Management of raised intracranial pressure and hyperosmolar therapy

Pract Neurol. 2014 Jun;14(3):152-8. doi: 10.1136/practneurol-2014-000811. Epub 2014 Jan 30.

Abstract

The management of raised intracranial pressure is undergoing rapid change. The choice of medical treatments to reduce intracranial pressure varies between institutions and regions of the world. The mainstay of therapy, however, continues to be the infusion of a hyperosmolar solution to achieve an osmotic gradient to force the exit of water from the brain. This review introduces the basic concepts of raised intracranial pressure, summarises several recent studies that have challenged dogma in the field, and provides practical advice on hyperosmolar treatment, based on personal experience and a critical reading of the literature.

Keywords: Hyperosmolar Therapy; Hypertonic Saline; Intracranial Pressure; Mannitol; Traumatic Brain Injury.

Publication types

  • Review

MeSH terms

  • Diuretics, Osmotic / therapeutic use
  • Humans
  • Intracranial Hypertension / drug therapy*
  • Mannitol / therapeutic use
  • Osmotic Pressure / physiology
  • Saline Solution, Hypertonic / therapeutic use

Substances

  • Diuretics, Osmotic
  • Saline Solution, Hypertonic
  • Mannitol