A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and Mannitol
Objective: The impact of hypertonic saline (HTS) on the control of increased intracranial pressure (ICP) in head-injured patients undergoing decompressive craniectomy (DC) has yet to be established. The current retrospective study was conducted to compare the effect of HTS and mannitol on lowering t...
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Frontiers Media S.A.
2018-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2018.00631/full |
| _version_ | 1818943329567506432 |
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| author | Feng Cheng Feng Cheng Min Xu Hua Liu Wenming Wang Zhimin Wang |
| author_facet | Feng Cheng Feng Cheng Min Xu Hua Liu Wenming Wang Zhimin Wang |
| author_sort | Feng Cheng |
| collection | DOAJ |
| description | Objective: The impact of hypertonic saline (HTS) on the control of increased intracranial pressure (ICP) in head-injured patients undergoing decompressive craniectomy (DC) has yet to be established. The current retrospective study was conducted to compare the effect of HTS and mannitol on lowering the ICP burden of these patients.Methods: We reviewed data on patients who had sustained a traumatic brain injury (TBI) and were admitted to the First People's Hospital of Kunshan between January 1, 2012, and August 31, 2017. Patients who received only one type of hyperosmotic agent, 3% HTS or 20% mannitol, after DC were included. The daily ICP burden (h/day) and response to the hyperosmolar agent were used as primary outcome measures. The numbers of days in the intensive care unit and in the hospital, and the 2-weeks mortality rates were also compared between the groups.Results: The 30 patients who received 3% HTS only and the 30 who received 20% mannitol only were identified for approximate matching and additional data analyses. The demographic characteristics of the patients in the two groups were comparable, but the daily ICP burden was significantly lower in the HTS group than in the mannitol group (0.89 ± 1.02 h/day vs. 2.11 ± 2.95 h/day, respectively; P = 0.038). The slope of the reduction in ICP in response to a bolus dose at baseline was higher with HTS than with mannitol (P = 0.001). However, the between-group difference in the 2-weeks mortality rates was not statistically significant (2 [HTS] vs. 1 [mannitol]; P = 0.554).Conclusion: When used in equiosmolar doses, the reduction in the ICP of TBI patients achieved with 3% HTS was superior to that achieved with 20% mannitol after DC. However, this advantage did not seem to confer any additional benefit terms of short-term mortality. |
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| publishDate | 2018-07-01 |
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| spelling | doaj.art-8cfa80e34958451890fbcc51a9e19c862022-12-21T19:48:32ZengFrontiers Media S.A.Frontiers in Neurology1664-22952018-07-01910.3389/fneur.2018.00631347810A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and MannitolFeng Cheng0Feng Cheng1Min Xu2Hua Liu3Wenming Wang4Zhimin Wang5Department of Neurosurgery, Suzhou Kowloon Hospital, Soochow University, Suzhou, ChinaDepartment of Neurosurgery, The First People's Hospital of Kunshan, Jiangsu University, Suzhou, ChinaDepartment of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, ChinaDepartment of Neurosurgery, The First People's Hospital of Kunshan, Jiangsu University, Suzhou, ChinaDepartment of Neurosurgery, The First People's Hospital of Kunshan, Jiangsu University, Suzhou, ChinaDepartment of Neurosurgery, Suzhou Kowloon Hospital, Soochow University, Suzhou, ChinaObjective: The impact of hypertonic saline (HTS) on the control of increased intracranial pressure (ICP) in head-injured patients undergoing decompressive craniectomy (DC) has yet to be established. The current retrospective study was conducted to compare the effect of HTS and mannitol on lowering the ICP burden of these patients.Methods: We reviewed data on patients who had sustained a traumatic brain injury (TBI) and were admitted to the First People's Hospital of Kunshan between January 1, 2012, and August 31, 2017. Patients who received only one type of hyperosmotic agent, 3% HTS or 20% mannitol, after DC were included. The daily ICP burden (h/day) and response to the hyperosmolar agent were used as primary outcome measures. The numbers of days in the intensive care unit and in the hospital, and the 2-weeks mortality rates were also compared between the groups.Results: The 30 patients who received 3% HTS only and the 30 who received 20% mannitol only were identified for approximate matching and additional data analyses. The demographic characteristics of the patients in the two groups were comparable, but the daily ICP burden was significantly lower in the HTS group than in the mannitol group (0.89 ± 1.02 h/day vs. 2.11 ± 2.95 h/day, respectively; P = 0.038). The slope of the reduction in ICP in response to a bolus dose at baseline was higher with HTS than with mannitol (P = 0.001). However, the between-group difference in the 2-weeks mortality rates was not statistically significant (2 [HTS] vs. 1 [mannitol]; P = 0.554).Conclusion: When used in equiosmolar doses, the reduction in the ICP of TBI patients achieved with 3% HTS was superior to that achieved with 20% mannitol after DC. However, this advantage did not seem to confer any additional benefit terms of short-term mortality.https://www.frontiersin.org/article/10.3389/fneur.2018.00631/fulltraumatic brain injuryintracranial pressuredecompressive craniectomyhypertonic salinemannitol |
| spellingShingle | Feng Cheng Feng Cheng Min Xu Hua Liu Wenming Wang Zhimin Wang A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and Mannitol Frontiers in Neurology traumatic brain injury intracranial pressure decompressive craniectomy hypertonic saline mannitol |
| title | A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and Mannitol |
| title_full | A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and Mannitol |
| title_fullStr | A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and Mannitol |
| title_full_unstemmed | A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and Mannitol |
| title_short | A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and Mannitol |
| title_sort | retrospective study of intracranial pressure in head injured patients undergoing decompressive craniectomy a comparison of hypertonic saline and mannitol |
| topic | traumatic brain injury intracranial pressure decompressive craniectomy hypertonic saline mannitol |
| url | https://www.frontiersin.org/article/10.3389/fneur.2018.00631/full |
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