EFFECTS OF HYPERTONIC SALINE HYDROXYETHYL STARCH SOLUTION AND MANNITOL IN PATIENTS WITH INCREASED INTRACRANIAL-PRESSURE AFTER STROKE

Background and Purpose-The purpose of this study was to prospectively evaluate a protocol with hypertonic saline hydroxyethyl starch (HS-HES ) and mannitol in stroke patients with increased intracranial pressure (ICP). Methods-We studied 30 episodes of ICP crisis in 9 patients. IC P crisis was defined as (1) a rise of ICP of more than 25 mm Hg (n=22) , or (2) pupillary abnormality (n=3), or (3) a combination of both (n= 5). Baseline treatment was performed according to a standardized proto col. For initial treatment, the patients were randomly assigned to eit her infusion of 100 mt HS-HES or 40 g mannitol over 15 minutes. For re peated treatments the 2 substances were alternated. ICP, blood pressur e, and cerebral perfusion pressure (CPP) were monitored over 4 hours. Blood gases, hematocrit, blood osmolarity, and sodium were measured be fore and 15 and 60 minutes after the start of infusion. Treatment was regarded as effective if ICP decreased >10% below baseline value or if the pupillary reaction had normalized. Results-Treatment was effectiv e in all 16 HS-HES-treated and in 10 of 14 mannitol-treated episodes. ICP decreased from baseline values in both groups, P<0.01. The maximum ICP decrease was 11.4 mm Hg (after 25 minutes) in the HS-HES-treated group and 6.4 mm Hg (after 45 minutes) in the mannitol-treated group. There was no constant effect on CPP in the HS-HES-treated group, where as CPP rose significantly in the mannitol-treated group. Blood osmolar ity rose by 6.2 mmol/L in the mannitol-treated group and by 10.5 mmol/ L in the HS-HES-treated group; sodium fell by 3.2 mmol/L in the mannit ol and rose by 4.1 mmol/L in the HS-HES-treated group. Conclusions-Inf usion of 40 g mannitol and 100 mt HS-HES decreases increased ICP after stroke. The maximum effect occurs after the end of infusion and is vi sible over 4 hours. HS-HES seems to lower ICP more effectively but doe s not increase CPP as much as does mannitol.