Osmotherapy in Neurocritical Care

Overview

Journal Curr Neurol Neurosci Rep

Specialty Neurology

Date 2007 Nov 15

PMID 17999898

Citations 14

Authors

Anish Bhardwaj

Affiliations

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Abstract

Osmotherapy is the mainstay in the medical management of cerebral edema with or without elevations in intracranial pressure. Several osmotic agents have been utilized in clinical practice over the past five decades in a variety of brain injury paradigms. The over-riding premise for their beneficial effects has been via egress of water from the brain into the vascular compartment. In addition, many of these agents have beneficial extraosmotic properties that portend their use in cerebral resuscitation and treatment of cerebral edema. Although there is a paucity of large, randomized clinical trials that compare various osmotic agents, data are emerging from prospective clinical case series. This article provides a historical perspective of osmotherapy, examines characteristics of osmotic agents, and discusses caveats in their use in the clinical setting. Furthermore, this review highlights the utility of osmotic agents as tools to understand emerging mechanistic concepts in the evolution of brain edema, which are yielding important data of translational significance from laboratory-based research.

Citing Articles

Potentially Detrimental Effects of Hyperosmolality in Patients Treated for Traumatic Brain Injury.

Dabrowski W, Siwicka-Gieroba D, Robba C, Bielacz M, Solek-Pastuszka J, Kotfis K J Clin Med. 2021; 10(18).

PMID: 34575255 PMC: 8467376. DOI: 10.3390/jcm10184141.

Synovial Fluid of Patient With Rheumatoid Arthritis Enhanced Osmotic Sensitivity Through the Cytotoxic Edema Module in Synoviocytes.

Ji M, Ryu H, Hong J Front Cell Dev Biol. 2021; 9:700879.

PMID: 34532317 PMC: 8438158. DOI: 10.3389/fcell.2021.700879.

Hyperosmolar Treatment for Patients at Risk for Increased Intracranial Pressure: A Single-Center Cohort Study.

Wiorek A, Jaworski T, Krzych L Int J Environ Res Public Health. 2020; 17(12).

PMID: 32630399 PMC: 7345768. DOI: 10.3390/ijerph17124573.

What is the Role of Hyperosmolar Therapy in Hemispheric Stroke Patients?.

Mohney N, Alkhatib O, Koch S, OPhelan K, Merenda A Neurocrit Care. 2019; 32(2):609-619.

PMID: 31342452 DOI: 10.1007/s12028-019-00782-9.

Effects of Conivaptan versus Mannitol on Post-Ischemic Brain Injury and Edema.

Can B, Oz S, Sahinturk V, Musmul A, Alatas I Eurasian J Med. 2019; 51(1):42-48.

PMID: 30911255 PMC: 6422625. DOI: 10.5152/eurasianjmed.2019.18368.

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