OBJECTIVE: To evaluate the clinical benefit of increasing the osmotic load of the hypertonic solution administered for the treatment of refractory @entity428 episodes in @entity1 with severe @entity542 . DESIGN: Prospective, randomized study. SETTINGS: A @entity130 center in a university hospital. @entity1 : Twenty consecutive @entity1 with @entity542 and persistent @entity772 who required infusions of an osmotic agent to treat episodes of @entity428 resistant to well-conducted standard modes of therapy were studied. Intracranial @entity101 was considered refractory when it persisted despite deep sedation, optimal hemodynamic status, and, in some @entity1 , drainage of cerebral spinal fluid. INTERVENTIONS: @entity1 were randomly assigned to receive isovolume infusions of either 7.5% hypertonic saline solution (2400 mOsm/kg/ @entity2507 ) or 20% @entity2656 (1160 mOsm/kg/ @entity2507 ). The @entity1 were given 2 mL/kg (body weight) of either solution, i.e., 361 +/- 13 mOsm of saline or 175 +/- 12 mOsm of @entity2656 per injection. MEASUREMENTS AND MAIN RESULTS: The main variables studied were the number and the duration of episodes of @entity428 per day during the study period, which was stopped after the last episode of @entity428 was recorded from intracranial pressure monitoring or after the allocated treatment failure. @entity1 in the @entity11339 group were monitored for 7 +/- 5 days and those in the @entity2656 group for 7 +/- 6 days (not significant). The rate of failure for each treatment was also evaluated. Failure was defined as the persistence of @entity428 despite two successive infusions of the same osmotic agent. The mean number of osmotic solute infusions was 3.7 +/- 5.3 in the @entity2656 group and 3.3 +/- 4.1 in the hypertonic saline solution group (not significant). The mean number (6.9 +/- 5.6 vs. 13.3 +/- 14.6 episodes) of @entity428 episodes per day and the daily duration (67 +/- 85 vs. 131 +/- 123 min) of @entity428 episodes were significantly lower in the hypertonic saline solution group (p <.01). The rate of clinical failure was also significantly lower in the hypertonic saline solution group: 1 of 10 @entity1 vs. 7 of 10 @entity1 (p <.01). CONCLUSION: In this study, when a hypertonic solute was required for the treatment of refractory @entity428 episodes in @entity1 with severe @entity542 , increasing the osmotic load by giving 2 mL/kg (body weight) of 7.5% saline (361 +/- 13 mOsm) was more effective than giving 2 mL/kg (body weight) of 20% @entity2656 (175 +/- 12 mOsm). Within the limitations of the present study, these data suggest that giving 2 mL/kg hypertonic saline solution (approximately 480 mOsm/70 kg body weight) is an effective and safe initial treatment for @entity428 episodes in @entity542 @entity1 when osmotherapy is indicated.

Isovolume hypertonic solutes (sodium chloride or @entity2656 ) in the treatment of refractory posttraumatic @entity428 : 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'PATIENTS'] @entity2656 :: ('MESH:D008353', 'Chemical') :: ['mannitol'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertension'] @entity428 :: ('MESH:D019586', 'Disease') :: ['intracranial hypertension'] @entity542 :: ('MESH:D006259', 'Disease') :: ['head trauma', 'head-trauma', 'head injury'] @entity772 :: ('MESH:D003128', 'Disease') :: ['coma'] @entity11339 :: ('MESH:D058747', 'Disease') :: ['HHS'] @entity2507 :: ('CHEBI:33813', 'Chemical') :: ['H(2)O'] @entity130 :: ('MESH:D014947', 'Disease') :: ['trauma']
@entity2656 :: (MESH:D008353,Chemical) :: ['mannitol']
