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Osmotherapy

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Management of Severe Traumatic Brain Injury

Abstract

Reducing the volume of the intracranial content, decreasing ICP, and increasing CPP by drawing water out of the brain into the vascular compartment along an osmotic gradient is a cornerstone in the medical treatment of elevated ICP. Solutions of mannitol and hypertonic saline are effective and used frequently in clinical practice (White et al. 2006; Bhardwaj 2007). Both solutions exert an early effect on ICP due to optimising of rheological properties of the blood resulting in decreased blood viscosity and haematocrit, increasing cerebral blood flow (CBF) and oxygen delivery, and resulting in reflex autoregulatory vasoconstriction of cerebral arterioles that reduces CBV and ICP. This is followed by an osmotic shrinkage of brain cells that peaks after 15–30 min (Ziai et al. 2007).

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Brendstrupgaardsvej 100, Skejby, Aarhus N, 8200, Denmark

    Jens Aage Kølsen-Petersen

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  1. Jens Aage Kølsen-Petersen
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Correspondence to Jens Aage Kølsen-Petersen .

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Editors and Affiliations

  1. , Department of Neurosurgery, Haukeland University Hospital, Jonas Liesvei 65, Bergen, 5021, Norway

    Terje Sundstrom

  2. , Department of Anaesthesia and Intensive, Lund University Hospital, Getingevägen 4, Lund, 22185, Sweden

    Per-Olof Grände

  3. Dept. Neuroanaesthesia & Neurosurgery, Arhus University Hospital, Aarhus C, 8000, Denmark

    Niels Juul

  4. , Department of Neurosurgery, Aarhus University Hospital, Norrebrograde 44, Aarhus C, 8000, Denmark

    Carsten Kock-Jensen

  5. , Department of Neurosurgery, Copenhagen University Hospital, Bledgamsvej 9, Copenhagen, 2100, Denmark

    Bertil Romner

  6. , Department of Surgical Sciences, University of Bergen, Jonas Liesvei, Bergen, 5021, Norway

    Knut Wester

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Kølsen-Petersen, J.A. (2012). Osmotherapy. In: Sundstrom, T., Grände, PO., Juul, N., Kock-Jensen, C., Romner, B., Wester, K. (eds) Management of Severe Traumatic Brain Injury. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28126-6_54

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