✓ There is little information as to the optimal use of mannitol. To determine the dose-response relationship, the osmotic gradient required, and the time course of intracranial pressure (ICP) reduction produced by mannitol, eight patients with acute head injury were studied in whom ICP was monitored with a ventriculostomy and found to be elevated. Ventilation was controlled to a pCO2 of 25 ± 3 mm Hg and all were paralyzed with Pavulon. None had received barbiturates. Before mannitol administration the intracranial volume-pressure response was determined. Mannitol was administered as a bolus of 0.25 gm/kg, 0.5 gm/kg, and in six patients, 1 gm/kg, separated by at least 8 hours.
In all patients the ICP reduction with 0.25 gm/kg (41.3 ± 10.2 mm Hg→16.4 ± 5.6, p < 0.01) was equivalent to that achieved with the larger doses. Serum osmolality rises of 10 mOsm or more were associated with a reduction in ICP. Much smaller doses than those previously recommended were effective in reducing the ICP acutely, although at 5 hours there was a trend toward persistent reduction when the larger dose is used. This trend was small and indicates that smaller and more frequent doses are as effective in reducing the ICP while avoiding the risk of osmotic disequilibrium and severe dehydration.
KühnerARoquefeuilBViguieEet al: The influence of high and low dosages of mannitol 25% in the therapy of cerebral edema in SchürmannKBrockMReulenH-Jet al (eds): Advances in Neurosurgery 1. Brain Edema. Berlin/Heidelberg/New York: Springer-Verlag1973 pp 81–91Kühner A Roquefeuil B Viguie E et al: The influence of high and low dosages of mannitol 25% in the therapy of cerebral edema in Schürmann K Brock M Reulen H-J et al (eds): Advances in Neurosurgery 1. Brain Edema. Berlin/Heidelberg/New York: Springer-Verlag 1973 pp 81–91
MillerJDLeechP: Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients.J Neurosurg42:274–2811975Burton AC: Physiology and Biophysics of the Circulation: An Introductory Text ed 2. Chicago: Year Book Medical Publishers 1972 pp 40
ShenkinHAGoluboffBHaftH: The use of mannitol for the reduction of intracranial pressure in intracranial surgery.J Neurosurg19:897–9011962Shenkin HA Goluboff B Haft H: The use of mannitol for the reduction of intracranial pressure in intracranial surgery. J Neurosurg 19:897–901 1962
StuartFPTorresEFletcherRet al: Effects of single, repeated and massive mannitol infusion in the dog: structural and functional changes in kidney and brain.Ann Surg172:190–2041970Stuart FP Torres E Fletcher R et al: Effects of single repeated and massive mannitol infusion in the dog: structural and functional changes in kidney and brain. Ann Surg 172:190–204 1970
WiseBLChaterN: The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal-fluid pressure.J Neurosurg19:1038–10431962Wise BL Chater N: The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal-fluid pressure. J Neurosurg 19:1038–1043 1962
WiseBLPerkinsRKStevensonEet al: Penetration of C14-labelled mannitol from serum into cerebrospinal fluid and brain.Exp Neurol10:264–2701964Wise BL Perkins RK Stevenson E et al: Penetration of C14-labelled mannitol from serum into cerebrospinal fluid and brain. Exp Neurol 10:264–270 1964