From the Departments of Neurology and Neurosurgery (A.A.), University of
Heidelberg, Germany.
Correspondence to Dr Stefan Schwarz, Department of Neurology, University of Heidelberg, 400 Im Neuenheimer Feld, Heidelberg 69120, Germany. E-mail Stefan_Schwarz{at}ukl.uni-heidelberg.de
Background and Purpose—The purpose
of this study was to prospectively evaluate a protocol with hypertonic
saline hydroxyethyl starch (HS-HES) and mannitol in stroke patients
with increased intracranial pressure (ICP).
Methods—We studied 30 episodes of ICP crisis in 9 patients. ICP
crisis was defined as (1) a rise of ICP of more than 25 mm Hg
(n=22), or (2) pupillary abnormality (n=3), or (3) a combination of
both (n=5). Baseline treatment was performed according to a
standardized protocol. For initial treatment, the patients were
randomly assigned to either infusion of 100 mL HS-HES or 40 g
mannitol over 15 minutes. For repeated treatments the 2 substances were
alternated. ICP, blood pressure, and cerebral perfusion pressure (CPP)
were monitored over 4 hours. Blood gases, hematocrit, blood osmolarity,
and sodium were measured before and 15 and 60 minutes after the start
of infusion. Treatment was regarded as effective if ICP decreased
>10% below baseline value or if the pupillary reaction had
normalized.
Results—Treatment was effective in all 16 HS-HES–treated and in
10 of 14 mannitol-treated episodes. ICP decreased from baseline values
in both groups, P<0.01. The maximum ICP decrease was
11.4 mm Hg (after 25 minutes) in the HS-HES–treated group and
6.4 mm Hg (after 45 minutes) in the mannitol-treated group. There
was no constant effect on CPP in the HS-HES–treated group, whereas CPP
rose significantly in the mannitol-treated group. Blood osmolarity rose
by 6.2 mmol/L in the mannitol-treated group and by 10.5
mmol/L in the HS-HES–treated group; sodium fell by 3.2 mmol/L in
the mannitol and rose by 4.1 mmol/L in the HS-HES–treated
group.
Conclusions—Infusion of 40 g mannitol and 100 mL HS-HES
decreases increased ICP after stroke. The maximum effect occurs after
the end of infusion and is visible over 4 hours. HS-HES seems to lower
ICP more effectively but does not increase CPP as much as does
mannitol.
© 1998 American Heart Association, Inc.
Original Contributions
Effects of Hypertonic Saline Hydroxyethyl Starch Solution and Mannitol in Patients With Increased Intracranial Pressure After Stroke
Key Words: brain edema • hypertonic hydroxyethyl starch • mannitol • intracranial pressure • stroke
This article has been cited by other articles:
 |
|
 |
|
  J. Bardutzky and S. Schwab Antiedema Therapy in Ischemic Stroke Stroke, November 1, 2007; 38(11): 3084 - 3094. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Juttler, S. Schwab, P. Schmiedek, A. Unterberg, M. Hennerici, J. Woitzik, S. Witte, E. Jenetzky, W. Hacke, and for the DESTINY Study Group Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): A Randomized, Controlled Trial Stroke, September 1, 2007; 38(9): 2518 - 2525. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Kimura, H. Nakase, R. Tamaki, and T. Sakaki Vascular Endothelial Growth Factor Antagonist Reduces Brain Edema Formation and Venous Infarction Stroke, June 1, 2005; 36(6): 1259 - 1263. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. L. Johnson and L. M. Criddle Pass the Salt: Indications for and Implications of Using Hypertonic Saline Crit. Care Nurse, October 1, 2004; 24(5): 36 - 48. [Full Text] [PDF]
|
|
|
|
|
|
D. Bereczki, L. Mihalka, S. Szatmari, K. Fekete, D. Di Cesar, B. Fulesdi, L. Csiba, and I. Fekete Mannitol Use in Acute Stroke: Case Fatality at 30 Days and 1 Year Stroke, July 1, 2003; 34(7): 1730 - 1735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. C. Ziai, M. A. Mirski, A. Bhardwaj, S. Schwarz, D. Georgiadis, S. Schwab, and A. Aschoff Use of Hypertonic Saline in Ischemic Stroke Stroke, April 1, 2002; 33(4): 1166 - 1167. [Full Text] [PDF]
|
|
|
|
|
|
S. Schwarz, D. Georgiadis, A. Aschoff, and S. Schwab Effects of Hypertonic (10%) Saline in Patients With Raised Intracranial Pressure After Stroke Stroke, January 1, 2002; 33(1): 136 - 140. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Steiner, P. Ringleb, and W. Hacke Treatment options for large hemispheric stroke Neurology, September 1, 2001; 57(90002): S61 - 68. [Abstract] [Full Text]
|
|
|
|
 |
|
 T. Brott and J. Bogousslavsky Treatment of Acute Ischemic Stroke N. Engl. J. Med., September 7, 2000; 343(10): 710 - 722. [Full Text] [PDF]
|
|
|
|
|
|
S. S. Kaplan, T. S. Park, E. R. Gonzales, J. M. Gidday, and J. A. Zivin Hydroxyethyl Starch Reduces Leukocyte Adherence and Vascular Injury in the Newborn Pig Cerebral Circulation After Asphyxia Editorial Comment Stroke, September 1, 2000; 31(9): 2218 - 2223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Paczynski, R. Venkatesan, M. N. Diringer, Y. Y. He, C. Y. Hsu, W. Lin, and P. H. Chan Effects of Fluid Management on Edema Volume and Midline Shift in a Rat Model of Ischemic Stroke Editorial Comment Stroke, July 1, 2000; 31(7): 1702 - 1708. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Davenport and M. Dennis Neurological emergencies: acute stroke J. Neurol. Neurosurg. Psychiatry, March 1, 2000; 68(3): 277 - 288. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J Sutcliffe Crystalloids and colloids for volume replacement Trauma, April 1, 1999; 1(2): 115 - 123. [Abstract] [PDF]
|
|
|
|
|
|
E. M. Manno, R. E. Adams, C. P. Derdeyn, W. J. Powers, and M. N. Diringer The effects of mannitol on cerebral edema after large hemispheric cerebral infarct Neurology, February 1, 1999; 52(3): 583 - 583. [Abstract] [Full Text]
|
|