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The role for osmotic agents in children with acute encephalopathies: a systematic review

BACKGROUND: Raised intracranial pressure (ICP) is known to complicate both traumatic and non-traumatic encephalopathies. It impairs cerebral perfusion and may cause death due to global ischaemia and intracranial herniation. Osmotic agents are widely used to control ICP. In children, guidelines for t...

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Autores principales: Gwer, Samson, Gatakaa, Hellen, Mwai, Leah, Idro, Richard, Newton, Charles R
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859077/
https://www.ncbi.nlm.nih.gov/pubmed/20398408
http://dx.doi.org/10.1186/1471-2431-10-23
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author Gwer, Samson
Gatakaa, Hellen
Mwai, Leah
Idro, Richard
Newton, Charles R
author_facet Gwer, Samson
Gatakaa, Hellen
Mwai, Leah
Idro, Richard
Newton, Charles R
author_sort Gwer, Samson
collection PubMed
description BACKGROUND: Raised intracranial pressure (ICP) is known to complicate both traumatic and non-traumatic encephalopathies. It impairs cerebral perfusion and may cause death due to global ischaemia and intracranial herniation. Osmotic agents are widely used to control ICP. In children, guidelines for their use are mainly guided by adult studies. We conducted this review to determine the current evidence of the effectiveness of osmotic agents and their effect on resolution of coma and outcome in children with acute encephalopathy. METHODS: We searched several databases for published and unpublished studies in English and French languages, between January 1966 and March 2009. We considered studies on the use of osmotic agents in children aged between 0 and 16 years with acute encephalopathies. We examined reduction in intracranial pressure, time to resolution of coma, and occurrence of neurological sequelae and death. RESULTS: We identified four randomized controlled trials, three prospective studies, two retrospective studies and one case report. Hypertonic saline (HS) achieved greater reduction in intracranial pressure (ICP) compared to mannitol and other fluids; normal saline or ringer's lactate. This effect was sustained for longer when it was given as continuous infusion. Boluses of glycerol and mannitol achieved transient reduction in ICP. Oral glycerol was associated with lower mortality and neurological sequelae when compared to placebo in children with acute bacterial meningitis. HS was associated with lower mortality when compared to mannitol in children with non-traumatic encephalopathies. CONCLUSION: HS appears to achieve a greater reduction in ICP than other osmotic agents. Oral glycerol seems to improve outcome among children with acute bacterial meningitis. A sustained reduction in ICP is desirable and could be achieved by modifying the modes and rates of administration of these osmotic agents, but these factors need further investigation.
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spelling pubmed-28590772010-04-24 The role for osmotic agents in children with acute encephalopathies: a systematic review Gwer, Samson Gatakaa, Hellen Mwai, Leah Idro, Richard Newton, Charles R BMC Pediatr Research article BACKGROUND: Raised intracranial pressure (ICP) is known to complicate both traumatic and non-traumatic encephalopathies. It impairs cerebral perfusion and may cause death due to global ischaemia and intracranial herniation. Osmotic agents are widely used to control ICP. In children, guidelines for their use are mainly guided by adult studies. We conducted this review to determine the current evidence of the effectiveness of osmotic agents and their effect on resolution of coma and outcome in children with acute encephalopathy. METHODS: We searched several databases for published and unpublished studies in English and French languages, between January 1966 and March 2009. We considered studies on the use of osmotic agents in children aged between 0 and 16 years with acute encephalopathies. We examined reduction in intracranial pressure, time to resolution of coma, and occurrence of neurological sequelae and death. RESULTS: We identified four randomized controlled trials, three prospective studies, two retrospective studies and one case report. Hypertonic saline (HS) achieved greater reduction in intracranial pressure (ICP) compared to mannitol and other fluids; normal saline or ringer's lactate. This effect was sustained for longer when it was given as continuous infusion. Boluses of glycerol and mannitol achieved transient reduction in ICP. Oral glycerol was associated with lower mortality and neurological sequelae when compared to placebo in children with acute bacterial meningitis. HS was associated with lower mortality when compared to mannitol in children with non-traumatic encephalopathies. CONCLUSION: HS appears to achieve a greater reduction in ICP than other osmotic agents. Oral glycerol seems to improve outcome among children with acute bacterial meningitis. A sustained reduction in ICP is desirable and could be achieved by modifying the modes and rates of administration of these osmotic agents, but these factors need further investigation. BioMed Central 2010-04-17 /pmc/articles/PMC2859077/ /pubmed/20398408 http://dx.doi.org/10.1186/1471-2431-10-23 Text en Copyright ©2010 Gwer et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research article
Gwer, Samson
Gatakaa, Hellen
Mwai, Leah
Idro, Richard
Newton, Charles R
The role for osmotic agents in children with acute encephalopathies: a systematic review
title The role for osmotic agents in children with acute encephalopathies: a systematic review
title_full The role for osmotic agents in children with acute encephalopathies: a systematic review
title_fullStr The role for osmotic agents in children with acute encephalopathies: a systematic review
title_full_unstemmed The role for osmotic agents in children with acute encephalopathies: a systematic review
title_short The role for osmotic agents in children with acute encephalopathies: a systematic review
title_sort role for osmotic agents in children with acute encephalopathies: a systematic review
topic Research article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859077/
https://www.ncbi.nlm.nih.gov/pubmed/20398408
http://dx.doi.org/10.1186/1471-2431-10-23
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