Just published: the European Society of Intensive Care Medicine´s consensus document on fluid administration in the NICU. It covers all manner of neurocritical conditions and sums up the available evidence for various fluid therapy approaches. As expected there are few recommendations that aren´t already well established and by now fairly uncontroversial (multimodal monitoring, avoiding colloids,… Continue reading Fluid Therapy in Neurointensive Care patients – An ESICM Recommendation
Right off the press: an open access review article from Critical Care on fluid therapy in the neurological patient. It provides a nice synopsis of the different fluid therapy paradigms that are advocated through various guidelines. The review challenges some of the tenets of basic treatment, such as empirical fluid maintenance and the definition of… Continue reading Critical Care: Fluid Therapy in Neurological Patients
Cochrane review from 2014: Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy. By Prabhakar et al. “From the limited data available on the use of mannitol and hypertonic saline for brain relaxation during craniotomy, it is suggested that hypertonic saline significantly reduces the risk of tense brain during craniotomy”
In this commentary in Critical Care 2012 Dr. Nicholas Marko argues in favour of choosing HS over mannitol in management of intracranial hypertension.
Well written overview of ICP-management and the role of hyperosmolar therapy. By Ropper, 2014. The chapter comparing hypertonic saline and mannitol is particularly interesting.
“…treatment with mannitol may increase the likelihood of death when compared to treatment with hypertonic saline.” Read the Cochrane review from 2013: Mannitol for acute traumatic brain injury.
“.. infusion of 2 ml kg(-1) during 20 min has a predictable and clinically significant beneficial effect on ICP and CPP.” Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: a prospective clinical trial in critically ill patients with subarachnoid hemorrhage. Bentsen et al, Norway. Acta Anaesthesiologica Scandinavica, 2004 Oct. Read the abstract here. Hypertonic… Continue reading SAH-patients: HyperHaes and reduction in ICP (2004)