Similar effects of hypertonic saline and mannitol on the inflammation of the blood-brain barrier microcirculation after brain injury in a mouse model

Marks, Joshua A.; Li, Shenghui; Gong, Wanfeng; Sanati, Paymon; Eisenstadt, Rachel; Sims, Carrie A.; Smith, Douglas H.; Reilly, Patrick; Pascual, José L.

doi:10.1097/ta.0b013e3182592f76

Cited by 18 publications

(22 citation statements)

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“…19,28 Clinically, HTS and mannitol have each been shown, in several observational and nonrandomized studies, to reduce ICP and improve brain physiology to different extents. In an initial prospective study, Härtl et al showed that 7.5% HTS reduced ICP and increased cerebral perfusion pressure (CPP) in patients with TBI.…”

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confidence: 99%

Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

Mangat

Chiu²,

Gerber

et al. 2015

JNS

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ObJect Increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI) is associated with a higher mortality rate and poor outcome. Mannitol and hypertonic saline (HTS) have both been used to treat high ICP, but it is unclear which one is more effective. Here, the authors compare the effect of mannitol versus HTS on lowering the cumulative and daily ICP burdens after severe TBI. MetHODS The Brain Trauma Foundation TBI-trac New York State database was used for this retrospective study. Patients with severe TBI and intracranial hypertension who received only 1 type of hyperosmotic agent, mannitol or HTS, were included. Patients in the 2 groups were individually matched for Glasgow Coma Scale score (GCS), pupillary reactivity, craniotomy, occurrence of hypotension on Day 1, and the day of ICP monitor insertion. Patients with missing or erroneous data were excluded. Cumulative and daily ICP burdens were used as primary outcome measures. The cumulative ICP burden was defined as the total number of days with an ICP of > 25 mm Hg, expressed as a percentage of the total number of days of ICP monitoring. The daily ICP burden was calculated as the mean daily duration of an ICP of > 25 mm Hg, expressed as the number of hours per day. The numbers of intensive care unit (ICU) days, numbers of days with ICP monitoring, and 2-week mortality rates were also compared between the groups. A 2-sample t-test or chisquare test was used to compare independent samples. The Wilcoxon signed-rank or Cochran-Mantel-Haenszel test was used for comparing matched samples. reSultS A total of 35 patients who received only HTS and 477 who received only mannitol after severe TBI were identified. Eight patients in the HTS group were excluded because of erroneous or missing data, and 2 other patients did not have matches in the mannitol group. The remaining 25 patients were matched 1:1. Twenty-four patients received 3% HTS, and 1 received 23.4% HTS as bolus therapy. All 25 patients in the mannitol group received 20% mannitol. The mean cumulative ICP burden (15.52% [HTS] vs 36.5% [mannitol]; p = 0.003) and the mean (± SD) daily ICP burden (0.3 ± 0.6 hours/day [HTS] vs 1.3 ± 1.3 hours/day [mannitol]; p = 0.001) were significantly lower in the HTS group. The mean (± SD) number of ICU days was significantly lower in the HTS group than in the mannitol group (8.5 ± 2.1 vs 9.8 ± 0.6, respectively; p = 0.004), whereas there was no difference in the numbers of days of ICP monitoring (p = 0.09). There were no significant differences between the cumulative median doses of HTS and mannitol (p = 0.19). The 2-week mortality rate was lower in the HTS group, but the difference was not statistically significant (p = 0.56). cONcluSiONS HTS given as bolus therapy was more effective than mannitol in lowering the cumulative and daily ICP burdens after severe TBI. Patients in the HTS group had significantly lower number of ICU days. The 2-week mortality rates were not statistically different between the 2 groups.http://thejns.org/doi/abs/10.3171/2014....

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confidence: 99%

Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

Mangat

Chiu²,

Gerber

et al. 2015

JNS

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“…Blunt chest trauma such as rib fractures, lung contusion, pneumothorax, and hemothorax have been frequently associated with extrathoracic injuries on the head, the abdomen, and the extremities 1, 8, 14, 15, 18, 19, 20. Of these injuries, it is reported that the four variables, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Of these injuries, it is reported that the four variables, i.e. flail chest, lung contusion, the number of rib fractures, and severe head injury, may cause PMV 8, 14…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for prolonged mechanical ventilation in patients with severe multiple injuries and blunt chest trauma: a single center retrospective case–control study

Okabe¹

2018

Acute Medicine & Surgery

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AimBlunt chest trauma is common and is associated with morbidity and mortality in patients with multiple injuries, frequently requiring invasive mechanical ventilation. The aim of this study was to elucidate risk factors for prolonged mechanical ventilation (PMV).MethodsConsecutive adult patients with multiple severe injuries and blunt chest trauma who treated in Chiba Emergency Medical Center (Chiba, Japan) between January 2008 and December 2015 were enrolled in this retrospective chart‐review study. According to ventilatory time, the patients were divided into PMV (≥7 days) and shortened mechanical ventilation (SMV; <7 days) groups. Thoracic Trauma Severity Score (TTSS) was calculated. To identify risk factors for PMV, univariate and multivariate logistic analyses and receiver operating characteristic analysis were carried out.ResultsEighty‐four and 49 patients were assigned to PMV and SMV groups, respectively. Compared with the SMV group, the PMV group had a significantly larger number of fractured ribs (P < 0.01), higher rate of severe Glasgow Coma Scale (GCS ≤8) (P < 0.05) and flail chest (P < 0.001), higher TTSS (P < 0.001), or longer intensive care unit and hospital stay (both P < 0.001). Logistic analysis showed that severe GCS (odds ratio [OR] = 4.6, P < 0.01), flail chest (OR = 3.0, P < 0.05), and TTSS (OR = 1.2; P < 0.01) were independent significant risk factors. Receiver operating characteristic analyses showed that the area under the curves for TTSS, flail chest, and severe GCS were 0.74, 0.70, and 0.58, respectively. When the three factors were combined, the area under the curve increased to 0.8.ConclusionSevere GCS (≤8), flail chest, or TTSS may be independent risk factors. Combining the three risk factors could provide high predictive performance for PMV.

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“…Several groups have shown in different animal injury models that HTS blunts polymorphonuclear neutrophil and endothelial cell activation and decreases the interactions between these cells, resulting in diminished microvascular injury and permeability [16,17]. However, in brain injury these effects are not as manifest and may not occur owing to the unique immune barrier at the blood-brain interface [18]. The persistent reduction of ICP by HTS has been proposed by some to relate to these immune modulatory effects reducing microvascular permeability [19].…”

Section: Mechanisms Of Action Of Htsmentioning

confidence: 97%

Hypertonic Saline for the Treatment of Intracranial Hypertension

Kheirbek

Pascual

2014

Curr Neurol Neurosci Rep

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Intracranial hypertension is caused by brain edema generated by different disorders, the commonest of which is traumatic brain injury. The treatment of brain edema focuses on drawing water out of brain tissue into the intravascular space. This is typically accomplished with osmolar therapy, most commonly mannitol and hypertonic saline. Recent human trials suggest that hypertonic saline may have a more profound and long-lasting effect in reducing intracranial hypertension following traumatic brain injury when compared with mannitol. However, reports suffer from inconsistencies in dose, frequency, concentration, and route of administration. Side effect profile, potential complications, and contraindications to administration need to be factored in when considering which first-line osmotherapy to choose for a given patient with head injury.

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Similar effects of hypertonic saline and mannitol on the inflammation of the blood-brain barrier microcirculation after brain injury in a mouse model

Abstract: MTL and HTS have indistinguishable effects on PMN-EC interactions in the brain after simulated TBI. Additional studies are needed to determine if either osmotherapy has more subtle effects on BBB PMN-EC interactions after injury exerting a potential clinical advantage.

Cited by 18 publications

References 30 publications

Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

Risk factors for prolonged mechanical ventilation in patients with severe multiple injuries and blunt chest trauma: a single center retrospective case–control study

Hypertonic Saline for the Treatment of Intracranial Hypertension

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