is a standard treatment in patients undergoing elective cranial neurosurgery and with traumatic brain injury.
applied as a part of the medical treatment algorithms is of great importance in the management of cerebral edema and increased intracranial pressure (ICP) following brain injury .
Ventilatory support, blood pressure reduction, intracranial pressure monitoring, osmotherapy
, fever control, seizure prophylaxis and nutritional supplementation are the cornerstones of supportive care in intensive care units6.
When ICP remained elevated after osmotherapy
, barbiturates were injected (sodium thiopental), with an intravenous (iv) bolus of 2-3 mg/kg, followed by a continuous infusion of 2-3 mg x [kg.sup.-1] x [h.sup-1] (12).
This edition has new chapters on neurological assessment of spinal injury, clearing the cervical spine, management of concurrent traumatic brain injury and spinal injury, blood pressure and oxygen management, temperature management, fluids and osmotherapy
, pharmacology, autonomic dysreflexia, infection after spinal cord injury, and emerging therapies, and it expands content on critical care and updates guideline recommendations.
The Eurotherm 32-35 trial established that hypothermia should not be used early (i.e., before other stage 2 treatments such as osmotherapy
) in patients with diffuse TBI, despite beneficial effects on intracranial pressure (ICP) control .
All of them responded well to short course (7 days) of dexamethasone at a dose of 0.15 mg/kg/dose q 6 hourly along with osmotherapy
(mannitol and/or hypertonic saline) and other supportive measures with temporary cessation of cysticidal therapy.
She was treated with osmotherapy
(i.e., mannitol and hypertonic saline) and propofol sedation for elevated intracranial pressure (ICP).
Hypertonic solution is another well-known agent for osmotherapy
. In a canine ICH model, hypertonic saline was seen to reduce intraparenchymal pressure difference that occurs during ICH with effect lasting for about 3 hours  which inevitably leads to the control of edema .
Blood pressure reduction, osmotherapy
, ultra haemolytic therapy were not found to be proven methods of benefit to patients.
Corticosteroids and osmotherapy
with mannitol, glycerol, or hypertonic saline are currently considered to be effective medical therapy.
This treatment comprised optimization of sedation with nonbarbiturate anaesthetics, osmotherapy
(including controlled hypernatraemia), and maintenance of MAP by means of norepinephrine.