mannitolo edema cerebrale metastasi

The strength of the panel’s recommendations was frequently downgraded due to the limited evidence available comparing the different treatments. Radiotherapists, when using external beam radiation to treat intracerebral metastases, commonly place these patients on steroids, glycerol, or mannitol … Mannitol is used in the management of severe head injury, where it is more effective than loop diuretics or hypertonic saline in reducing brain water content, and has been used with success in treating cerebral edema complicating hepatic failure. Sakellaridis N, Pavlou E, Karatzas S, et al. In patients receiving mannitol, does osmolarity or osmolar gap best predict the likelihood for AKI? 2004;1(4):435–40. Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. There is insufficient evidence to determine whether hypertonic sodium solutions or mannitol is more effective to reduce ICP or cerebral edema in patients with community-acquired bacterial meningitis. Neurosurgery. Winkelman C. Effect of backrest position on intracranial and cerebral perfusion pressures in traumatically brain-injured adults. included 10 RCTs published from 1963 to 2007 and determined that corticosteroids were not associated with decreased mortality overall [64]. Stroke. 2015;49(9):978–85. Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials. �? Several medications such as mannitol, steroids, and diuretics, were frequently used to relieve brain edema.However, the effects of these drugs were limited in some patients with refractory edema. The panel identified 11 studies that evaluated hyperosmolar therapy for reducing ICP or cerebral edema in patients with AIS. Thomas R, Le Tulzo Y, Bouget J, et al. Medicine. 0000504608 00000 n 2007;22(5):E1. Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. 1998;65(5):799–800. Although treatment effect of these agents on elevated ICP or cerebral edema may be expected based on the literature, neither agent has been demonstrated to improve neurological outcomes. Mannitol … 0000428482 00000 n Sayre MR, Daily SW, Stern SA, Storer DL, van Loveren HR, Hurst JM. The Neurocritical Care Society partially supported travel and virtual meetings. 2002;165(5):713–7. Stroke. Crit Care Med. J Neurosurg. The incidence of AKI is estimated to be between 6 and 12% of patients treated with mannitol [88, 89]. The panel acknowledges that there are some commonly referenced articles reporting on the use of mannitol in patients with ICH that were not included in this guideline, as they did not address these specific PICO questions [50,51,52]. We recommend that brief episodes of hyperventilation can be used for patients with acute elevations in intracranial pressure (strong recommendation, very low-quality evidence). The influence of adrenocortical steroids on severe cerebrovascular accidents. Int J Stroke. Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. 2009;16(6):662–73. J Stroke Cerebrovasc Dis. However, it appears HTS may have a more rapid onset of action, a more robust and durable ICP reduction, and may be advantageous for patients in whom mannitol failed [36, 40]. Acute treatment of cerebral edema and elevated intracranial pressure is a common issue in patients with neurological injury. Giovanni Migliaccio Medico Ospedaliero Specialista in Neurochirurgia MILANO (MI) In addition, the harm associated with hyperventilation is generally related to the risk for cerebral ischemia with prolonged vasoconstriction. 2003;105(2):87–9. We suggest against the use of prophylactic scheduled mannitol in acute ischemic stroke due to the potential for harm (conditional recommendation, low-quality evidence). Fernandes D, Goncalves-Pereira J, Janeiro S, Silvestre J, Bento L, Povoa P. Acute bacterial meningitis in the intensive care unit and risk factors for adverse clinical outcomes: retrospective study. Case report: mannitol nephrotoxicity syndrome: role of hemodialysis and postulate of mechanisms. Poungvarin N, Bhoopat W, Viriyavejakul A, et al. Neurocrit Care. 1986;65(5):636–41. In two prospective, randomized studies, the reduction in ICP from HTS was quicker, more pronounced, and more sustained compared to mannitol [21, 36]. O’Toole RD, Thornton GF, Mukherjee MK, Nath RL. Correspondence to A review of progress in understanding the pathophysiology and treatment of brain edema. In fact, several studies suggest that CPP is slightly reduced as the extent of head of bed elevation increases, though not to a clinically significant degree. These treatments are often administered without consideration of the underlying disease process, when in fact their efficacy may hinge upon the pathophysiology at hand. 1996;79(2):83–90. Crit Care Med. J Intensive care Med. These designations denote the degree of certainty that the estimate of effect in each study approximates the true effect. 2001;20(1):1–6. Nevertheless, the results suggested some benefits of mannitol in this context. Canalese J, Gimson AE, Davis C, Mellon PJ, Davis M, Williams R. Controlled trial of dexamethasone and mannitol for the cerebral oedema of fulminant hepatic failure. The literature search excluded articles that were not available in English, pediatric studies, animal studies, and unpublished works. The majority of these studies suggested that both HTS and mannitol were efficacious in reducing ICP in AIS, although some of these studies had a mixed patient population [9, 21, 36,37,38,39]. Crit Care Med. The panel defined outcomes of interest as any related to renal dysfunction. H�R(T�0 u Sixteen percent of patients developed AKI, which was associated with a longer intensive care unit (ICU) length of stay and a greater in-hospital mortality. Retrospective analyses of patients with liver failure who received hyperosmolar therapy show conflicting results based on imaging: 23.4% NaCl reduced brain tissue volume (as measured by MRI or diffusion tensor imaging), whereas mannitol did not affect brain water or clinical status [84, 85]. Larive LL, Rhoney DH, Parker D Jr, Coplin WM, Carhuapoma JR. We recommend dexamethasone 10 mg intravenous every 6 h for 4 days to reduce neurological sequelae (primarily hearing loss) in patients with community-acquired bacterial meningitis (strong recommendation, moderate-quality evidence). 0000506536 00000 n J Am Med Assoc. 2010;75(17):1533–9. Of these studies, only one was an RCT (which compared mannitol to no hyperosmolar therapy) [41]. reported on a mixed neurocritical care patient population that included 120 patients with ICH [9]. Indian J Neurotrauma. Cook, A.M., Morgan Jones, G., Hawryluk, G.W.J. In a subgroup analysis of patients with Streptococcus pneumoniae meningitis, neurological outcomes and the rate of neurological sequelae were improved in the dexamethasone group compared with placebo. Patil H, Gupta R. A comparative study of bolus dose of hypertonic saline, mannitol, and mannitol plus glycerol combination in patients with severe traumatic brain injury. PubMed Google Scholar. The evaluation of mannitol therapy in acute ischemic stroke patients by serial somatosensory evoked potentials. CAS  Oertel et al. Corticosteroids for bacterial meningitis in adults in sub-Saharan Africa. Gudina EK, Tesfaye M, Wieser A, Pfister HW, Klein M. Outcome of patients with acute bacterial meningitis in a teaching hospital in Ethiopia: a prospective study. Several meta-analyses have reached conflicting conclusions; some found no difference in ICP-related outcomes in TBI patients, whereas others favored HTS [27, 28]. Effectiveness of high dose dexamethasone in the treatment of acute stroke. Given these concerns, along with the lack of published articles assessing the impact of mannitol on short-term outcomes, the panel was unable to recommend use of mannitol in this population at this time. Wang X, Arima H, Yang J, et al. Differences in therapeutic response and safety may exist between HTS and mannitol. All meta-analyses that were excluded due to an inability to differentiate results by specific neurological injury are listed as footnotes on the applicable evidentiary tables that are included as electronic supplementary material. Le ernie cerebrali richiedono un trattamento con mannitolo. In making this recommendation, the panel felt that while the quality of evidence was very low, the consistency of the literature suggested HTS was at least as safe and effective as mannitol. 2010;9(3):254–63. Acta Neurochir Suppl. Below is the link to the electronic supplementary material. Ann Pharmacother. Due to the high risk of heterogeneity across these meta-analyses and the low quality of some of the studies included in each meta-analysis, the overall quality of these meta-analyses was classified as low and the strength of these findings should be cautiously applied in practice. 2019;125:e221–8. Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Other non-pharmacologic therapies such as surgical decompression and therapeutic hypothermia were not included, as they are adequately addressed by other guidelines [3]. 1998;71:31–3. completed 57 trials of hyperventilation in 27 patients with TBI and noted a significant reduction in ICP in 96.5% of the patients [118]. Yechoor VK, Shandera WX, Rodriguez P, Cate TR. 2012;43(6):1711–37. Data from the aforementioned Koenig study was included to address this PICO question as patients with ICH were included even though they could not be separated out from the other patient populations [10]. 1999;47(4):659–65. J Clin Neurosci. Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury. The panel evaluated several studies to inform recommendations on the use of HTS and/or mannitol to improve ICP, cerebral edema, or neurological outcomes (Table 1, Questions 3 and 4). 2007;78(10):1092–6. Horn P, Munch E, Vajkoczy P, et al. The latter type of edema … Physiologically, it may be reasonable to assume that CSF drainage can lower ICP by decreasing the volume of the intracranial compartment by shunting CSF from the ventricles (as opposed to decreasing cerebral edema). The Koenig study was also included to address this PICO question, but the potential benefit of 23.4% NaCl in AIS patients is not discernable from this report [10]. Once screened for inclusion, data abstraction from each of the pertinent articles was performed by a minimum of two panel members pertaining to each PICO question (Table 1). The panel discussed at length the lack of high-quality evidence supporting preferential use of one hyperosmolar agent as first line treatment of elevated ICP in TBI. 0000260569 00000 n Recent guidelines for the management of AIS, ICH, and TBI, among others, discuss the treatment of cerebral edema. 2011;42(6):1540–5. 0000504145 00000 n The panel identified five studies that evaluated either mannitol or HTS as monotherapy, but did not find any studies that directly compared the two agents [81,82,83,84,85]. Pediatr Infect Dis J. The goals of research activities in this area should address specific questions, adequately reflect the scope of planned patient enrollment, and select reasonable outcome measures. J Med Assoc Thailand = Chotmaihet thangphaet. Diagnosi. In cases where a specific sodium salt or concentration was evaluated, it was identified as stated in the study if the specific formulation was pertinent for the results. Drs. L'edema cerebrale è una raccolta di liquido che si forma in un tessuto del cervello, premendo contro i capillari sanguigni della zona interessata. Glycerol adjuvant therapy in adults with bacterial meningitis in a high HIV seroprevalence setting in Malawi: a double-blind, randomised controlled trial. Froelich M, Ni Q, Wess C, Ougorets I, Hartl R. Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients. 2018;27(4):1061–7. Twenty per cent mannitol solution was administered 29 times to 27 patients undergoing craniotomy. Randomized controlled trial of dexamethasone in tuberculous meningitis. Le metastasi cerebrali e vertebrali di tumori sistemici hanno. Am J Crit Care. In addition to its use in the food and pharmaceutical industries, mannitol is also widely used in medical practice for a variety of indicatio… While the overall quality of the evidence in this area is low, the panel felt there was enough consistency across the published studies to suggest that both HTS and mannitol are effective in reducing ICP elevations and cerebral edema. Mannitol and outcome in intracerebral hemorrhage: propensity score and multivariable intensive blood pressure reduction in acute cerebral hemorrhage trial 2 results. Is adjunctive corticosteroid beneficial in pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone? Bourdeaux CP, Brown JM. 0000033078 00000 n Surg Neurol. It is considered one of the more common contributors to elevated ICP, which has been identified as a predictor of poor outcome in patients with TBI, stroke, and other intracranial pathologies [1, 2]. 0000501596 00000 n In addition, the impact of HTS on acid–base balance is not well defined in studies including neurocritical care patients. Early continuous hypertonic saline infusion in patients with severe cerebrovascular disease. 0000507100 00000 n 2006;34(12):2912–7. A systematic review software was used for screening and abstraction of the available literature (DistillerSR, Evidence Partners, Ottawa, Canada). 1991;10(3):179–83. This guideline evaluates the role of hyperosmolar agents (mannitol… 2012;16(5):R193. 0000509034 00000 n In addition, several of the early studies evaluating HTS used a combination product which included HES. Crit Care Med. There was no difference in ICP or mortality between the two groups. All authors contributed to the implementation of the methods, creation and evaluation of the recommendations, and writing of the manuscript. CPP and SJO2 with ICP reduction therapy after severe head injury. Osmole gap in neurologic-neurosurgical intensive care unit: its normal value, calculation, and relationship with mannitol serum concentrations. Bentsen G, Stubhaug A, Eide PK. 2011;26(4):363–72. Clinicians must be able to select appropriate therapies for initial cerebral edema management based on available evidence while balancing efficacy and safety. endstream endobj 364 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>/Shading<>>> endobj 365 0 obj <> endobj 366 0 obj <> endobj 367 0 obj <> endobj 368 0 obj <> endobj 369 0 obj <> endobj 370 0 obj <> endobj 371 0 obj <> endobj 372 0 obj <> endobj 373 0 obj <> endobj 374 0 obj <>stream The available data are limited by patient heterogeneity, low sample size, and inconsistent methods among studies. Clinicians should monitor intravascular volume status, renal function, and some measure of serum osmolarity closely when using mannitol in patients with cerebral edema. Specific antimicrobial use and the corticosteroid timing in relation to antibiotic dose were not always described but are noted in the applicable evidentiary table when the information was available. 2008;36(8):2414–9. PLoS ONE. The NCS Guidelines Committee tasked two Chairs (AC, LS) to form a panel of experts in neurocritical care, pharmacotherapy, and nursing to execute the guideline. Only two other studies classified outcomes separately between mannitol and HTS in AIS; however, these studies did not directly compare these treatments and therefore an analysis of the relative efficacy was not possible [42, 43]. This work was commissioned and approved by the Neurocritical Care Society (NCS) Board of Directors. Based on the available evidence, the use of 3% NaCl to target a specific serum sodium concentration does not consistently demonstrate reductions in ICP crises and does not appear to improve neurological outcome in patients with AIS. Sayre et al. Zentralbl Chir. Safety and efficacy of repeated doses of 14.6 or 23.4% hypertonic saline for refractory intracranial hypertension. 0000019321 00000 n Predictors of acute kidney injury in neurocritical care patients receiving continuous hypertonic saline. Eur J Clin Microbiol Infect Dis. Conditional recommendations (“We suggest,” “Clinicians should consider”) should be further considered based upon the clinical scenario and carefully evaluated by stakeholders before being implemented as policy. Treatment with Mannitol is associated with increased risk for in-hospital mortality in patients with acute ischemic stroke and cerebral Edema. We suggest that severe hypernatremia and hyperchloremia during treatment with hypertonic sodium solutions should be avoided due to the association with acute kidney injury (conditional recommendation, low-quality evidence). Baunbaek-Knudsen G, Solling M, Farre A, Benfield T, Brandt CT. Mannitol use in acute stroke: case fatality at 30 days and 1 year. Edema cerebrale: Terapia con Mannitolo - Usare soltanto in caso di sintomatologia neurologica severa per rapidità d’azione. Cordialmente Dott. One evaluation suggested that the use of continuous HTS to target a serum sodium concentration of 145–155 mEq/L may be associated with fewer ICP crises per patient, while the other demonstrated no difference [9, 37]. Early publications describing a serum osmolarity threshold of 320 mOsm/L included variable mannitol dosing regimens under different treatment paradigms that may no longer apply to current therapy (e.g., continuous infusion) [87, 93]. Crit Care Med. The available evidence suggests hyperosmolar therapy may be helpful in reducing ICP elevations or cerebral edema in patients with SAH, TBI, AIS, ICH, and HE, although neurological outcomes do not appear to be affected. These studies were graded as low quality because they variably and inconsistently assessed the effect of mannitol on ICP. administered 2 ml/kg of 23.5% NaCl to 44 patients with poor-grade SAH [14]. We recently discussed the use of mannitol and hypertonic saline for pediatric traumatic brain injury, but when should we consider these medications for the patient presenting with DKA? The authors declare that they have no conflicts of interest. mannitol for the initial management of elevateICP or cerebral edema in patients witTBI(conditional recommenda,-uality evidenc).We sug-gest that neitHTSol be used with the expectation for improving … Buchholz G, Koedel U, Pfister HW, Kastenbauer S, Klein M. Dramatic reduction of mortality in pneumococcal meningitis. � L’insorgenza di un edema cerebrale può avere molte cause; di seguito un elenco di quelle si registrano più comunemente: traumi cerebrali (traumi alla testa)– Alcuni infortuni subiti alla testa possono creare danni cerebrali; in genere un trauma cerebrale è conseguente a una caduta, a incidenti sul lavoro o stradali, a urti violenti contro un determinato oggetto, a una colluttazione, a un infortunio durante pratiche sportive (di solito in sport di contatto, … J Neurosurg. Il cancro cerebrale metastatico è il cancro al cervello che si è diffuso da un’altra parte del corpo.. 0000509917 00000 n The panel identified four studies examining HTS alone, one related to mannitol, and no studies comparing the two agents. 0000503538 00000 n Renal considerations. Dziedzic T, Szczudlik A, Klimkowicz A, Rog TM, Slowik A. The effect of continuous hypertonic saline infusion and hypernatremia on mortality in patients with severe traumatic brain injury: a retrospective cohort study. 2007;107(2):274–82. 1):121. Gondim FdAA, Aiyagari V, Shackleford A, Diringer MN. Bodilsen J, Dalager-Pedersen M, Schonheyder HC, Nielsen H. Dexamethasone treatment and prognostic factors in community-acquired bacterial meningitis: a Danish retrospective population-based cohort study. Stroke. JAMA. 2011;15(1):42–5. Acute treatment of cerebral edema and herniation syndromes is often necessary in the pre-hospital setting. Durward QJ, Amacher AL, Del Maestro RF, Sibbald WJ. Wronski M, Arbit E, McCormick B: Surgical treatment of 70 patients with brain metastases … endstream endobj 375 0 obj <> endobj 376 0 obj <>stream The panel classified recommendations as strong (“We recommend”) when they are the preferred treatment for most patients and should be adopted as policy in the majority of situations. 2015;23(2):285–91. BMJ. Col termine tumore cerebrale si indica una neoplasia che interessa il cervello.Questa denominazione viene usata molto frequentemente anche a indicare i tumori che si sviluppano nella scatola cranica o in generale nel sistema nervoso centrale (SNC).. Can J Neurol Sci. Acta Neurochir (Wien). Arch Intern Med. However, well-designed clinical trials did not suggest any benefit from the use of HTS in the pre-hospital setting on long-term outcomes in patients with TBI. Tseng, et al. In making this recommendation, the panel felt that the quality of evidence was very low and the literature in patients with hepatic encephalopathy was not compelling to recommend one form hyperosmolar therapy over the other. 2000;12(4):324–33. In making this recommendation, the panel rated the quality of evidence as very low. Tan SK, Kolmodin L, Sekhon MS, et al. 2007;3:CD001153. Other studies have also suggested patients with Streptococcus pneumoniae meningitis may exhibit reduced hearing loss and lower risk of mortality from corticosteroid therapy [63, 64, 69, 70]. In addition, HTS bolus administration may also raise serum sodium, improve brain pH, and increase brain tissue oxygenation [17, 18]. Koenig MA, Bryan M, Lewin IJL, Mirski MA, Geocadin RG, Stevens RD. 1965;141(3):291–9. J Trauma. 1998;44(1):50–8. Edema cerebrale intorno ad un tumore al cervello I tumori cerebrali anche secernono sostanze che impediscono al sistema immunitario di riconoscere le cellule tumorali e quindi distruggerle. 0000509548 00000 n 0000508778 00000 n This potential treatment bias could not be fully accounted for after multivariable adjustment. e progressione verso l’insufficienza respiratoria. Gadallah MF, Lynn M, Work J. 0000004145 00000 n They concluded that HTS administration in this manner decreased ICP and improved CBF, though their results were obtained via logistic regression analysis of dose-dependent effects of HTS on CBF as measured by CT scan perfusion studies. One prospective, randomized, placebo-controlled trial (n = 93) of dexamethasone to placebo in patients with ICH was halted due to increased rates of infectious and diabetic complications, while another (n = 40) showed no difference in mortality or neurological outcomes [55, 62]. 2014;46(6):418–25. Bennett I, Finland M, Hamburger M, Kass EH, Lepper M, Waisbren BA. Clinical features of bacterial meningitis in Italy: a multicenter prospective observational study. Neurol Res. Necrosi cerebrale sottocorticale responsabile di fenomeni convulsivi non responsivi alla terapia dell’edema cerebrale (mannitolo e glucorticoidi) e alla somministrazione di glucosio si può produrre a seguito di intense crisi ipoglicemiche. 2016;25(1):110–6. Introduzione. 1983;59(6):938–44. Ichai C, Armando G, Orban J-C, et al. Part of Springer Nature. Hypernatremia predicts adverse cardiovascular and neurological outcomes after SAH. Clinicians should monitor renal function, electrolytes, and acid–base balance closely when using HTS. 2006;148(8):845–51. Hepatology (Baltimore, Md.). In making this recommendation, the panel felt that while the quality of evidence was very low, the consistency of the literature justified symptom-based bolus dosing of HTS as an effective means of reducing ICP and cerebral edema in patients with SAH. Neurocrit Care 32, 647–666 (2020). 1981;15(2):148–52. Mahfoud F, Beck J, Raabe A. Intracranial pressure pulse amplitude during changes in head elevation: a new parameter for determining optimum cerebral perfusion pressure? Overall, reversal of TTH was associated with a > 5 mEq/L rise in serum sodium concentration (p < 0.001) or an absolute serum sodium of > 145 mEq/L (p < 0.007) within 1 h after 23.4% HTS administration. Studies have also evaluated emergent, pre-hospital resuscitation with HTS or mannitol in patients with TBI. Three meta-analyses have shown varying effects of corticosteroid treatment on outcomes in community-acquired bacterial meningitis [63,64,65]. An additional subgroup analysis removing primarily HIV-positive patients demonstrated that corticosteroid treatment was associated with lower mortality [64, 66]. Rahman ML, Basher A, Rashid M, et al. 2013;44(3):870–947. grazie ! 2000;92(4):606–14. 0000502589 00000 n We suggest using hypertonic sodium solutions over mannitol for the initial management of elevated ICP or cerebral edema in patients with TBI (conditional recommendation, low-quality evidence). Comparison of effects of equiosmolar doses of mannitol and hypertonic saline on cerebral blood flow and metabolism in traumatic brain injury. At 3–18-month follow-up, corticosteroid use reduced mortality by almost 25%, but did not change overall neurological outcomes. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Cheng F, Xu M, Liu H, Wang W, Wang Z. 2000;9(6):373–80 (quiz 381–372). A separate, propensity-matched retrospective cohort study which included patients with ICH found that those who received continuous infusion 3% NaCl and developed hyperchloremia (Cl > 115 mEq/L) had significantly higher rates of AKI [106]. Neurology. Throughout the document, “hypertonic saline” was referred to as “hypertonic sodium solutions” to account for the differences in sodium salt formulation. In patients with SAH, does sodium target-based dosing with hypertonic sodium solutions (sodium chloride, lactate, or bicarbonate) improve neurological outcomes at discharge compared to intermittent, symptom-based bolus doses of hypertonic sodium solutions? These two agents have been compared in at least eight randomized, controlled trials of patients with elevated ICP from a variety of causes, including TBI [19,20,21,22,23,24,25,26]., DOI:, Over 10 million scientific documents at your fingertips, Not logged in 2003;34(7):1730–5. J Neurol Neurosurg Psychiatry. GRADE guidelines: 15. 0000505487 00000 n Rosner MJ, Coley IB. Fortune et al. Ayaz C, Celen MK, Geyik MF, Ulug M. The efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis.

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