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Titolo:
Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: A randomized trial
Autore:
Cruz, J; Minoja, G; Okuchi, K;
Indirizzi:
CICNEM, Comprehens Int Ctr Neuroemergencies, BR-04093970 Sao Paulo, SP, Brazil CICNEM Sao Paulo SP Brazil BR-04093970 BCR-04093970 Sao Paulo, SP, Brazil Univ Sao Paulo, BR-05508 Sao Paulo, Brazil Univ Sao Paulo Sao Paulo Brazil BR-05508 ulo, BR-05508 Sao Paulo, Brazil Univ Insubria, Dept Anesthesiol & Crit Care Med, Varese, Italy Univ Insubria Varese Italy t Anesthesiol & Crit Care Med, Varese, Italy Nara Med Univ, Dept Emergency & Crit Care Med, Nara, Japan Nara Med Univ Nara Japan v, Dept Emergency & Crit Care Med, Nara, Japan
Titolo Testata:
NEUROSURGERY
fascicolo: 4, volume: 49, anno: 2001,
pagine: 864 - 871
SICI:
0148-396X(200110)49:4<864:ICOFAS>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
CEREBRAL BLOOD-FLOW; ACUTE BRAIN INJURY; ACUTE HEAD-INJURY; COMATOSE PATIENTS; INTRACRANIAL HYPERTENSION; OXYGEN-CONSUMPTION; ACUTE ANEMIA; METABOLISM; HYPERVENTILATION; HYPEREMIA;
Keywords:
acute subdural hematoma; arteriojugular lactate difference; cerebral extraction of oxygen; head injury; intracranial pressure; mannitol;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Cruz, J CICNEM, Comprehens Int Ctr Neuroemergencies, POB Cx Postal 57011, BR-04093970 Sao Paulo, SP, Brazil CICNEM POB Cx Postal 57011 Sao Paulo SP Brazil BR-04093970 BCrazil
Citazione:
J. Cruz et al., "Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: A randomized trial", NEUROSURGER, 49(4), 2001, pp. 864-871

Abstract

OBJECTIVE: To evaluate clinical outcomes and postoperative physiological findings for comatose patients with acute subdural hematomas who received preoperative high-dose mannitol (HDM) versus conventional-dose mannitol treatment. METHODS: One hundred seventy-eight adult patients with non-missile, traumatic, acute, subdural hematomas were prospectively and randomly assigned to receive emergency, preoperative, intravenous HDM treatment (91 patients), compared with a control group treated with a lower preoperative mannitol dose (87 patients). RESULTS: Preoperative improvement of abnormal pupillary widening was significantly more frequent in the study group than in the control group of patients (P < 0.0001). Preoperative HDM treatment was also associated with significantly better clinical outcomes at 6-month follow-up evaluations (P < 0.01). Postoperative physiological findings revealed statistically significant between-group differences, with higher intracranial pressure and lower cerebral extraction of oxygen (relative cerebral hyperperfusion) in the control group, compared with the HDM group. Postoperative global brain ischemia (abnormally low arteriojugular lactate difference values) was rare and was detected in 2.2 and 3.4% of the patients in the study and control groups, respectively. CONCLUSION: Emergency preoperative HDM administration was associated with improved clinical outcomes for patients with acute subdural hematomas. Preoperative improvement of abnormal pupillary widening and better postoperative control of intracranial hypertension and associated relative cerebral hyperperfusion seemed to be relevant factors associated with improved outcomes.

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Documento generato il 01/12/20 alle ore 00:55:42