A Novel Step-Down Infusion Therapy: Its Safety and Effectiveness in Intracranial Pressure Control Using Barbiturate Therapy

2019 ◽  
Author(s):  
Yukako Yamakawa ◽  
Motohiro Morioka ◽  
Tetsuya Negoto ◽  
Kimihiko Orito ◽  
Munetake Yoshitomi ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Pressure Control ◽  
Infusion Therapy ◽  
Barbiturate Therapy ◽  
Step Down

scholarly journals A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Yukako Yamakawa ◽  
Motohiro Morioka ◽  
Tetsuya Negoto ◽  
Kimihiko Orito ◽  
Munetake Yoshitomi ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Pressure Control ◽  
Barbiturate Therapy ◽  
Infusion Method ◽  
Step Down

Barbiturate Therapy in Uncontrolled Intracranial Hypertension

Neurosurgery ◽  
1983 ◽  
Vol 12 (4) ◽  
pp. 401-404 ◽  
Author(s):  
Gary L. Rea ◽  
Gaylan L. Rockswold
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Vegetative State ◽  
Head Injuries ◽  
Total Mortality ◽  
Prognostic Indicators ◽  
Good Recovery ◽  
Therapeutic Modalities ◽  
Barbiturate Therapy ◽  
Mass Lesions

Abstract From July 1978 to September 1981, 27 patients from a group of 210 patients with severe head injuries developed uncontrolled intracranial hypertension despite intensive medical and surgical management. These 27 patients were considered appropriate candidates for barbiturate therapy. Abnormal posturing or flaccidity was present in 70%; of the patients, and 41%; had bilaterally fixed pupils. Twenty-five of 27 patients had mass lesions requiring operation. Of the 15 patients who responded to barbiturate therapy with normalization of intracranial pressure for 24 hours, 5 died (33%; mortality). Nine of the 12 patients who did not respond to the barbiturate therapy died (75%; mortality). The total mortality in this group of 27 patients was 52%;. Of the survivors, 69%; had a recovery classified as good recovery/moderate disability, and 31%; were in a severe disability/vegetative state. The morbidity and mortality in these patients is high, but comparisons with previous studies show that this is a selected group of severe head injuries with a high percentage of poor prognostic indicators. Our experience suggests that barbiturates can be effective in lowering intracranial pressure in patients with otherwise unresponsive intracranial hypertension and, by doing so, may decrease the mortality in a group of patients considered untreatable by the usual therapeutic modalities.

Management of 136 consecutive supratentorial berry aneurysms

1978 ◽  
Vol 49 (6) ◽  
pp. 794-804 ◽  
Author(s):  
Sean Mullan ◽  
Kathy Hanlon ◽  
Frederick Brown
Keyword(s):  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Pressure Control ◽  
Carotid Occlusion ◽  
Respiratory Support ◽  
University Of Chicago ◽  
Content Type ◽  
The University ◽  
Medical Judgment ◽  
Fine Print

✓ A series of 103 consecutive cases admitted to the University of Chicago Hospitals with a recently ruptured supratentorial aneurysm were medically managed by antifibrinolytic medication, and, when applicable, by hypotension, intracranial pressure control, and respiratory support. Nine patients deteriorated and died, and six rebled and died before they were judged fit for surgical treatment. Four were treated by carotid occlusion. Nine, because of refusal or medical judgment, did not have surgical treatment. Sixty-nine of these patients and a further 33, electively admitted, underwent craniotomy. In these 102 patients, there was no mortality. Seven developed postoperative hemiparesis or hemiplegia. Six recovered. One has a residual monoparesis.

scholarly journals Effect of hypertonic saline in the management of elevated intracranial pressure in children with cerebral edema: A systematic review and meta-analysis

2021 ◽  
Vol 9 ◽  
pp. 205031212110048
Author(s):  
Farzana Afroze ◽  
Monira Sarmin ◽  
CA Kawser ◽  
Sharika Nuzhat ◽  
Lubaba Shahrin ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Cerebral Edema ◽  
Meta Analysis ◽  
Final Analysis ◽  
Saline Group ◽  
Infusion Therapy ◽  
Raised Intracranial Pressure ◽  
Elevated Intracranial Pressure ◽  
Eligibility Criteria

Objective: To determine the hypertonic saline efficacy in children with cerebral edema and raised intracranial pressure. Method: Studies assessing the efficacy and safety of hypertonic saline in children with cerebral edema and elevated intracranial pressure were identified using Medline, Web of Science, Scopus, and Google Scholar databases. Two reviewers independently assessed papers for inclusion. The primary outcome was a reduction of elevated intracranial pressure by the administration of hypertonic saline. Results: We initially evaluated 1595 potentially relevant articles, and only 7 studies met the eligibility criteria for the final analysis. Out of the seven studies, three of them were randomized controlled trials. Three of the studies found that hypertonic saline significantly reduced elevated intracranial pressure compared to control. One study reported a resolution of the comatose state as a measure of reduced intracranial pressure. It also found a significantly higher resolution of coma in the hypertonic saline group rather than the control. Three studies reported that the reduction of intracranial pressure was comparable between the groups. The random-effects model using pooled estimates from four studies showed no difference in hypertonic saline and conventional therapy mortality outcomes. Hypertonic saline was administered as bolus-only therapy at a rate of 1–10 mL/kg/dose over 5 min to 2 h and or bolus followed by infusion therapy (0.5–2 mL/kg/h). One study reported a twofold faster resolution of high intracranial pressure following hypertonic saline administration compared to controls. The re-dosing schedule varied greatly in all included studies. However, three studies reported adverse events but not methodically, and there were no reports on neurological sequelae. Conclusion: Hypertonic saline appears to reduce intracranial pressure in children with cerebral edema. However, we cannot draw a firm conclusion regarding the safest dose regimens of hypertonic saline, including the safe and effective therapeutic hypernatremia threshold in the management of raised intracranial pressure with cerebral edema. Future clinical trials should focus on the appropriate concentration, dose, duration, mode of administration, and adverse effects of hypertonic saline to standardize the treatment.

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