{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:59:47Z","timestamp":1784696387176,"version":"3.55.0"},"reference-count":54,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[1998,8]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            \u2014The purpose of this study was to prospectively evaluate a protocol with hypertonic saline hydroxyethyl starch (HS-HES) and mannitol in stroke patients with increased intracranial pressure (ICP).\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            \u2014We studied 30 episodes of ICP crisis in 9 patients. ICP crisis was defined as (1) a rise of ICP of more than 25 mm Hg (n=22), or (2) pupillary abnormality (n=3), or (3) a combination of both (n=5). Baseline treatment was performed according to a standardized protocol. For initial treatment, the patients were randomly assigned to either infusion of 100 mL HS-HES or 40 g mannitol over 15 minutes. For repeated treatments the 2 substances were alternated. ICP, blood pressure, and cerebral perfusion pressure (CPP) were monitored over 4 hours. Blood gases, hematocrit, blood osmolarity, and sodium were measured before and 15 and 60 minutes after the start of infusion. Treatment was regarded as effective if ICP decreased &gt;10% below baseline value or if the pupillary reaction had normalized.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            \u2014Treatment was effective in all 16 HS-HES\u2013treated and in 10 of 14 mannitol-treated episodes. ICP decreased from baseline values in both groups,\n            <jats:italic>P<\/jats:italic>\n            &lt;0.01. The maximum ICP decrease was 11.4 mm Hg (after 25 minutes) in the HS-HES\u2013treated group and 6.4 mm Hg (after 45 minutes) in the mannitol-treated group. There was no constant effect on CPP in the HS-HES\u2013treated group, whereas CPP rose significantly in the mannitol-treated group. Blood osmolarity rose by 6.2 mmol\/L in the mannitol-treated group and by 10.5 mmol\/L in the HS-HES\u2013treated group; sodium fell by 3.2 mmol\/L in the mannitol and rose by 4.1 mmol\/L in the HS-HES\u2013treated group.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014Infusion of 40 g mannitol and 100 mL HS-HES decreases increased ICP after stroke. The maximum effect occurs after the end of infusion and is visible over 4 hours. HS-HES seems to lower ICP more effectively but does not increase CPP as much as does mannitol.\n          <\/jats:p>","DOI":"10.1161\/01.str.29.8.1550","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:08:03Z","timestamp":1308341283000},"page":"1550-1555","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":205,"title":["Effects of Hypertonic Saline Hydroxyethyl Starch Solution and Mannitol in Patients With Increased Intracranial Pressure After Stroke"],"prefix":"10.1161","volume":"29","author":[{"given":"Stefan","family":"Schwarz","sequence":"first","affiliation":[{"name":"From the Departments of Neurology and Neurosurgery (A.A.), University of Heidelberg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schwab","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology and Neurosurgery (A.A.), University of Heidelberg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Bertram","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology and Neurosurgery (A.A.), University of Heidelberg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Aschoff","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology and Neurosurgery (A.A.), University of Heidelberg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Hacke","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology and Neurosurgery (A.A.), University of Heidelberg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_1_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1996.00550040037012"},{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1991.75.5.0731"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.48.6.1608"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1978.48.2.0169"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1984.61.4.0700"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199610000-00013"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199601000-00031"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01420045"},{"key":"e_1_3_1_9_2","first-page":"854","volume":"77","year":"1992","unstructured":"Kaufman AM, Cardoso ER. 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