New trends in hyperosmolar therapy?
New trends in hyperosmolar therapy?
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DOI：
10.1097/mcc.0b013e32835eba30
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发表时间：
2013-04
影响因子：
3.3
通讯作者：
Diringer MN
中科院分区：
文献类型：
--
作者：
Diringer MN
discuss trends in the use of osmotic therapy. use of osmotic therapy has evolved from bolus administration of mannitol to routine use of hypertonic saline (HS) as a bolus as well as in continuous infusions to creating a sustained hyperosmolar state. In a survey of neurointensivists 55% favored HS over mannitol. Retrospective studies suggest better ICP control with HS. While a prospective study in adults with head injury compared alternating doses of mannitol and HS found no difference in change in ICP control or outcome, two meta-analyses, which did not include this study, favored HS for ICP control (although the absolute difference of 2 mm Hg is of little clinical values) with no difference in outcome. HS has also been administered by infusions to creating a sustained stable hyperosmolar state. Two studies, using historical controls, suggested benefit of HS infusions. In a prospective, randomized study, in children with severe head injury Lactated Ringer’s solution was compared hypertonic saline. Although ICP control was similar, the HS group required fewer other interventions. the existing data do not support favoring boluses of HS over mannitol in terms of ICP control let alone outcome. The rationale for continuous infusions to create a sustained hyperosmolar state is open to discussion and use of this approach should be curtailed pending further research.
