Abstract
Introduction
Animal experiments recently demonstrated that replacing urinary loses with crystalloid
diminishes the therapeutic effect of mannitol by reducing the increase in osmolality.
We aimed to investigate whether this effect is similarly seen in in brain-injured
patients by studying the association between total body fluid balance (TBB) and the
osmolar response to mannitol.
Methods
We performed a retrospective cohort study of adult patients with acute brain injury
between 2015 and 2021 who received ≥ 2 doses of mannitol within 8 hours and no intercurrent
concentrated saline solution. We analyzed the association between the change in TBB
(∆TBB) and change in osmolality (∆Osm) before and after mannitol in a linear model, both as univariate and after adjustment
for common confounding factors.
Results
Of 6,145 patients who received mannitol, 155 patients met inclusion criteria (mean
age 60 ± 17 years, 48% male, 83% white). The mean total mannitol dose was 2 ± 0.5
g/kg and the mean change in plasma osmolality was 7.9 ± 7.1 mOsm/kg. Each 1 L increase
in ∆TBB was associated with a change of -1.1 mOsm/L in ∆Osm (95% CI [-2.2, -0.02], p = 0.045). The magnitude of association was similar to that
of total mannitol dose and remained consistent in an adjusted model and after excluding
outliers.
Conclusions
In patients with acute brain injury, a positive TBB is associated with a diminished
mannitol-induced increase in plasma osmolality. Future prospective studies are needed
to confirm these findings and their influence on the therapeutic effect of mannitol.
Keywords
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References
- Hyperosmolar therapy for raised intracranial pressure.N Engl J Med. 2012; 367: 746-752
- New trends in hyperosmolar therapy?.Curr Opin Crit Care. 2013; 19: 77-82
- Effect of mannitol on the kidney: changes in intrarenal hemodynamics.N Engl J Med. 1965; 272: 382-386
- Pharmacokinetics and effects of mannitol on hemodynamics, blood and cerebrospinal fluid electrolytes, and osmolality during intracranial surgery.J Neurosurg Anesthesiol. 1993; 5: 4-12
- Intraoperative Fluid Management During Craniotomy, Anesthesia and Neurosurgery.4th ed. Mosby, Philadelphia2001
- Variation in osmotic response to sustained mannitol administration.Neurocrit Care. 2008; 9: 204-209
- Hypernatremia complicating prolonged mannitol diuresis.N Engl J Med. 1965; 272: 1116-1117
- Effects of volume replacement for urinary losses from mannitol diuresis on brain water in normal rats.Neurocrit Care. 2021; 35: 24-29
- Osmotic therapy: fact and fiction.Neurocrit Care. 2004; 1: 219-233
- The effect of intravenous fluid replacement on the response to mannitol in experimental cerebral edema: an analysis of intracranial pressure, serum osmolality, serum electrolytes, and brain water content.Acta Neurochir Suppl. 2006; 96: 125-129
- Effect of mannitol on cerebrospinal fluid dynamics and brain tissue edema.Anesth Analg. 1994; 78: 58-66
- Dose-response relationship of mannitol and intracranial pressure: a metaanalysis.J Neurosurg. 2008; 108: 80-87
- Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients.J Neurosurg. 1984; 61: 700-706
Article info
Publication history
Published online: November 02, 2022
Accepted:
October 26,
2022
Received in revised form:
October 24,
2022
Received:
August 25,
2022
Footnotes
Institutions where work was done: Massachusetts General Hospital, Brigham and Women's Hospital
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106867
Copyright
© 2022 Elsevier Inc. All rights reserved.