Optimizing Mannitol Use in Managing Increased Intracranial Pressure: A Comprehensive Review of Recent Research and Clinical Experiences

• Published in: Korean journal of neurotrauma Vol. 19; no. 2; pp. 162 - 176
• Main Authors: Kim, Jae Hyun, Jeong, Heewon, Choo, Yoon-Hee, Kim, Moinay, Ha, Eun Jin, Oh, Jiwoong, Shim, Youngbo, Kim, Seung Bin, Jung, Han-Gil, Park, So Hee, Kim, Jung Ook, Kim, Junhyung, Kim, Hye Seon, Lee, Seungjoo
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Neurotraumatology Society 01.06.2023
• Subjects: Special issue: Neurocritical Care and Neurotrauma; Intracranial pressure; Osmolar concentration; Mannitol; Hypertonic solutions
• ISSN: 2234-8999; 2288-2243
• DOI: 10.13004/kjnt.2023.19.e25

Mannitol, derived from mannose sugar, is crucial in treating patients with elevated intracranial pressure (ICP). Its dehydrating properties at the cellular and tissue levels increase plasma osmotic pressure, which is studied for its potential to reduce ICP through osmotic diuresis. While clinical guidelines support mannitol use in these cases, the best approach for its application continues to be debated. Important aspects needing further investigation include: 1) bolus administration versus continuous infusion, 2) ICP-based dosing versus scheduled bolus, 3) identifying the optimal infusion rate, 4) determining the appropriate dosage, 5) establishing fluid replacement plans for urinary loss, and 6) selecting monitoring techniques and thresholds to assess effectiveness and ensure safety. Due to the lack of adequate high-quality prospective research data, a comprehensive review of recent studies and clinical trials is crucial. This assessment aims to bridge the knowledge gap, improve understanding of effective mannitol use in elevated ICP patients, and provide insights for future research. In conclusion, this review aspires to contribute to the ongoing discourse on mannitol application. By integrating the latest findings, this review will offer valuable insights into the function of mannitol in decreasing ICP, thereby informing better therapeutic approaches and enhancing patient outcomes.