HYPERTONIC SOLUTIONS FOR THE TREATMENT OF INTRACRANIAL HYPERTENSION

Administration of hypertonic solutions is the method of choice for acu te treatment of intracranial hypertension. Recording of the intracrani al pressure during treatment facilitates adjustment of the dosis to th e actual ICP-response, avoiding thereby administration of an excessive osmotic load as a basis to prolong therapeutical efficacy. The mechan isms underlying reduction of the intracranial pressure by hypertonic s olutions are still controversially discussed. Dehydration of normal pr obably also of edematous brain parenchyma and constriction of cerebral resistance vessels as an autoregulatory response causing reduction of the intracranial blood volume are the most likely options. Administra tion of hypertonic/hyperoncotic solutions has regained attention on ac count of its unmatched therapeutical efficacy to reestablish normal co nditions in severe hemorrhagic shock. Administration of, e. g. 7,2 % N aCl/10 % Dextran 60 in an amount equivalent of only 10 % of the shed b lood volume is immediately normalizing cardiac output and improving th e microcirculation in peripheral organs. These therapeutical propertie s are relevant in head injury, since inflicted patients quite often ar e suffering from peripheral trauma and consequently from hemorrhagic s hock. No evidence has been obtained in a variety of experimental studi es that hypertonic/hyperoncotic solutions have adverse effects on the brain in the presence of a cerebral lesion. To the contrary, the fluid mixture has been found to lower the increased intracranial pressure. Administration of hypertonic/hyperoncotic solutions appears therefore appropriate in acute cerebral insults from head injury and impending c irculatory failure from shock in order to inhibit development of secon dary brain damage.