A systematic Review of treatment outcomes following hyperosmolar solutions for the treatment of brain edema in patients with intracerebral hemorrhage

Authors

  • Rayakorn Moonla Department of Anesthesiology, Chiangmai Neurological Hospital
  • Pornsuree Kuvijitsuwan Department of Research, Development and Academic support, Chiangmai Neurological Hospital
  • Phuping Akavipat Department of Anesthesiology, Prasat Neurological Institute

Keywords:

Intracerebral hemorrhages, Critical care, Brain edema, Mannitol, Hypertonic saline

Abstract

Background: The treatment of intracerebral hemorrhage (ICH) is a medical emergency. Surgery has been found to be an effective form of medical treatment. Appropriate medical treatments including hyperosmolar solutions are essential for satisfactory outcomes. Objective: This systematic review was conducted to review state-of-the-art hyperosmolar solutions for the treatment of brain edema in patients with ICH. Methods: A systematic review was performed in accordance with established standards for systematic reviews following meta-analyses guidelines. Trials were identified by electronic searches using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Pubmed and Science direct. The primary outcomes measured focused on mortality rate, clinical outcomes and quality of life. Secondary outcomes included intracranial pressure (ICP), Glasgow coma scale (GCS), length of stay in an intensive care unit and adverse effects. Results: Five studies comprising 225 patients were included in the review. Hyperosmolar solutions found in the included studies were hypertonic saline and mannitol. Their protocols were various, especially the formulation and dose of the solutions. No statistically significant differences were identified in terms of mortality rate, quality of life, ICP, GCS, length of stay in an intensive care unit or adverse effects between mannitol groups and hypertonic saline solution group. No study reported clinical outcomes. Conclusions: Current evidence indicates that the effects of hyperosmolar solutions including mannitol and hypertonic saline on mortality rate, quality of life, ICP, GCS and length of stay in an intensive care unit remain undefined.

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References

Poon MT, Bell SM, Al-Shahi Salman R. Epidemiology of intracerebral haemorrhage. Front Neu rol Neurosci 2015; 37:1-12.

Meretoja A, Strbian D, Putaala J, Curtze S, Haapaniemi E, Mustanoja S, et al. SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage. Stroke 2012;43:2592-7.

Fewel ME, Thompson BG Jr, Hoff JT. Spontaneous intracerebral hemorrhage: a review. Neurosurg Focus 2003;15:1-16.

Lok J, Leung W, Murphy S, Butler W, Noviski N, Lo EH. Intracranial hemorrhage: mechanisms of secondary brain injury. Acta Neurochir Supple 2011;111:63-9.

Forsyth LL, Liu-DeRyke X, Parker D, Jr., Rhoney DH. Role of hypertonic saline for the management of intracranial hyper tension after stroke and traumatic brain injury. Pharmacotherapy 2008;28:469-84.

Hemphill JC, Greenberg Steven M, Anderson Craig S, Becker K, Bendok Bernard R, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke 2015; 46:2032-60.

Fogarty Mack P. Intracranial haemorrhage: therapeutic interventions and anaesthetic management. Br J Anaesth 2014; 113:ii17-ii25.

Curry P, Viernes D, Sharma D. Perioperative management of traumatic brain injury. Int J Crit Illn Inj Sci 2011;1:27-35.

Thongrong C, Kong N, Govindarajan B, Allen D, Mendel E, Bergese S. Current purpose and practice of hypertonic saline in neurosurgery: a review of the literature. World Neurosurg 2014;82:1307-18.

Cottrell James EMD, Robustelli AMD, Post KMD, Turndorf HMD. Furosemide and mannitol induced changes in intracranial pressure and serum osmolality and electrolytes. Anesthesiology 1977;47:28-30.

Torre-Healy A, Marko NF, Weil RJ. Hyperosmolar therapy for intracranial hypertension. Neurocrit Care 2012;17:117-30.

Yu YL, Kumana CR, Lauder IJ, Cheung YK, Chan FL, Kou M, et al. Treatment of acute cerebral hemorrhage with intravenous glycerol. A double-blind, placebo-controlled, randomized trial. Stroke 1992; 23:967-71.

Javid M, Settlage P. Effect of urea on cerebrospinal fluid pressure in human subject: preliminary report. J Am Med Assoc 1956; 160:943-9.

Westwood M-M, Shawkat H, Mortimer A. Mannitol: a review of its clinical uses. Continuing Education in Anaesthesia Critical Care & Pain 2012; 12:82-5.

Froelich M, Ni Q, Wess C, Ougorets I, Hartl R. Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients. Crit Care Med 2009;37:1433-41.

Bereczki D, Liu M, Prado G Fd, Fekete In JS. Cochrane report: a systematic review of mannitol therapy for acute ischemic stroke and cerebral parenchymal hemorrhage. Stroke 2000; 31:2719-22.

Gu J, Huang H, Huang Y, Sun H, Xu H. Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. Neurosurg Rev 2019;42:499-509.

Lee EJ, Hung YC, Wang LC, Chung KC, Chen HH. Factors influencing the functional outcome of patients with acute epidural hematomas: analysis of 200 patients undergoing surgery. J Trauma 1998;45: 946-52.

Gerard C, Busl KM. Treatment of acute subdural hematoma. Curr Treat Options Neurol 2014;16:275.

Connolly ES, Rabinstein Alejandro A, Carhuapoma JR, Derdeyn Colin P, Dion J, Higashida Randall T, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke 2012;43:1711-37.

Teernstra OP, Evers SM, Kessels AH. Meta-analyses in treatment of spontaneous supratentorial intracerebral haematoma. Acta Neurochir (Wien) 2006;148:521-8.

Kim HT, Lee JM, Koh EJ, Choi HY. Surgery versus conservative treatment for spontaneous supratentorial intracerebral hemorrhage in spot sign positive patients. J Korean Neurosurg Soc 2015;58:309-15.

Seppo J, Olli H, Antti P, Simo V, Timo K, Markku K, et al. The treatment of spontaneous intracerebral hemorrhage. Journal of Neurosurgery 1989;70:755-8.

Kahan BC, Rehal S, Cro S. Risk of selection bias in randomised trials. Trials 2015;16:405.

Otvos B, Kshettry VR, Benzel EC. The history of urea as a hyperosmolar agent to decrease brain swelling. Neurosurg Focus 2014;36:E3.

Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH Score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001;32:891-7.

Mendelow A, Gregson B, N. Rowan E, D. Murray G, Gholkar A, Mitchell P, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013; 382: 397-408.

Salinas J, Sprinkhuizen SM, Ackerson T, Bernhardt J, Davie C, George MG, et al. An international standard set of patient-centered outcome measures after stroke. Stroke 2016;47:180-6.

Sykora M, Steinmacher S, Steiner T, Poli S, Diedler J. Association of intracranial pressure with outcome in comatose patients with intracerebral hemorrhage. J Neurol Sci 2014;342:141-5.

Rutten-Jacobs LC, Maaijwee NA, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, et al. Clinical characteristics and outcome of intracerebral hemorrhage in young adults. J Neurol 2014;261:2143-9.

Chan CL, Ting HW, Huang HT. The Definition of a prolonged intensive care unit stay for spontaneous intracerebral hemorrhage patients: an application with national health insurance research database. Biomed Res Int 2014; 2014:9.

Francony G, Fauvage B, Falcon D, Canet C, Dilou H, Lavagne P, et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Crit Care Med 2008; 36:795-800.

Harutjunyan L, Holz C, Rieger A, Menzel M, Grond S, Soukup J. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients - a randomized clinical trial. Crit Care 2005;9:R530-R540.

Misra UK, Kalita J, Ranjan P, Mandal SK. Mannitol in intracerebral hemorrhage: a randomized controlled study. J Neurol Sci 2005;234:41-5.

Misra UK, Kalita J, Vajpayee A, Phadke RV, Hadique A, Savlani V. Effect of single mannitol bolus in intracerebral hemorrhage. Eur J Neurol 2007;14:1118-23.

Kalita J, Misra UK, Ranjan P, Pradhan PK, Das BK. Effect of mannitol on regional cerebral blood flow in patients with intracerebral hemorrhage. J Neurol Sci 2004;224:19-22.

Wang X, Arima H, Yang J, Zhang S, Wu G, Woodward M, et al. Mannitol and outcome in intracerebral hemorrhage: propensity score and multivariable intensive blood pressure reduction in acute cerebral hemorrhage trial 2 results. Stroke 2015;46:2762-7.

Cruz J, Minoja G, Okuchi K. Major clinical and physiological benefits of early high doses of mannitol for intraparenchymal temporal lobe hemorrhages with abnormal pupillary widening: a randomized trial. Neurosurgery 2002;51:628-38.

Prabhakar H, Singh GP, Anand V, Kalaivani M. Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy. Cochrane database syst rev 2014:Cd010026.

Infanti JL. Challenging the gold standard: should mannitol remain our first-line defense against intracranial hypertension? J Neurosci Nurs 2008; 40:362-8.

Nau R, Dreyhaupt T, Kolenda H, Prange HWJS. Low blood-to-cerebrospinal fluid passage of sorbitol after intravenous infusion. Stroke 1992; 23:1276-9.

Bourdeaux C, Brown J. Sodium bicarbonate lowers intracranial pressure after traumatic brain injury. Neurocrit Care 2010;13:24-8.

Shen L, Wang Z, Su Z, Qiu S, Xu J, Zhou Y, et al. Effects of intracranial pressure monitoring on mortality in patients with severe traumatic brain injury: a meta-analysis. PloS one 2016;11:e0168901.

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Published

30-12-2019

How to Cite

1.
Moonla R, Kuvijitsuwan P, Akavipat P. A systematic Review of treatment outcomes following hyperosmolar solutions for the treatment of brain edema in patients with intracerebral hemorrhage. j dept med ser [Internet]. 2019 Dec. 30 [cited 2022 Aug. 8];44(6):20-8. Available from: https://he02.tci-thaijo.org/index.php/JDMS/article/view/244791

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Original Article