Hypertonic saline for peri-operative fluid management

McAlister, Vivian C.; Burns, Karen E. A.; Znajda, Tammy; Church, Brian T.

doi:10.1002/14651858.cd005576.pub2

Cited by 26 publications

(18 citation statements)

References 28 publications

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“…In contrast, mannitol caused a transient acute dilutional hyponatremia [20,22,26], with a concomitant stepwise increase of potassium over time [22]. However, sodium levels tend to normalize over time, as a result of the diuretic effects of mannitol [28,34,35,41].…”

Section: Discussionmentioning

confidence: 99%

“…Considering that hypovolaemia could be detrimental after brain injury, this has led to a resurgence of interest in the use of HTS in NCC setting, as it seems that the advantage of HTS in this setting is the maintenance of blood pressure with low volume resuscitation and thus avoiding potentially iatrogenic ICP increase [8]. This aspect is further supported by a recent SR of HTS compared to isotonic solution for perioperative fluid management, which indicates that HTS can reduce the intravenous fluid replacement needs in patients undergoing surgery [41].…”

Section: Tablementioning

confidence: 99%

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Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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AIMOsmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic haemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients. METHODA database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting. The primary end-points were alterations of cardiac output (CO) and other haemodynamic variables, while the impact of osmotic agents on intracranial pressure, brain relaxation, plasma osmolality, electrolyte levels and urinary output constituted secondary outcomes. RESULTSEight studies, enrolling 182 patients in total, were included. HTS exerted a more profound cardiac output augmentation than mannitol, but no distinct difference between groups occurred. Central venous pressure, stroke volume and stroke volume variation were favourably affected by both osmotic agents, whilst the reported changes in blood pressure were inconclusive. HTS infusion yielded a larger intracranial pressure reduction than mannitol but had an equivalent effect on brain relaxation. Mannitol presented a more potent diuretic effect than HTS. Effect on serum osmolality was alike in both osmotic agents, but contrary to HTS-promoted hypernatraemia, mannitol use induced transient hyponatraemia. CONCLUSIONSMannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion. This effect combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Osmotherapy with either mannitol or hypertonic saline (HTS) is the recommended first-line medical intervention for optimizing cerebral perfusion through brain relaxation.• Mannitol has long been used as osmotic agent for ensuring brain relaxation in neurosurgical patients undergoing craniotomy, but the clinical benefit of mannitol infusion in acute brain injury setting, has not yet been proven according to evidence-based medicine.• Recent guidelines suggest the use of HTS as a second-line therapy in case mannitol fails to reduce intracranial pressure, in patients sustaining traumatic brain injury. WHAT THIS STUDY ADDS• Both mannitol and HTS induce an increase in cardiac output, which is more pronounced after HTS than mannitol administration.• Mannitol and HTS infusion are associated with a trend towards to mean arterial pressure and heart rate reduction.• Both osmotic agents induced an intracranial pressure reduction and brain relaxation, an effect that seems to be more prominent in HTS-treated patients.

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Section: Discussionmentioning

confidence: 99%

Section: Tablementioning

confidence: 99%

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Клинические проявления клеточной дегидратации как следствие плазменной гипернатриемии прежде всего должны проявляться со стороны центральной нервной системы, одна ко ни одного случая судорог или усугубления неврологичес кой симптоматики у пациентов, получавших ГР, зарегистриро вано не было [5].…”

Section: о б з о р ыunclassified

“…Большое количество исследо ваний выполнено у взрослых кардиохирургических пациентов, которые имели повышенный риск интраоперационных карди альных осложнений. Главным условием к использованию ГР в периоперационном периоде являются предотвращение гипо волемии и обеспечение адекватной оксигенации тканей с одно временным исключением перегрузки жидкостью [5].…”

Section: о б з о р ыunclassified

“…Предоперационная гемодилюция с использованием ГР у пациентов с аорто коронарным шунтированием (АКШ) с нор мальной фракцией выброса левого желудочка (ЛЖ) проде монстрировала уменьшение в необходимости периоперацион ного использования внутривенной инфузии жидкости [5].…”

Section: о б з о р ыunclassified

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