Effect of mannitol on brain metabolism and tissue oxygenation in severe haemorrhagic stroke

Helbok, Raimund; Kurtz, Pedro; Schmidt, J. Michael; Stuart, R. Morgan; Fernandez, Luis; Malhotra, Rishi; Presciutti, Mary; Ostapkovich, Noeleen; Connolly, E. Sander; Lee, Ki-Won; Badjatia, Neeraj; Mayer, Stephan A.; Claassen, Jan

doi:10.1136/jnnp.2009.198754

Cited by 29 publications

(23 citation statements)

References 24 publications

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“…The important clinical conclusion from this finding -however is that pbtO2 monitoring technology should be used in addition to ICP monitoring as the two monitoring parameters are not ultimately linked. Further evidence to support this finding is provided in a series of 12 patients after severe haemorrhagic stroke [78]. The authors report that: "…CPP increased 45 min [from 73 +/-18 to 85 +/-22 mm Hg, p=0.002] after the start of mannitol infusions, whereas mean arterial blood pressure and pbtO2did not change significantly [78]".…”

Section: Nimodipine Mannitol and Hypertonic Saline Solutionmentioning

confidence: 96%

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Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Lang

Jaeger²

2013

TOCCMJ

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This review has been compiled to assess publications related to the clinical application of direct cerebral tissue oxygenation (pbtO2) monitoring published in international, peer-reviewed scientific journals, or major meeting reports published as journal supplements. Its goal was to extract relevant, i.e. positive and negative, information on indications, clinical application, safety issues and impact on clinical situations, as well as treatment strategies in neurosurgery, neurosurgical anaesthesiology, neurosurgical intensive care, neurology, and related specialties. For completeness' sake it also presents related basic science research and case reports. This review is an update of its previous edition published elsewhere in 2007. This review reflects publications from 2004 to 2012. Only relevant publications prior to 2004, which explicitly addressed or systematically examined the above issues, are included in this review and are listed in the reference section. Based on 349 citations it is the most comprehensive review available on direct cerebral oxygen monitoring to this date.Keywords: Review, cerebral oxygenation, raumedic, licox, neurotrend, cerebral partial pressure of oxygen, brain tissue oxygenation. METHODSThis review is based on a systematic "Medline" literature search using the following search terms: licox, neurotrend, neurovent, raumedic, brain tissue oxygen, brain tissue oxygenation, cerebral oxygenation, cerebral tissue oxygen, cerebral partial pressure of oxygen, btO2, ptiO2, pti(O)2, ptiO(2), pbrO2, PBr(O2), P(bt)O(2), P(br)O(2), PbrO(2), BTpO2, tP(O2), PbO2, PbtO2, Pbto, PbtO(2).Only few publications were not retrieved using this technique. They were, however, identified through personal communication with scientists in the field, meeting proceedings and reviewer assignments. This strategy provided sufficient certainty that relevant papers have not been missed. Unpublished meeting abstracts and published conference proceedings were excluded for this review expect for few which provided comparative studies between different probes. To address relevant matters, related to specific pbtO2 issues, selected non-peer reviewed papers published in supplements were also used only when no other peer-reviewed information was available. RESULTSThis review is based on a previous review [1]. It is currently based on 349 papers, 274 more papers compared to its previous version in 2007, which warrants the update.

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Section: Nimodipine Mannitol and Hypertonic Saline Solutionmentioning

confidence: 96%

“…It has also been used in patients with spontaneous intraparenchymal hemorrhage [69][70][71][72][73][74][75][76], ischemic stroke in children and adults [36,71,77], severe haemorrhagic stroke [78], and in silent infarcts after subarachnoid hemorrhage [79].…”

Section: Pbto2mentioning

confidence: 99%

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Lang

Jaeger²

2013

TOCCMJ

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“…The standard protocol included elevating the head of the bed by 15e30 , administering sedation (lorazepam) or analgesia (fentanyl) if patients were agitated, and intermittent drainage of cerebrospinal fluid if an external ventricular drain was in place. 1,14,15 ABP was continuously measured using a radial artery fluidcoupled system. ICP was monitored using flexible intraparenchymal probes (Codman Microsensors ICP Transducer; Codman and Shurtleff, Raynham, MA, USA; and Licox CCI.SB; Integra NeuroSciences, Plainsboro, NJ, USA, respectively) inserted via a double-lumen skull bolt kit (Licox IM2; Integra Neuro-Sciences).…”

Section: Management Of Increased Icpmentioning

confidence: 99%

“…6,10e13 Recently, one study used an intraparenchyma microdialysis method and demonstrated a significant decrease of lactateepyruvate ratio, which indicated an improvement of intracranial metabolism following mannitol treatment in patients with severe hemorrhagic stroke. 14 However, lowering ICP via the use of mannitol in patients with increased ICP did not refer to an overall beneficial effect on functional outcome in various neurological diseases. 6,15,16 Cerebrovascular pressure reactivity (CVPR) is the ability of cerebral vessels to respond to changes in transmural pressure, which indicates that cerebral arterioles would constrict in response to an increase in cerebral perfusion, and vice versa.…”

Section: Introductionmentioning

confidence: 98%

Effect of mannitol on cerebrovascular pressure reactivity in patients with intracranial hypertension

Tang

Lin

Shieh

et al. 2015

Journal of the Formosan Medical Association

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“…In a series of patients with cerebral hemorrhage and ICP >20 mmHg, infusion of mannitol (1 g/kg) resulted in a significant decrease in ICP and cerebral LP ratio, increased cerebral perfusion pressure, and unchanged PbtO 2 and concentration of cerebral glucose. 43 In a study of patients treated with hypertonic sodium lactate therapy (1000 mmol/L), the authors reported a significant decrease in ICP while LP ratio remained unaffected and PbtO 2 decreased. 42 The decrease in ICP is, however, fully explained by the fact that a hyperosmolar sodium solution was infused.…”

Section: Hyperosmotic Agents and Cerebral Energy Metabolism In Tbi Pamentioning

confidence: 99%

Microdialysate concentration changes do not provide sufficient information to evaluate metabolic effects of lactate supplementation in brain-injured patients

Dienel

Rothman

Nordstrom

2016

J Cereb Blood Flow Metab

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Cerebral microdialysis is a widely used clinical tool for monitoring extracellular concentrations of selected metabolites after brain injury and to guide neurocritical care. Extracellular glucose levels and lactate/pyruvate ratios have high diagnostic value because they can detect hypoglycemia and deficits in oxidative metabolism, respectively. In addition, patterns of metabolite concentrations can distinguish between ischemia and mitochondrial dysfunction, and are helpful to choose and evaluate therapy. Increased intracranial pressure can be life-threatening after brain injury, and hypertonic solutions are commonly used for pressure reduction. Recent reports have advocated use of hypertonic sodium lactate, based on claims that it is glucose sparing and provides an oxidative fuel for injured brain. However, changes in extracellular concentrations in microdialysate are not evidence that a rise in extracellular glucose level is beneficial or that lactate is metabolized and improves neuroenergetics. The increase in glucose concentration may reflect inhibition of glycolysis, glycogenolysis, and pentose phosphate shunt pathway fluxes by lactate flooding in patients with mitochondrial dysfunction. In such cases, lactate will not be metabolizable and lactate flooding may be harmful. More rigorous approaches are required to evaluate metabolic and physiological effects of administration of hypertonic sodium lactate to brain-injured patients.

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Effect of mannitol on brain metabolism and tissue oxygenation in severe haemorrhagic stroke

Abstract: Mannitol effectively reduces ICP and appeared to benefit brain metabolism as measured by the lactate-pyruvate ratio.

Cited by 29 publications

References 24 publications

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Effect of mannitol on cerebrovascular pressure reactivity in patients with intracranial hypertension

Microdialysate concentration changes do not provide sufficient information to evaluate metabolic effects of lactate supplementation in brain-injured patients

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