To determine if hyperosmolar therapy (mannitol or hypertonic saline) administration was associated with higher rates of mortality, ventilator days, intensive care unit (ICU) days, and 90-day modified Rankin scale scores (mRS). 

Hyperosmolar therapy is commonly used in neurocritical care units to treat cerebral edema and manage intracranial hypertension. While hyperosmolar therapy has utility in these scenarios, its administration is also associated with heart failure, hyperchloremia, pulmonary edema, and renal failure. Clinicians may hesitate in their administration of hyperosmolar therapies because the risk-benefit trade off may not always be clear. The purpose of this study is to help clarify hyperosmolar therapy risks. 

We performed a large retrospective review of 174 consecutively admitted patients diagnosed with spontaneous, non-traumatic intracranial hemorrhages. Adult patients (>18 years) with at least two head computerized tomography scans were considered eligible. Demographic data, hyperosmolar therapy doses, volumes, and outcome data were collected into a secured database. Hypertonic saline and mannitol administration were treated as binary independent variables. Outcomes of interest included mortality, number of ICU days, ventilator days, and mRS. Fisher’s exact test was used to evaluate death; all other variables were evaluated with Wilcoxon Rank Sum testing. 

Mannitol administration was associated with increased ventilator days (3.56 vs. 7.42, p<0.001) and death (82.5% vs 56.7%, p=0.03). There was no association between hypertonic saline and outcomes of interest. Administration of any hyperosmolar therapy was associated with increased ventilator days (3.38 vs 7.96, p<0.001).