High colloid oncotic therapy for contusional brain edema.
We investigated whether prolonged high colloid oncotic therapy for two weeks can suppress contusional brain edema. Eighteen patients with cerebral contusion were randomly divided into two groups of patients receiving high oncotic pressure (HOP; 26-30 mmHg) treatment and those receiving normal oncotic pressure (NOP; 22-26 mmHg) treatment. Oncotic pressure was maintained for two weeks with administration of a 25% albumin solution with additional use of furosemide. Edema volume was calculated by summation of all measured low-density areas in each CT slice multiplied by 1.0 cm of slice of thickness. We expressed contusional brain edema volume as a percent increase based on each patient's initial CT. The mean percent increase of contusional brain edema in the NOP group was significantly higher than that in the HOP group at 9-15 days (208.9% and 14.0%, respectively) and 16-25 days (188.8% and 10.0%, respectively). There were no complications such as heart failure or renal failure during treatment. All the patients in the HOP group recovered with minimal or no neurological deficit. On the other hand, 30% of patients in the NOP group remained in poor condition. With frequent measurement of oncotic pressure and adjustment of fluids and electrolytes, continuous oncotic therapy for two weeks effectively and safely reduced contusional brain edema.
Department of Neurosurgery, Musashino Red-Cross Hospital, Tokyo, Japan.
H
H
Tomita
U
U
Ito
O
O
Tone
H
H
Masaoka
B
B
Tominaga
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000008:administration & dosage*; D001798:Blood Proteins / Q000378:metabolism*; D001812:Blood-Brain Barrier / Q000187:drug effects* / Q000502:physiology; D001924:Brain Concussion / Q000188:drug therapy* / Q000503:physiopathology; D001929:Brain Edema / Q000188:drug therapy* / Q000503:physiopathology; D003131:Combined Modality Therapy; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D015600:Glasgow Coma Scale; D005990:Glycerol / Q000008:administration & dosage*; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects* / Q000502:physiology
D000418:Albumins; D001798:Blood Proteins; D005665:Furosemide; D005990:Glycerol