Osmotherapy

Osmotherapy is the cornerstone of medical management of cerebral edema. The beneficial effects of osmotherapy are due to the reduction in total brain water content as a result of outflow of water along the osmotic gradient into the vascular compartment across the intact blood brain barrier. Prompt reduction of cerebral edema can lead to improvement in cerebral hemodynamic and oxygenation, which can lead to favourable outcome. Several of these agents exert beneficial extra osmotic properties such as the rheologic, free-radical scavenging properties signify their use in critically ill patients with acute brain injury. Intensivists managing critically injured patients should understand the pharmacokinetics and pharmacodynamics of these agents thoroughly. One should also be cognizant of the adverse effects related to the hyperosmolar agents. This chapter deals with the characteristics of osmotic agents and discusses their pragmatic use in neurocritical care units with reference to the existing guidelines.