Effect of Mannitol on Cerebral Blood Volume in Patients With Head Injury

Diringer, Michael N.; Scalfani, Michael T.; Zazulia, Allyson R.; Videen, Tom O.; Dhar, Rajat

doi:10.1227/neu.0b013e3182417bc2

Cited by 35 publications

(17 citation statements)

References 20 publications

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“…Out of the 11 patients who were operated in our patient group, whose GSC scores were below 8, only four of the seven patients lying longer than seven days had an outflow scoreHyperosmolar treatments remain as a therapeutic option in intracranial hypertension. The intracranial pressure-reducing effect of mannitol is thought to reduce direct brain edema [11] .…”

Section: Discussionmentioning

confidence: 99%

Analysis Of The Adult Traumatic Brain Injury Patients, Experiences of Neurosurgery and Intensive Care Unit

Özgültekin¹

2020

Haydarpasa Numune Med J

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Introduction: Traumatic brain injuries and intracranial bleeding are the most severe forms of traumatic injuries with a high probability of devastating prognosis. Secondary injuries of the brain, following the primary injury, are preventable, and transportation to and in the hospital; the interventions in the emergency department, operational procedures and intensive care (ICU) stay are all crucial for the prevention of the secondary insult to the injured brain. In this retrospective cohort study, we analyzed the traumatic brain injuries that were followed by the neurosurgical and intensive care departments together in ICU for the last two years. Methods: With the written permission of the hospital administration, the data in the Hospital Information System were examined. Fifty-six patients admitted to the ICU with the diagnosis of traumatic intracranial bleeding over the age of 18 were analyzed. GCS scores on admission and discharge from ICU were regarded as ≥8 (Good outcome) and <8 (Bad outcome), and patients' clinical measures were examined according to these groups. Results: Pupillary reflexes showed a statistically significant difference between the ≥8 and <8 patients on admission. Blood glucose levels were clinically higher in the GCS<8 group. On the analysis of the 17 patients whose GCS scores <8 (Bad outcome) on discharge, it was seen that 8 of them had GCS scores below 8 on admission. These patients had severe head trauma, multiple intracranial pathologies and underwent decompressive surgery besides the polytrauma of the whole body. Discussion and Conclusion: We found that patients who had polytrauma with high intracranial pressure that could not be controlled with the first-line therapies and undergoing decompressive surgery, and also the patients who had high glucose levels on admission (>200mg/dl) showed worse prognosis. Hospitals should have an algorithmic approach and periodic analysis of the performances to prevent those delicate patients from having secondary insults to the brain during the emergency interventions and after.

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Section: Discussionmentioning

confidence: 99%

Analysis Of The Adult Traumatic Brain Injury Patients, Experiences of Neurosurgery and Intensive Care Unit

Özgültekin¹

2020

Haydarpasa Numune Med J

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“…Hyperglycemia also stimulates release of proinflammatory mediators, such as, IL-1β, IL-6, TNF-α, and TGF-β, and production of reactive oxygen species (ROS) by immune cells, worsening neurological outcomes (Kumar & Loane, 2012; Shi et al, 2016). In addition, hyperglycemia damages the blood–brain barrier and increases blood viscosity, which reduces flow velocity and increase tendency for thrombosis (Chesnut, 2007; Diringer et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Temporal Patterns and Influential Factors of Blood Glucose Levels During the First 10-Day Critical Period After Brain Injury

Lee

Shin

et al. 2017

Clin Nurs Res

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This study was conducted to document temporal patterns of blood glucose level changes during the first 10-day critical period and to identify factors that influence stress-induced hyperglycemia development in brain injury patients. The medical records of 190 brain injury patients were retrospectively reviewed. Blood glucose levels in the poor recovery group were significantly higher than in the good recovery group, particularly during the first 72 hr (158-172 mg/dl). The poor recovery group showed persistent, fluctuating hyperglycemia, whereas the good recovery group exhibited hyperglycemic peaks during the first 3 days that subsequently reduced linearly to normal. Gender, preexisting hypertension, disease severity at admission, total calorie intake, and steroid use were found to influence stress-induced hyperglycemia development significantly. In conclusion, close monitoring and adjustment are required to maintain safe blood glucose levels and the development of protocols for safe glycemic management is essential to improve critical care in brain injury patients.

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“…Bolus intravenous administration of mannitol to reduce ICH does not acutely lower CBV. 213 These studies provide evidence for an alternative mechanism-acute reduction of brain water-to explain the effect of mannitol. Another study examined the effect of tight (80-110 mg/dL) versus loose (120-150 mg/dL) glycemic control, using both FDG PET and microdialysis.…”

mentioning

confidence: 86%

A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury

Amyot

Arciniegas

et al. 2015

Journal of Neurotrauma

173

147

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The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.

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Effect of Mannitol on Cerebral Blood Volume in Patients With Head Injury

Cited by 35 publications

References 20 publications

Analysis Of The Adult Traumatic Brain Injury Patients, Experiences of Neurosurgery and Intensive Care Unit

Analysis Of The Adult Traumatic Brain Injury Patients, Experiences of Neurosurgery and Intensive Care Unit

Temporal Patterns and Influential Factors of Blood Glucose Levels During the First 10-Day Critical Period After Brain Injury

A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury

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