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Osmotherapy in brain edema: a questionable therapy.
Per-Olof Grände1, Bertil Romner
1Departments of Anesthesia and Intensive Care, Lund University Hospital, Lund, Sweden. per-olof.grande@med.lu.se
Journal of Neurosurgical Anesthesiology
|September 8, 2012
Summary
Osmotherapy, used for brain edema, offers a transient reduction in intracranial pressure (ICP). However, potential adverse effects and lack of proven outcome benefits question its routine use.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Pharmacology
Background:
- Osmotherapy has been utilized for brain edema since the 1960s, with over 150 publications on head injury.
- Limited data exists regarding the actual impact of osmotherapy on patient outcomes.
- The mechanisms and effects of osmotherapy, particularly mannitol and hypertonic saline, require critical evaluation.
Purpose of the Study:
- To describe the actions of osmotherapy, focusing on potential benefits and adverse effects.
- To critically assess the use of osmotherapy in managing brain edema.
- To evaluate the evidence for osmotherapy's impact on patient outcomes.
Main Methods:
- Review of existing literature on osmotherapy in brain edema and head injury.
- Analysis of documented effects, including intracranial pressure (ICP) reduction and rebound phenomena.
- Examination of reported side effects and outcomes from clinical studies and meta-analyses.
Main Results:
- Osmotherapy demonstrates a transient ICP-reducing effect.
- A rebound increase in ICP after cessation of osmotherapy is a recognized pathophysiological event.
- Adverse effects include renal and pulmonary issues, electrolyte disturbances, and potential negative impact on outcomes.
Conclusions:
- The routine use of osmotherapy for brain edema is questionable due to a lack of proven benefits and potential harms.
- Recent meta-analyses have not identified significant positive effects on outcomes.
- Osmotherapy may be justifiable as a temporary measure to prevent brainstem compression before definitive surgical interventions.
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