Overlapping Hyperosmolar Therapy in Patients With Elevated and Refractory Intracranial Pressure.

IF 1.2 4区医学 Q4 CLINICAL NEUROLOGY

Clinical Neuropharmacology Pub Date : 2026-09-01 Epub Date: 2026-04-20 DOI:10.1097/WNF.0000000000000687

Madelyn J Johnson, Caitlin S Brown, Alejandro A Rabinstein, Maximiliano A Hawkes, Kristin C Cole, Nicholas J Vollmer

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引用次数: 0

Abstract

Objectives: Elevated intracranial pressure (ICP) remains a challenge and immediate danger in patients with acute brain injury. Current literature supports the use of a single hyperosmolar agent to reduce ICP. However, the efficacy and safety of overlapping hyperosmolar agents have not been evaluated. The objectives of this study are to analyze the ICP lowering effects and evaluate the safety profile of overlapping hyperosmolar therapy.

Materials and methods: This single-center, retrospective study included adults (≥18 y) admitted to the Neurosciences Intensive Care Unit between May 2018 and September 2024 with acute brain injury leading to intracranial hypertension refractory to a single hyperosmolar agent and an ICP monitor. They received overlapping doses of mannitol and hypertonic sodium approximately every 3 hours. We evaluated the impact of overlapping hyperosmolar therapy on ICP. Safety outcomes included acute kidney injury incidence, electrolyte disturbances, and volume status changes.

Results: Forty-six patients were included in this study with a median (IQR) age of 46.5 (35.9, 62.4) years. Median (IQR) dose of mannitol was 40.1 (34.6, 50.0) g, while median (IQR) dose of hypertonic sodium was 120 (90, 125) mEq. About 86% of patients experienced a decrease in ICP after initiation of overlapping hyperosmolar therapy. Six acute kidney injuries occurred, and 7 patients experienced pulmonary edema. Median (IQR) peak sodium, chloride, and osmolar gap values were 149 (144, 155) mEq/L, 115 (111, 119) mEq/L, and 5.7 (0.7, 9.0) mOsm/kg.

Conclusions: Overlapping hyperosmolar therapy may provide a transient ICP reduction without excessive adverse effects in patients with refractory ICP to a single hyperosmolar agent.

查看原文本刊更多论文

颅内压升高和难治性患者的重叠高渗治疗。

目的：颅内压升高（ICP）仍然是急性脑损伤患者面临的挑战和直接危险。目前的文献支持使用单一的高渗透压剂来降低ICP。然而，重叠高渗透性药物的有效性和安全性尚未得到评价。本研究的目的是分析重叠高渗治疗的ICP降低效果并评估其安全性。材料和方法：这项单中心回顾性研究纳入了2018年5月至2024年9月期间入住神经科学重症监护病房的急性脑损伤导致颅内高压的成年人（≥18岁），这些患者对单一高渗剂和ICP监测仪难以治疗。他们大约每3小时接受一次重叠剂量的甘露醇和高渗钠。我们评估了重叠高渗治疗对ICP的影响。安全性指标包括急性肾损伤发生率、电解质紊乱和容量状态改变。结果：本研究纳入46例患者，中位（IQR）年龄为46.5（35.9,62.4）岁。甘露醇的中位（IQR）剂量为40.1 (34.6,50.0)g，高渗钠的中位（IQR）剂量为120 (90,125)mEq。大约86%的患者在开始重叠高渗治疗后经历ICP下降。急性肾损伤6例，肺水肿7例。中位（IQR）峰值钠、氯和渗透压间隙值分别为149(144、155)mEq/L、115(111、119)mEq/L和5.7(0.7、9.0)mOsm/kg。结论：对于难治性ICP患者，单一高渗剂治疗可以提供短暂的ICP降低，而不会产生过多的不良反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neuropharmacology 医学-临床神经学

CiteScore

1.20

自引率

10.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Clinical Neuropharmacology is a peer-reviewed journal devoted to the pharmacology of the nervous system in its broadest sense. Coverage ranges from such basic aspects as mechanisms of action, structure-activity relationships, and drug metabolism and pharmacokinetics, to practical clinical problems such as drug interactions, drug toxicity, and therapy for specific syndromes and symptoms. The journal publishes original articles and brief reports, invited and submitted reviews, and letters to the editor. A regular feature is the Patient Management Series: in-depth case presentations with clinical questions and answers.