A Character of Surgical Intervention and Its Effect on Tactics of Using Hyperosmotic Solutions in Cases with Intracranial Hemorrhage

A.A. Solodov, S.S. Petrikov, Yu.V. Titova, H.T. Guseynova

Sklifosovsky Research Institute of Emergency care, Moscow, Russia

 

Cerebral decompression (CD) is one of the methods for correction of intracranial hypertension (ICH). However, it does not exclude possible increase of intracranial pressure (ICP) and necessity of using hyperosmotic solutions (HS).

The study goal has been comparing a volume of injected HS and a rate of their use in cases with intracranial hemorrhages after osteoplastic trephination (OPT) and cerebral decompression.

Material and Methods. There were 27 cases with intracranial hemorrhages and consciousness disturbances (the score of 4-9 according to Glasgow Coma Scale). OPT and CD were performed in 15 (Group I) and 12 (Group II) of them, respectively. Invasive monitoring of ICP was carried out in all the cases. Persistent increase of ICP (more than 20 mm Hg) demanded bolus I/V injection of 400 ml of 15% mannitol solution or 250 ml of 7.2% NaCl solution in 6% HEC 200/0.5 (HyperHAES). A volume of HS, injected during the first three postoperative days, and a rate of their use were analyzed.

Results. There were 41 episodes of ICP increase in cases of Group I, which caused necessity of HS injection. A number of such episodes in Group II was 22. CD was accompanied by decrease of a volume of injected HS.

Table

Volume of HS (ml) used for decrease of ICP

Type of operation

Day of operation

First

Second

Third

15% Mannitol

HAES

15% Mannitol

HAES

15% Mannitol

HAES

OPT

609±539

0

590±495

35.7±89.6

444±426

69±115

CD

333±477

21±72

291±361

22±75

254±401

45±101

Conclusion. CD does not exclude possibility of intracranial hypertension development, but reduces a volume of injected HS and a rate of their use in critical cases with intracranial hypertension.