Improving Clinical Outcomes from Acute Subdural Hematomas with the Emergency Preoperative Administration of High Doses of Mannitol: A Randomized Trial

Comparison of Hypertonic Saline and Mannitol on Whole Blood Coagulation In Vitro Assessed by Thromboelastometry

“…The osmotic response to mannitol treatment seems to be variable. Moreover, there is a high risk of a rebound increase in ICP after repeated doses of mannitol if the blood brain barrier (BBB) is damaged [25,26]. HS boluses or infusions, on the other hand, can result in hypernatremia which often is associated with hyperchloremic metabolic acidosis.…”

Effects of Mannitol Bolus Administration on Intracranial Pressure, Cerebral Extracellular Metabolites, and Tissue Oxygenation in Severely Head-Injured Patients

“…Caution is therefore advised not to extrapolate from these findings to continuous infusions or, as recently proposed, even higher doses of mannitol (1.4 -2.1 g/kg mannitol 20%). 30,31 The investigated small molecular compounds that are clearly compartmentalized (extracellular, intracellular), are at least partially restricted by the blood-brain barrier and use bidirectional energy-dependent transport systems. At the same time they are substrates of the neuronal, glial, and endothelial energy metabolism and as such subject to changes in the steady state.…”

Hypertonic saline: First-line therapy for cerebral edema?

“…The rheologic effects are most effective with rapid bolus administration rather than continuous infusion [20,21]. Other properties of mannitol include reduction in systemic vascular resistance (and hence afterload), combined with transiently increased preload and a mild positive ionotropic effect resulting in improved cardiac output and oxygen delivery [22,23], and scavenging of toxic oxygen free radicals with potential cytoprotection [24].…”