AANS Neurosurgeon | Volume 27, Number 2, 2018


Mannitol Dosing Errors Made During Patient Transport to Tertiary Hospitals

In a study recently published in The Journal of Neurosurgery, researchers from Canada investigated the use of the drug mannitol before and during the transportation of patients with intracranial emergencies from peripheral hospitals to tertiary facilities that house neurosurgery departments. The focus of the study revolved around the appropriate use of the drug and the extent to which potential dosing errors occurred. During the study, the authors found a 22- percent dosing error-rate, with slightly more patients receiving a dose smaller, rather than larger than the dose range recommended by the Brain Tumor Foundation. The authors examined data on mannitol doses and durations of mannitol infusions given to patients with intracranial injuries before and during helicopter medical evacuations to tertiary hospitals in Alberta, Canada, between 2004 and 2012. These data are housed in the Shock Trauma Air Rescue Society (STARS) patient database. The authors examined the data in light of the Brain Trauma Foundation’s Guidelines for the Management of Severe Traumatic Brain Injury. Results of the study showed that given the dose-dependent effect of mannitol, the more worrisome potential error in mannitol dosing is underdosing, which occurred in 8.3 percent of cases. The authors pointed out that the mean dose in patients who received low doses was 0.07 grams per kilogram — far below the recommended amount. They also state that the 7-percent rate of nonbolus administration is of concern because continuous infusion, as opposed to bolus infusion, does not effect a rapid decrease in intracranial pressure. To read more about this study, click here.

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