Osmotherapy for increased intracranial pressure: comparison between mannitol and glycerol.
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.
Biestro
A
A
Department of Intensive Medicine, Hospital de Clínicas, Faculty of Medicine, Montevideo, Uruguay.
Alberti
R
R
Galli
R
R
Cancela
M
M
Soca
A
A
Panzardo
H
H
Borovich
B
B
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D005990:Glycerol / Q000008:administration & dosage*; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008353:Mannitol / Q000008:administration & dosage*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014882:Water-Electrolyte Balance / Q000187:drug effects* / Q000502:physiology
D008353:Mannitol; D005990:Glycerol