Note to myself: I reviewed the article today. I didn’t find it that helpful.
I found Dr. Nangayach’s EMCrit post of October 11, 2020, NeuroEMCrit – Everything you wanted to know about Hyperosmolar agents for the Management of ICP and Cerebral Edema, more helpful than the Guidelines linked to below.
In this post I link to and excerpt from Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Neurocrit Care. 2020 Jun;32(3):647-666.
The above article has been cited by 5 articles.
What follows is excerpted from the abstract.
Background: Acute treatment of cerebral edema and elevated intracranial pressure is a common issue in patients with neurological injury. Practical recommendations regarding selection and monitoring of therapies for initial management of cerebral edema for optimal efficacy and safety are generally lacking. This guideline evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema. Clinicians must be able to select appropriate therapies for initial cerebral edema management based on available evidence while balancing efficacy and safety.
Results: The panel generated recommendations regarding initial management of cerebral edema in neurocritical
care patients with subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage,
bacterial meningitis, and hepatic encephalopathy.
Conclusion: The available evidence suggests hyperosmolar therapy may be helpful in reducing ICP elevations or cerebral edema in patients with SAH, TBI, AIS, ICH, and HE, although neurological outcomes do not appear to be affected. Corticosteroids appear to be helpful in reducing cerebral edema in patients with bacterial meningitis, but not ICH.
Differences in therapeutic response and safety may exist between HTS and mannitol. The use of these agents in these
critical clinical situations merits close monitoring for adverse effects. There is a dire need for high-quality research to
better inform clinicians of the best options for individualized care of patients with cerebral edema.
Keywords: Intracranial pressure, Neurocritical care, Osmotherapy, Hyperventilation, Hypertonic, Mannitol