Osmotherapy: Use Among Neurointensivists
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Angela N. Hays • Christos Lazaridis • Ron Neyens • Joyce Nicholas • Sarah Gay • Julio A. Chalela
- چاپ و سال / کشور: 2011
Description
Background Cerebral edema and raised intracranial pressure are common problems in neurological intensive care. Osmotherapy, typically using mannitol or hypertonic saline (HTS), has become one of the first-line interventions. However, the literature on the use of these agents is heterogeneous and lacking in class I studies. The authors hypothesized that clinical practice would reflect this heterogeneity with respect to choice of agent, dosing strategy, and methods for monitoring therapy. Methods An on-line survey was administered by e-mail to members of the Neurocritical Care Society. Multiplechoice questions regarding use of mannitol and HTS were employed to gain insight into clinician practices. Results A total of 295 responses were received, 79.7% of which were from physicians. The majority (89.9%) reported using osmotherapy as needed for intracranial hypertension, though a minority reported initiating treatment prophylactically. Practitioners were fairly evenly split between those who preferred HTS (54.9%) and those who preferred mannitol (45.1%), with some respondents reserving HTS for patients with refractory intracranial hypertension. Respondents who preferred HTS were more likely to endorse prophylactic administration. Preferred dosing regimens for both agents varied considerably, as did monitoring parameters. Conclusions Treatment of cerebral edema using osmotically active substances varies considerably between practitioners. This variation could hamper efforts to design and implement multicenter trials in neurocritical care
Neurocrit Care (2011) 14:222–228 DOI 10.1007/s12028-010-9477-4 Published online: 14 December 2010
