Mannitol is comparable to hypertonic saline for raised intracranial pressure in Acute Liver Failure (MAHAL Study): A RCT

2021 ◽  
Author(s):  
Chetan Ramesh Kalal ◽  
Rakhi Maiwall ◽  
Ashok Choudhary ◽  
Madhumita Premkumar ◽  
Guresh Kumar ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Kidney Injury ◽  
Hepatitis E ◽  
Optic Nerve Sheath Diameter ◽  
Comparable Efficacy ◽  
Raised Intracranial Pressure ◽  
King’S College Criteria ◽  
Group B ◽  
Rebound Increase

Background: Raised intracranial pressure due to cerebral edema (CE) is central to development of hepatic encephalopathy in ALF. Mannitol (MT) & Hypertonic saline (HS) has been shown to improve CE. We compared the efficacy & safety of the two modalities Methods: ALF with CE were prospectively randomized in an open study to receive either 5 ml/kg of either 3% HS, as continuous infusion; titrated every 6 hourly to achieve serum sodium of <160(Group A; n=26) or 1 g/kg of 20% MN as a IV bolus, repeated every six hourly (Group B; n=25) in addition to standard ALF care. Primary end-point was reduction of intracranial pressure defined as optic nerve sheath diameter <5mm and middle cerebral arterial pulsatility index (PI) <1.2 at 12 hours. Results: Fifty-one patients with ALF, hepatitis E being commonest (33.3%), median jaundice to HE interval of 8(1-16) days, were randomized to HS (n=26) or MN (n=25). Baseline characteristics were comparable including King’s college criteria [>2: 38.4% vs.40%]. Overall, 61.5% patients in HS and 56% in MN group showed reduction in ICP at 12 hr. (p=0.25). Rebound increase in ICP indices was noted in 5(20%) patients in MT and none in HS (p<0.05) group. New onset acute kidney injury was commoner in MT than HS group. The ICU stay, and 28-day transplant free survival were not different between the groups. Conclusions: While both agents had comparable efficacy in reducing ICP and mortality in ALF patients was comparable, HS was significantly better in preventing reducing rebound CE with lower renal dysfunction.

scholarly journals Individualizing hyperosmolar therapy for management of intracranial hypertension

2018 ◽  
Vol 4 (2) ◽  
pp. 54-56
Author(s):  
Gentle Sunder Shrestha
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Hypertonic Saline ◽  
Significant Heterogeneity ◽  
Raised Intracranial Pressure ◽  
Threshold Method ◽  
Treatment Threshold ◽  
Hyperosmolar Therapy ◽  
Surgical Options ◽  
Selection Of

Intracranial hypertension is a major cause of morbidity and mortality in patients with brain injury. If not appropriately treated, it can precipitate brain ischemia, brain herniation and death. Hyperosmolar therapy remains the main armamentarium for management of raised intracranial pressure, especially in patients with diffuse lesions and where surgical options are not applicable. Substantial amount of studies have tried to explore the superiority of hypertonic saline or mannitol over the other. Due to significant heterogeneity in the pathophysiology of patients, variation in treatment threshold, method of drug administration and drug concentration, substantial evidence is lacking to support one agent over other. Hypertonic saline may be more effective than mannitol for lowering raised intracranial pressure. Well designed novel trials need to try to find the answer. Clinical, pathophysiological and biochemical data should be incorporated at bedside while individualizing selection of hyperosmolar therapy, with the aim to improve outcome and minimize harm.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 54-56 

Evaluation of Optic Nerve Sheath Diameter and Transcranial Doppler As Noninvasive Tools to Detect Raised Intracranial Pressure in Children

2020 ◽  
Vol 21 (11) ◽  
pp. 959-965
Author(s):  
Indar Kumar Sharawat ◽  
Ananthanarayanan Kasinathan ◽  
Arun Bansal ◽  
Jitendra Kumar Sahu ◽  
Kushaljit Singh Sodhi ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Transcranial Doppler ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Raised Intracranial Pressure ◽  
Nerve Sheath

Measurement of Optic Nerve Sheath Diameter for the Assessment of Risk of Raised Intracranial Pressure

2009 ◽  
Vol 4 (1) ◽  
pp. 50 ◽  
Author(s):  
Thomas Geeraerts ◽  
David K Menon ◽  
Dan Benhamou ◽  
◽  
◽  
...  
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Brain Magnetic Resonance Imaging ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Raised Intracranial Pressure ◽  
Nerve Sheath ◽  
Patients At Risk ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Raised intracranial pressure (ICP) is associated with poor outcome after brain injury, but is difficult to detect without invasive devices. As a part of the central nervous system, the optic nerve is surrounded by a dural sheath, and the subarachnoid space surrounding the optic nerve is subject to the same pressure changes as the intracranial compartment. Distension of the optic nerve sheath reflects an increase in cerebrospinal fluid (CSF) pressure and can be used to estimate the risk of raised ICP. Ocular sonography or brain magnetic resonance imaging (MRI) enables valid measurement of the distension of the dural sheath surrounding the optic nerve. An optic nerve sheath diameter greater than 5.8mm is likely to be associated with raised ICP. This non-invasive estimate of ICP may detect patients at risk, help make decisions regarding the placement of invasive ICP devices and allow the selection of patients for transfer to specialist centres.

scholarly journals How accurate is ultrasound of the optic nerve sheath diameter performed by inexperienced operators to exclude raised intracranial pressure?

2015 ◽  
Vol 19 (1) ◽  
Author(s):  
G. J. Du Toit ◽  
D. Hurter ◽  
M. Nel
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Lumbar Puncture ◽  
Predictive Value ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Ultrasound Measurement ◽  
Raised Intracranial Pressure ◽  
Cross Sectional ◽  
Nerve Sheath

Background: It has been well documented that ultrasound measurement of the optic nerve sheath diameter performed by an experienced operator shows good correlation with raised intracranial pressure, irrespective of the cause. Objective: To establish the accuracy of this technique performed by inexperienced operators.Method: A prospective analytical cross-sectional study was conducted. All patients ≥18 years of age who presented at our medical casualty and emergency departments with suspected meningitis were enrolled in the study. All patients were evaluated with the use of optic nerve sheath diameter ultrasound with or without computed tomography brain scan prior to lumbar puncture. Lumbar puncture opening pressure measurements were compared with the ultrasound measurements.Results: A total of 73 patients were enrolled in the study, of whom 14 had raised intracranial pressure. The study had a sensitivity of 50% (95% confidence interval (CI) 26.8%–73.2%) and specificity of 89.8% (95% CI 79.5%–95.3%) with a positive predictive value of 54.8% (95% CI 29.1%–76.8%) and negative predictive value of 88.3% (95% CI 77.8%–94.2%). The likelihood ratio of a positive test was 4.92 (95% CI 1.95–11.89) and that of a negative test 0.56 (95% CI 0.29–0.83). Cohen’s kappa value was 0.41 which indicates a moderate agreement. The receiver operating characteristic (ROC) curve had an area under the curve (AUC) of 0.73 (95% CI 0.51–0.95). Conclusion: Ultrasound measurement of the optic nerve sheath diameter can be used to exclude raised intracranial pressure, even in the hands of inexperienced operators.

Sign in / Sign up

Export Citation Format

Share Document