Department of Neurosciences, Division of Adult Neurology, Medical University of South Carolina, Charleston, SC, USA.
Neurocrit Care. 2011 Apr;14(2):222-8. doi: 10.1007/s12028-010-9477-4.
Cerebral edema and raised intracranial pressure are common problems in neurological intensive care. Osmotherapy, typically using mannitol or hypertonic saline (HTS), has become one of the first-line interventions. However, the literature on the use of these agents is heterogeneous and lacking in class I studies. The authors hypothesized that clinical practice would reflect this heterogeneity with respect to choice of agent, dosing strategy, and methods for monitoring therapy.
An on-line survey was administered by e-mail to members of the Neurocritical Care Society. Multiple-choice questions regarding use of mannitol and HTS were employed to gain insight into clinician practices.
A total of 295 responses were received, 79.7% of which were from physicians. The majority (89.9%) reported using osmotherapy as needed for intracranial hypertension, though a minority reported initiating treatment prophylactically. Practitioners were fairly evenly split between those who preferred HTS (54.9%) and those who preferred mannitol (45.1%), with some respondents reserving HTS for patients with refractory intracranial hypertension. Respondents who preferred HTS were more likely to endorse prophylactic administration. Preferred dosing regimens for both agents varied considerably, as did monitoring parameters.
Treatment of cerebral edema using osmotically active substances varies considerably between practitioners. This variation could hamper efforts to design and implement multicenter trials in neurocritical care.
脑水肿和颅内压升高是神经重症监护中的常见问题。渗透性治疗，通常使用甘露醇或高渗盐水（HTS），已成为一线干预措施之一。然而，关于这些药物的使用的文献存在异质性，缺乏 I 类研究。作者假设，临床实践将反映出在选择药物、剂量策略和监测治疗方法方面的这种异质性。
通过电子邮件向神经重症监护学会成员发送在线调查。采用多项选择题来了解临床医生使用甘露醇和 HTS 的情况。
共收到 295 份回复，其中 79.7%来自医生。大多数（89.9%）报告根据颅内压升高的需要使用渗透性治疗，但少数报告预防性开始治疗。从业者在 HTS（54.9%）和甘露醇（45.1%）之间相当均匀地分配，一些从业者将 HTS 保留给难治性颅内压升高的患者。喜欢 HTS 的受访者更有可能赞成预防性给药。两种药物的首选剂量方案差异很大，监测参数也不同。
使用渗透性药物治疗脑水肿在从业者之间存在很大差异。这种差异可能会阻碍在神经重症监护中设计和实施多中心试验的努力。
