Taylor Waguespack, PharmD
PGY2 Critical Care Pharmacy Resident
Ochsner Medical Center
New Orleans, Louisiana
Disclosure information not submitted.
Natalie Tucker, PharmD
Neurocritical Care Clinical Pharmacist
Ochsner Medical Center, United States
Disclosure information not submitted.
Lauren Kimmons, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist
Methodist Healthcare Memphis Hospitals, United States
Disclosure information not submitted.
G. Morgan Jones, BCPS, PharmD
Clinical Pharmacy Specialist - Neurocritical Care
Methodist LeBonheur Healthcare
Germantown, Tennessee, United States
Disclosure information not submitted.
Title: Impact of Early Mannitol Administration on Hematoma Size in Intracerebral Hemorrhage
Introduction:
Mannitol is often administered following intracerebral hemorrhage (ICH) to treat cerebral edema or elevated intracranial pressure (ICP). Despite decades of use, recent literature has indicated potential safety concerns, with a meta-analysis of Chinese studies finding a 36.3% rate of hematoma expansion (HE) following mannitol use in the early phase of ICH. This study seeks to determine the effect of early mannitol administration on HE in patients with ICH.
Methods:
We completed a retrospective cohort study of ICH patients who were treated between January 2012 and June 2019 and received mannitol within 24 hours of initial brain imaging. The primary objective was to determine the rate of HE following mannitol administration. Patients were determined to have the primary outcome if the hematoma volume on any follow-up image obtained within 24 hours of mannitol documentation was increased by >33%, or the absolute volume increased by >5 mL, from baseline. Secondary outcomes included an assessment of mortality in those with and without HE, which was defined as in-hospital death or discharge to hospice.
Results:
Fifty patients were included. The median age was 57.5 years and 54% of patients were female. Nearly all patients (90%) had a spontaneous, non-traumatic ICH with a median baseline volume of 42.2 mL. After receiving a median mannitol dose of 75 g (0.9 g/kg), 19 (38%) patients experienced HE (95% confidence interval 25.5 - 51.8) on repeat imaging. Mortality was significantly increased in those with HE (63.2%) compared to those without HE (29%; p=0.02).
Conclusions:
We observed a 38% rate of HE following mannitol administration in early ICH, which is consistent with other literature. Mortality was also increased in those who experienced HE. Further research is needed to verify the safety and efficacy of mannitol following ICH.