respectively). Patients with vasopressor support required larger amounts of mannitol, and their admission ICP was 28.7 +/- 20.7 versus 17.5 +/- 8.6 mm Hg for the nonvasopressor group. Although the death rate in the former group was higher, the outcome quality of the survivors was the same (Glasgow Outcome Scale scores 4.3 +/- 0.9 vs. 4.5 +/- 0.7). Surgical mass lesion patients had outcomes equal to those of the closed head-injury group. Mortality ranged from 52% of patients with a GCS score of 3 to 12% of those with a GCS score of 7; overall mortality was 29% across GCS categories. Favorable outcomes ranged from 35% of patients with a GCS score of 3 to 75% of those with a GCS score of 7. Only 2% of the patients in the series remained vegatative and if patients survived, the likelihood of their having a favorable recovery was approximately 80%. These results are significantly better than other reported series across GCS categories in comparisons of death rates, survival versus dead or vegetative, or favorable versus nonfavorable outcome classifications (Mantel-Haenszel chi 2, p < 0.001). Better management could have improved outcome in as many as 35% to 50% of the deaths.

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Toxic Effects of Nutritional Support in the Severely Head Injured Patient

Cited by 3 publications

References 7 publications

Osmotherapy for increased intracranial pressure: Comparison between mannitol and glycerol

Osmotherapy for increased intracranial pressure: Comparison between mannitol and glycerol

Traitement de l’œdème cérébral

Cerebral perfusion pressure: management protocol and clinical results

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