Erschienen in:
04.04.2016 | Editorials
Managing critically ill patients with severe traumatic brain injury: How should we season the recipe?
verfasst von:
Paule Lessard Bonaventure, MD, François Lauzier, MD, Alexis F. Turgeon, MD
Erschienen in:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
|
Ausgabe 6/2016
Einloggen, um Zugang zu erhalten
Excerpt
Maintaining adequate cerebral perfusion remains the overarching objective in the management of critically ill patients with severe traumatic brain injury. Despite limited evidence, the concept of maintaining normal intracranial pressure has been the driving force behind most interventions over the last few decades. The current guidelines for the management of severe traumatic brain injury advocate limiting brain edema using hyperosmolar therapy with mannitol to control elevated intracranial pressure.
1 Nevertheless, concerns that the diuretic effect of mannitol induces hypovolemia have led to the popularity of using hypertonic saline solutions as an alternative option—this despite limited evidence.
2,
3 Moreover, concerns that hyponatremia may lead to increased cerebral edema have led to a broader use of hypertonic saline as a continuous infusion with the goal of either normalizing or obtaining a greater than normal serum sodium.
4 …
