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If there is an intact blood–brain barrier, osmotherapy (mannitol or hypertonic saline) may be used to decrease ICP. [33] It is unclear whether mannitol or hypertonic saline is superior, or if they improve outcomes. [34] [35] Struggling, restlessness, and seizures can increase metabolic demands and oxygen consumption, as well as increasing ...
Hypertonic Saline which contains sodium chloride works in regulating ICP, intravascular volume and cardiac output without causing significant diuresis, but there are theoretical side effects ranging from neurological complications to subdural hematoma. Hypertonic saline solution has been choice of neuro critical care for the past few years. [1]
The effects of hypertonic saline can be prolonged with combination to agents such as dextran or hydroxyethyl starch, although their use is currently controversial. [44] When compared to mannitol, hypertonic saline has been shown to be as effective as mannitol in decreased ICP in neurocritical care and is more effective in many cases. [44]
Hypertonic saline can improve ICP by reducing the amount of cerebral water (swelling), though it is used with caution to avoid electrolyte imbalances or heart failure. [ 10 ] [ 100 ] [ 101 ] Mannitol , an osmotic diuretic , [ 10 ] appears to be as effective as hypertonic saline at reducing ICP; [ 102 ] [ 103 ] [ 100 ] [ 104 ] however, some ...
Hypertonic saline—7% NaCl solutions are considered mucoactive agents and thus are used to hydrate thick secretions in order to make it easier to cough up and out (expectorate). 3% hypertonic saline solutions are also used in critical care settings, acutely increased intracranial pressure, or severe hyponatremia. [27]
Mannitol is used intravenously to reduce acutely raised intracranial pressure until more definitive treatment can be applied, [16] e.g., after head trauma. While mannitol injection is the mainstay for treating high pressure in the skull after a bad brain injury, it is no better than hypertonic saline as a first-line treatment.
Any osmotically active agent that is filtered by the glomerulus but not reabsorbed causes water to be retained in these segments and promotes a water diuresis. Such agents can be used to reduce intracranial pressure and to promote prompt removal of renal toxins. The prototypical osmotic diuretic is mannitol. [5]
In contrast, the most proximal occlusions result in widespread effects that can lead to significant cerebral edema, increased intracranial pressure, loss of consciousness and could even be fatal. [1] In such occasions, mannitol (osmotic diuretic) or hypertonic saline are given to draw fluid out of the edematous cerebrum to minimise secondary ...