Summary
Little is known about the effect of post-traumatic mannitol infusion on cerebral metabolism and oxygenation. The purpose of this study was to investigate the effects of mannitol in comatose patients on PtiO2, PtiCO2 and brain tissue pH using Clark-type electrodes implanted into cerebral white matter. In the neurosurgical intensive care unit PtiO2, PtiCO2, brain tissue pH, arterial blood pressure, intracranial pressure (ICP), cerebral perfusion pressure (CPP) and jugular bulb oxygen saturation (SjvO2) were prospectively studied in eleven patients with severe traumatic brain injury (TBI) during a total of 30 mannitol administrations (125 ml of 20% Mannitol infused over 30 min through a central vein). When the initial ICP before mannitol infusion was below 20 mmHg neither ICP nor any of the other parameters changed significantly during or after mannitol infusion. With a pre-infusion ICP above 20 mmHg a significant effect was seen on ICP (decrease from 23 ± 1 to 16 ± 2 mmHg at 60 min) and CPP (increase from 68 ± 2 to 80 ± 3 mmHg at 120 min). These effects were not reflected in PtiO2 or SjvO2, which were 29 ± 4 mmHg and 61 ± 3%, respectively, at the beginning of mannitol injection and remained unchanged during the observation period. PtiCO2 and brain tissue pH were not affected by mannitol infusion. Future studies should focus on the identification of ICP or CPP thresholds where infusion of mannitol may actually improve O2 supply to the brain.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Berger S, Schürer L, Härtl R, et al (1995) Reduction of posttraumatic intracranial hypertension by hypertonie/hyperoncotic saline/dextran and mannitol. Neurosurgery 37: 98–108
Chesnut RM, Marshall SB, Piek J, et al (1993) Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir (Wien) [Supp] 59: 121–125
Eisenberg HM, Frankowski RF, Contant CF, et al (1988) Highdose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 69: 15–23
Freshman SP, Battistella FD, Matteucci M, et al (1993) Hypertonic saline (7.5%) versus mannitol: a comparison for treatment of acute head injuries. J Trauma 35: 344–348
Gaab M, Seegers K, Smedema R (1990) A comparative analysis of THAM in traumatic brain edema. Acta Neurochir (Wien) [Suppl] 51: 320–323
Härtl R, Bardt T, Kiening K, et al (1996) Brain-tissue PO2 during cardiac arrest and cerebral herniation in severely head-injured patients. Cardiovasc Eng
Kiening K, Unterberg A, Bardt T, et al (1996) Monitoring of cerebral oxygenation in severely head-injured patients: brain tissue PO2 vs. jugular venous oxygen saturation. J Neurosurg
Maas A, Fleckenstein W, de Jong D, et al (1993) Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue tension. In: Unterberg AW, Schneider G-H, Lanksch W (eds) Monitoring of cerebral blood flow and metabolism in intensiv care. Acta Neurochir (Wien) [Suppl] 59: 50–57
Miller JD, Becker DP (1982) Secondary insults to the injured brain. J R Coll Surg Edinb 27: 292–298
Muizelaar JP, Lutz HA, Becker DP (1984) Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg 61: 700–706
Muizelaar JP, Wei EP, Kontos HA, et al (1983) Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 59: 822–828
Rosner M, Coley I (1987) Cerebral perfusion pressure: a hemodynamic mechanism of mannitol and the pre-mannitol hemo-gram. Neurosurgery 21: 147–156
Santbrink H v, Maas A, Avezaat C (1996) Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 38: 21–31
Sheinberg M, Kanter MJ, Robertson CS, et al (1992) Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg 76: 212–217
Takagi H, Saito T, Kitahara T (1983) The mechanism of the ICP reducing effect of mannitol. In: Ishii S, Nagai H, Brock N (eds) Intracranial pressure V. Springer, Berlin Heidelberg New York Tokyo, pp 729–733
Unterberg A, Kiening K, Schneider G-H, et al (1995) Monitoring of cerebral oxygenation in severe head injury — jugular venous oxygen saturation vs. brain tissue pO2 and near infrared spectroscopy. J Neurotrauma 12: 405
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1997 Springer-Verlag
About this paper
Cite this paper
Härtl, R., Bardt, T.F., Kiening, K.L., Sarrafzadeh, A.S., Schneider, GH., Unterberg, A.W. (1997). Mannitol Decreases ICP but Does Not Improve Brain-Tissue pO2 in Severely Head-Injured Patients with Intracranial Hypertension. In: James, H.E., et al. Brain Edema X. Acta Neurochirurgica Supplements, vol 70. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6837-0_12
Download citation
DOI: https://doi.org/10.1007/978-3-7091-6837-0_12
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-7418-0
Online ISBN: 978-3-7091-6837-0
eBook Packages: Springer Book Archive