Category: Neurocritical care

Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating condition with a 1-month mortality rate of 10–40%. Effective pharmacological interventions are crucial, in addition to surgical or endovascular repair, to effectively treat aneurysmal subarachnoid hemorrhage and its cascade of secondary complications. These treatment strategies focus on stabilizing the patient, securing the ruptured aneurysm, and preventing or managing complications like delayed cerebral ischemia and hydrocephalus.

Elevated intracranial pressure (ICP) in traumatic brain injury is a life-threatening emergency. In cases of subdural hematoma (SDH), a condition where blood collects between the brain's covering and its surface, the question often arises: can we give mannitol in SDH? Yes, mannitol is a potent osmotic diuretic used as a standard temporizing measure to reduce ICP, but its application is specifically reserved for patients showing clinical or radiographic signs of increased pressure, and it is not used prophylactically.

Intracranial hypertension, a sustained pressure above 20 mmHg, is a life-threatening emergency often seen after traumatic brain injury, and its presence significantly increases the risk of death [1.2.2]. So, in these critical moments, **what does hypertonic saline do to the brain?**

Hyperosmolar therapy is a core component of medical management for patients with acute intracranial hypertension. A foundational discovery in 1919 demonstrated that intravenous hyperosmolar solutions could significantly reduce intracranial pressure (ICP) and brain volume. What is hyperosmolar therapy? It is a life-saving strategy that uses highly concentrated solutions to create an osmotic gradient, drawing excess fluid from the brain to alleviate swelling.

In the United States, about 33% of children with severe traumatic brain injury receive hypertonic saline and 40% receive mannitol as part of osmotic therapy to manage brain swelling. So, **what is osmotic therapy?** It is a critical medical intervention that uses osmotically active substances to reduce fluid volume in the brain.