Intracranial pressure response after pharmacologic treatment of intracranial hypertension.

Colton K, Yang S, Hu PF, Chen HH, Bonds B, Scalea TM, Stein DM.

J Trauma Acute Care Surg. 2014 Jul;77(1):47-53.

Patients older than 17 years, admitted and requiring ICP monitoring between 2008 and 2010 at a high-volume urban trauma center, were retrospectively evaluated. Timing and dose of ICP-directed therapy were recorded from paper and electronic medical records. ICP data were collected automatically at 6-second intervals and from manual charts
A total of 117 patients met inclusion criteria; 450 treatments were administered when nursing records indicate an ICP greater than 20 mm Hg, while 968 treatments were given when ICP was greater than 20 mm Hg by automated data.
 Pharmacologic treatments identified include hypertonic saline (HTS), mannitol, barbiturates, and dose escalations of propofol or fentanyl infusions.
Treatment with HTS resulted in the largest ICP decrease of the treatments examined, with a 1-hour ICP reduction of 8.8/9.9 mm Hg (for a small/large dose) according to manual data and a reduction of 3.0/2.4 mm Hg according to automated data. Propofol and fentanyl escalations resulted in smaller but significant ICP reductions. Mannitol (n = 8) resulted in statistically insignificant trends down in the first hour but rebounded by the second hour after administration. The average ICP in the hour before medication administration was higher for barbiturates (27 mm Hg) and mannitol (32 mm Hg) than for the other interventions (18-19 mm Hg).

CONCLUSION:

ICP fell after administration of HTS, mannitol, or barbiturates and showed continued improvement after 2 hours. ICP fell initially after treatment with short-acting propofol and fentanyl but trended back up after 2 hours

Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage

Clinical article

Min Young Kim ,MD et al

Journal of Neurosurgery

Jun 2014 / Vol. 120 / No. 6 / Pages 1340-1348 

 The objectives of this study were to assess the impact of mannitol on the incidence and severity of acute kidney injury (AKI) and to identify risk factors and outcome for AKI in patients with intracranial hemorrhage (ICH).

 The authors retrospectively evaluated 153 adult patients who received mannitol infusion after ICH between January 2005 and December 2009 in the neurosurgical intensive care unit.

 The overall incidence of AKI among study participants was 10.5% 

(n = 16). 

Acute kidney injury occurred more frequently in patients who received mannitol infusion at a rate ≥ 1.34 g/kg/day than it did in patients who received mannitol infusion at a rate < 1.34 g/kg/day.

 A higher mannitol infusion rate was associated with more severe AKI. Independent risk factors for AKI were mannitol infusion rate ≥ 1.34 g/kg/day, age ≥ 70 years, diastolic blood pressure (DBP) ≥ 110 mm Hg, and glomerular filtration rate < 60 ml/min/1.73 m²

Blood component transfusion increases the risk of death in children with traumatic brain injury

Acker, Shannon N. MD; Partrick, David A. MD; Ross, James T. BS; Nadlonek, Nicole A. MD; Bronsert, Michael PhD; Bensard, Denis D. MDJournal of Trauma and 

Acute Care Surgery:

April 2014 - Volume 76 - Issue 4 - p 1082-1088

Pediatric patients sustaining TBI who receive blood transfusion and do not require operative intervention have worse outcomes compared with patients who do not receive transfusion. This includes an increased risk of death. These data suggest that a transfusion trigger of hemoglobin level at 8.0 g/dL in injured children with TBI may be beneficial.

Recovery from Anesthesia after Craniotomy for Supratentorial Tumors: Comparison of Propofol-Remifentanil and Sevoflurane-Sufentanil (the PROMIFLUNIL Trial)

Necib, Skander MD; Tubach, Florence MD, PhD; Peuch, Clarisse MD; LeBihan, Eric MD; Samain, Emmanuel MD, PhD; Mantz, Jean MD, PhD; Dahmani, Souhayl MD, PhD

Journal of Neurosurgical Anesthesiology:

January 2014 - Volume 26 - Issue 1 - p 37-44

During craniotomy for Supratentorial  tumors, the authors could not demonstrate a reduction in the time to extubation when comparing a BIS-guided anesthesia associating Propofol-Remifentanil  to a BIS-guided anesthesia associating  Sevoflurane-Sufentanil