Sunday, October 11, 2020

Hyperosmolar agents for ICP and Cerebral Edema

 NeuroEMCrit - October 11, 2020 - By Neha Dangayach
...“So, let’s get started. You’ve probably taken care of a patient with suspected raised intracranial pressure (ICP) and cerebral edema recently. Cerebral edema-simply speaking is an abnormal increase in the fluid content of brain parenchyma. Cerebral edema could be cytotoxic, vasogenic or interstitial or a combination of these different types of edema. You might have suspected raised ICP and cerebral edema either because of their clinical presentation, radiographic imaging or by invasive measurement of their ICP via an External ventricular drain (EVD) or fiber optic parenchymal probe or via a non-invasive surrogate measure of ICP such as Optic nerve sheath diameter (ONSD). In various stepwise protocols described in literature for treating raised ICP, hyperosmolar therapies have been included as first line treatments to prevent herniation and death.
In this blog post, let’s review hyperosmolar therapies for management of raised ICP and cerebral edema, key mechanisms of action for mannitol and hypertonic saline (HTS) and what do some recent guidelines say about using hyperosmolar therapies...“