A Study On 9 Patients

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Battison, Hons, Andrews, Graham, & Petty (2005) did their study on 9 patients, 6 were from TBI and 3 from subarachnoid hemorrhage. Subject criteria were above 16 years of age presenting to Western Genreal Hospital Edinburgh with an ICP greater than 20 mmHg for a minimum of 5 minutes, one of their patient had an ICP > 40 mmHg. The patients received 2 treatments of each agent in a random order through their card selection every 4 hours or prior if necessary. A few other medications were added such as: Propofol, thiopentone, midazolam, fentanyl, atracurium, noradrenaline and dobutamine. The PcO2 was maintained through intubation and mechanical ventilation. The concentrations used were MTL 20% in a 100 ml bolus, Hypertonic saline 7.5% with dextran 6% in 100 ml bolus allowing them to acquired equimolar strength at 250 mOsm per dose. The authors didn’t apply any restriction regarding the blood osmolality and sodium concentration allowing the level to get higher than normally tolerated. The ICP monitoring was through a doppler monitoring peak flow velocities in the middle cerebral artery. Their results were that MTL reduced ICP below 20 mmHg in 14 of 18 events (ICP averaging 24.0 mmHg pre-agent with a mean reduction of 7.5 mmHg), HTS with Dextran 6% reduced ICP below 20 mmHg in 16 of 18 events (ICP averaging 22.0 mmHg pre-agent with a mean reduction of 13.0 mmHg). The duration of treatment for the MTL to maintain an ICP subthreshold was an average time of 89.5 minutes and HTS was 148 minutes. They came to the conclusion that HTS with Dextran 6% was superior than MTL but the question of cost-benefit ratio was mentioned. In Francony, et al. (2008) a bigger population was used for their studie including 20 patients in stable condit... ... middle of paper ... ... for MTL was 20% (2.5ml/kg) bolus and the HTS concentration was 3% (2.5ml/kg) bolus. The osmolality goal was no more than 320 mOsm/L and a serum sodium concentration smaller than 160 mmol/dL. The ICP was calculated with an external ventricular drain catheter for most severe patients, the other received a transducer. The results on ICP reduction was with MTL was a mean of 8.9 + 8.4 mmHg and with HTS 10.1 + 8.7 mmHg p = 0.135. The duration effect was 57 + 31 mintutes for the MTL group and 55 + 32 minutes for HTS group, p = 0.4. ICP was in therapeutic range (< 20 mmHg) for 93% of the day on the first day for the MTL group and 73% for the HTS group. On the 6th day the MTL group was 49% of the day and 63% for HTS in the therapeutic range. Also 239 doses of MTL were effective versus 153 for HTS. In total 62 doses for MTL and 34 doses for HTS were found ineffective.
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