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Updated: May 27, 2026
07:15
Intranasal Administration of CNS Therapeutics to Awake Mice
Published on: April 8, 2013
Hyperosmolar therapy for intracranial hypertension.
Andrew Torre-Healy1, Nicholas F Marko, Robert J Weil
1Department of Neurosurgery, Cleveland Clinic, Cleveland, OH 44195, USA.
Neurocritical Care
|November 18, 2011
Summary
Hyperosmolar agents like mannitol and hypertonic saline effectively reduce intracranial pressure in cerebral edema. However, limited high-quality evidence necessitates careful consideration of their use in managing intracranial hypertension.
Area of Science:
- Neurology
- Critical Care Medicine
- Pharmacology
Background:
- Hyperosmolar agents have been used for over a century to manage intracranial hypertension.
- Mannitol and hypertonic saline are mainstays for treating cerebral edema.
- Their efficacy is supported by mechanisms like volume redistribution and anti-inflammatory effects.
Purpose of the Study:
- To review current evidence on hyperosmolar therapy for intracranial hypertension.
- To discuss practical concerns regarding the initiation, dosage, and monitoring of mannitol and hypertonic saline.
- To highlight the need for higher-quality clinical trials.
Main Methods:
- Review of existing literature on hyperosmolar agents for intracranial hypertension.
- Analysis of evidence from retrospective studies and case series.
- Discussion of theoretical and practical aspects of therapy administration.
Main Results:
- Hyperosmolar therapy, including mannitol and hypertonic saline, shows efficacy in reducing intracranial pressure.
- Current evidence is largely based on lower-level studies (Class III and IV) due to practice variations and lack of RCTs.
- Mechanisms of action include plasma expansion, rheologic modification, and anti-inflammatory effects.
Conclusions:
- Hyperosmolar agents remain crucial for managing intracranial hypertension and cerebral edema.
- Standardized protocols and robust clinical trials are needed to strengthen the evidence base.
- Further research should focus on optimizing the initiation, dosage, and monitoring of these therapies.
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