Increases in lung and brain water following experimental stroke: Effect of mannitol and hypertonic saline

Thomas J K Toung, Yi Chang, Jonathan Lin, Anish Bhardwaj

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objective: Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large ischemic stroke, we tested the hypotheses that lung water increases following cerebral ischemia and determined the effects of osmotherapy with hypertonic saline and mannitol on total lung water, as well as on cerebral edema. Design: Prospective laboratory animal study. Setting: Research laboratory in a university teaching hospital. Subjects: Adult male Wistar rats (300-450 g, n = 103). Interventions: Under controlled conditions of normoxia, normocarbia, and normothermia, spontaneously breathing, halothane-anesthetized (1.0-1.5%) rats were subjected to permanent middle cerebral artery occlusion by the intraluminal occlusion technique. Measurements and Main Results: Cerebral perfusion was monitored by laser-Doppler flowmetry over ipsilateral parietal cortex to ensure adequate vascular occlusion. At 6 hrs following middle cerebral artery occlusion, rats were treated in a blinded randomized fashion with no intravenous fluids (n = 24), a continuous intravenous infusion (0.3 mL/hr) of 0.9% saline (n = 21), 20% mannitol (2 g/Kg) (n = 20), 5% hypertonic saline (n = 20), or 7.5% hypertonic saline (n = 18) as a chloride/acetate mixture (50:50) until the end of the experiment. Brains and lungs were harvested, and tissue water content was estimated by comparing wet-to-dry weight ratios of ipsilateral and contralateral cerebral hemispheres at 48 hrs postischemia. Sham-operated rats served as controls (n = 20). Serum osmolality was determined at the end of the experiment in all animals. Lung water content was increased significantly in rats subjected to middle cerebral artery occlusion and treated with no intravenous fluids (76.7 ± 0.7%, 317 ± 7 mOsm/L) (mean ± SD) and saline (76.8 ± 1.2%, 311 ± 10 mOsm/L), compared with sham-operated controls (74.5 ± 0.9%, 302 ± 4 mOsm/L). Treatment with 20% mannitol (74.4 ± 1.2%, 352 ± 15 mOsm/L), 5% hypertonic saline (75.6 ± 1.3%, 339 ± 16 mOsm/L), and 7.5% hypertonic saline (749 ± 0.7%, 360 ± 23 mOsm/L) significantly attenuated lung water content. Hemispheric brain water content increased both in the ipsilateral ischemic and contralateral hemispheres treated with saline (ipsilateral, 85.1 ± 1.7%; contracteral, 80.7 ± 0.7%), compared with sham-operated controls (ipsilateral, 79.6 ± 0.9%; contralateral, 79.5 ± 0.9%), as well as in rats that received no fluids (ipsilateral, 84.6 ± 1.8%; contralateral, 80.4 ± 0.9%). Treatment with 5% hypotonic saline (ipsilateral, 83.8 ± 1.0%; contralateral, 79.7 ± 0.6%) and 7.5% hypertonic saline (ipsilateral, 82.3 ± 1.3%; contralateral, 78.6 ± 0.7%) resulted in attenuation of stroke-associated increases in brain water content to a greater extent than mannitol (ipsilateral, 83.6 ± 1.6%; contralateral, 79.1 ± 1.0%). Conclusions: In a well-characterized animal model of large ischemic stroke, total lung water content increases, which is likely neurogenic in origin. Attenuation of stroke-associated increases in lung and brain water content with continuous infusion of hypertonic saline may have therapeutic implication in the treatment of cerebral and pulmonary edema following ischemic stroke.

Original languageEnglish (US)
Pages (from-to)203-208
Number of pages6
JournalCritical Care Medicine
Volume33
Issue number1
DOIs
StatePublished - Jan 2005
Externally publishedYes

Fingerprint

Mannitol
Stroke
Lung
Water
Brain
Middle Cerebral Artery Infarction
Brain Edema
Pulmonary Edema
Animal Models
Parietal Lobe
Laser-Doppler Flowmetry
Cerebrum
Laboratory Animals
Halothane
Brain Ischemia
Intravenous Infusions
Teaching Hospitals
Osmolar Concentration
Brain Injuries
Infarction

Keywords

  • Focal cerebral ischemia
  • Hypertonic saline
  • Osmotherapy
  • Pulmonary edema
  • Stroke

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Increases in lung and brain water following experimental stroke : Effect of mannitol and hypertonic saline. / Toung, Thomas J K; Chang, Yi; Lin, Jonathan; Bhardwaj, Anish.

In: Critical Care Medicine, Vol. 33, No. 1, 01.2005, p. 203-208.

Research output: Contribution to journalArticle

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abstract = "Objective: Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large ischemic stroke, we tested the hypotheses that lung water increases following cerebral ischemia and determined the effects of osmotherapy with hypertonic saline and mannitol on total lung water, as well as on cerebral edema. Design: Prospective laboratory animal study. Setting: Research laboratory in a university teaching hospital. Subjects: Adult male Wistar rats (300-450 g, n = 103). Interventions: Under controlled conditions of normoxia, normocarbia, and normothermia, spontaneously breathing, halothane-anesthetized (1.0-1.5{\%}) rats were subjected to permanent middle cerebral artery occlusion by the intraluminal occlusion technique. Measurements and Main Results: Cerebral perfusion was monitored by laser-Doppler flowmetry over ipsilateral parietal cortex to ensure adequate vascular occlusion. At 6 hrs following middle cerebral artery occlusion, rats were treated in a blinded randomized fashion with no intravenous fluids (n = 24), a continuous intravenous infusion (0.3 mL/hr) of 0.9{\%} saline (n = 21), 20{\%} mannitol (2 g/Kg) (n = 20), 5{\%} hypertonic saline (n = 20), or 7.5{\%} hypertonic saline (n = 18) as a chloride/acetate mixture (50:50) until the end of the experiment. Brains and lungs were harvested, and tissue water content was estimated by comparing wet-to-dry weight ratios of ipsilateral and contralateral cerebral hemispheres at 48 hrs postischemia. Sham-operated rats served as controls (n = 20). Serum osmolality was determined at the end of the experiment in all animals. Lung water content was increased significantly in rats subjected to middle cerebral artery occlusion and treated with no intravenous fluids (76.7 ± 0.7{\%}, 317 ± 7 mOsm/L) (mean ± SD) and saline (76.8 ± 1.2{\%}, 311 ± 10 mOsm/L), compared with sham-operated controls (74.5 ± 0.9{\%}, 302 ± 4 mOsm/L). Treatment with 20{\%} mannitol (74.4 ± 1.2{\%}, 352 ± 15 mOsm/L), 5{\%} hypertonic saline (75.6 ± 1.3{\%}, 339 ± 16 mOsm/L), and 7.5{\%} hypertonic saline (749 ± 0.7{\%}, 360 ± 23 mOsm/L) significantly attenuated lung water content. Hemispheric brain water content increased both in the ipsilateral ischemic and contralateral hemispheres treated with saline (ipsilateral, 85.1 ± 1.7{\%}; contracteral, 80.7 ± 0.7{\%}), compared with sham-operated controls (ipsilateral, 79.6 ± 0.9{\%}; contralateral, 79.5 ± 0.9{\%}), as well as in rats that received no fluids (ipsilateral, 84.6 ± 1.8{\%}; contralateral, 80.4 ± 0.9{\%}). Treatment with 5{\%} hypotonic saline (ipsilateral, 83.8 ± 1.0{\%}; contralateral, 79.7 ± 0.6{\%}) and 7.5{\%} hypertonic saline (ipsilateral, 82.3 ± 1.3{\%}; contralateral, 78.6 ± 0.7{\%}) resulted in attenuation of stroke-associated increases in brain water content to a greater extent than mannitol (ipsilateral, 83.6 ± 1.6{\%}; contralateral, 79.1 ± 1.0{\%}). Conclusions: In a well-characterized animal model of large ischemic stroke, total lung water content increases, which is likely neurogenic in origin. Attenuation of stroke-associated increases in lung and brain water content with continuous infusion of hypertonic saline may have therapeutic implication in the treatment of cerebral and pulmonary edema following ischemic stroke.",
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TY - JOUR

T1 - Increases in lung and brain water following experimental stroke

T2 - Effect of mannitol and hypertonic saline

AU - Toung, Thomas J K

AU - Chang, Yi

AU - Lin, Jonathan

AU - Bhardwaj, Anish

PY - 2005/1

Y1 - 2005/1

N2 - Objective: Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large ischemic stroke, we tested the hypotheses that lung water increases following cerebral ischemia and determined the effects of osmotherapy with hypertonic saline and mannitol on total lung water, as well as on cerebral edema. Design: Prospective laboratory animal study. Setting: Research laboratory in a university teaching hospital. Subjects: Adult male Wistar rats (300-450 g, n = 103). Interventions: Under controlled conditions of normoxia, normocarbia, and normothermia, spontaneously breathing, halothane-anesthetized (1.0-1.5%) rats were subjected to permanent middle cerebral artery occlusion by the intraluminal occlusion technique. Measurements and Main Results: Cerebral perfusion was monitored by laser-Doppler flowmetry over ipsilateral parietal cortex to ensure adequate vascular occlusion. At 6 hrs following middle cerebral artery occlusion, rats were treated in a blinded randomized fashion with no intravenous fluids (n = 24), a continuous intravenous infusion (0.3 mL/hr) of 0.9% saline (n = 21), 20% mannitol (2 g/Kg) (n = 20), 5% hypertonic saline (n = 20), or 7.5% hypertonic saline (n = 18) as a chloride/acetate mixture (50:50) until the end of the experiment. Brains and lungs were harvested, and tissue water content was estimated by comparing wet-to-dry weight ratios of ipsilateral and contralateral cerebral hemispheres at 48 hrs postischemia. Sham-operated rats served as controls (n = 20). Serum osmolality was determined at the end of the experiment in all animals. Lung water content was increased significantly in rats subjected to middle cerebral artery occlusion and treated with no intravenous fluids (76.7 ± 0.7%, 317 ± 7 mOsm/L) (mean ± SD) and saline (76.8 ± 1.2%, 311 ± 10 mOsm/L), compared with sham-operated controls (74.5 ± 0.9%, 302 ± 4 mOsm/L). Treatment with 20% mannitol (74.4 ± 1.2%, 352 ± 15 mOsm/L), 5% hypertonic saline (75.6 ± 1.3%, 339 ± 16 mOsm/L), and 7.5% hypertonic saline (749 ± 0.7%, 360 ± 23 mOsm/L) significantly attenuated lung water content. Hemispheric brain water content increased both in the ipsilateral ischemic and contralateral hemispheres treated with saline (ipsilateral, 85.1 ± 1.7%; contracteral, 80.7 ± 0.7%), compared with sham-operated controls (ipsilateral, 79.6 ± 0.9%; contralateral, 79.5 ± 0.9%), as well as in rats that received no fluids (ipsilateral, 84.6 ± 1.8%; contralateral, 80.4 ± 0.9%). Treatment with 5% hypotonic saline (ipsilateral, 83.8 ± 1.0%; contralateral, 79.7 ± 0.6%) and 7.5% hypertonic saline (ipsilateral, 82.3 ± 1.3%; contralateral, 78.6 ± 0.7%) resulted in attenuation of stroke-associated increases in brain water content to a greater extent than mannitol (ipsilateral, 83.6 ± 1.6%; contralateral, 79.1 ± 1.0%). Conclusions: In a well-characterized animal model of large ischemic stroke, total lung water content increases, which is likely neurogenic in origin. Attenuation of stroke-associated increases in lung and brain water content with continuous infusion of hypertonic saline may have therapeutic implication in the treatment of cerebral and pulmonary edema following ischemic stroke.

AB - Objective: Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large ischemic stroke, we tested the hypotheses that lung water increases following cerebral ischemia and determined the effects of osmotherapy with hypertonic saline and mannitol on total lung water, as well as on cerebral edema. Design: Prospective laboratory animal study. Setting: Research laboratory in a university teaching hospital. Subjects: Adult male Wistar rats (300-450 g, n = 103). Interventions: Under controlled conditions of normoxia, normocarbia, and normothermia, spontaneously breathing, halothane-anesthetized (1.0-1.5%) rats were subjected to permanent middle cerebral artery occlusion by the intraluminal occlusion technique. Measurements and Main Results: Cerebral perfusion was monitored by laser-Doppler flowmetry over ipsilateral parietal cortex to ensure adequate vascular occlusion. At 6 hrs following middle cerebral artery occlusion, rats were treated in a blinded randomized fashion with no intravenous fluids (n = 24), a continuous intravenous infusion (0.3 mL/hr) of 0.9% saline (n = 21), 20% mannitol (2 g/Kg) (n = 20), 5% hypertonic saline (n = 20), or 7.5% hypertonic saline (n = 18) as a chloride/acetate mixture (50:50) until the end of the experiment. Brains and lungs were harvested, and tissue water content was estimated by comparing wet-to-dry weight ratios of ipsilateral and contralateral cerebral hemispheres at 48 hrs postischemia. Sham-operated rats served as controls (n = 20). Serum osmolality was determined at the end of the experiment in all animals. Lung water content was increased significantly in rats subjected to middle cerebral artery occlusion and treated with no intravenous fluids (76.7 ± 0.7%, 317 ± 7 mOsm/L) (mean ± SD) and saline (76.8 ± 1.2%, 311 ± 10 mOsm/L), compared with sham-operated controls (74.5 ± 0.9%, 302 ± 4 mOsm/L). Treatment with 20% mannitol (74.4 ± 1.2%, 352 ± 15 mOsm/L), 5% hypertonic saline (75.6 ± 1.3%, 339 ± 16 mOsm/L), and 7.5% hypertonic saline (749 ± 0.7%, 360 ± 23 mOsm/L) significantly attenuated lung water content. Hemispheric brain water content increased both in the ipsilateral ischemic and contralateral hemispheres treated with saline (ipsilateral, 85.1 ± 1.7%; contracteral, 80.7 ± 0.7%), compared with sham-operated controls (ipsilateral, 79.6 ± 0.9%; contralateral, 79.5 ± 0.9%), as well as in rats that received no fluids (ipsilateral, 84.6 ± 1.8%; contralateral, 80.4 ± 0.9%). Treatment with 5% hypotonic saline (ipsilateral, 83.8 ± 1.0%; contralateral, 79.7 ± 0.6%) and 7.5% hypertonic saline (ipsilateral, 82.3 ± 1.3%; contralateral, 78.6 ± 0.7%) resulted in attenuation of stroke-associated increases in brain water content to a greater extent than mannitol (ipsilateral, 83.6 ± 1.6%; contralateral, 79.1 ± 1.0%). Conclusions: In a well-characterized animal model of large ischemic stroke, total lung water content increases, which is likely neurogenic in origin. Attenuation of stroke-associated increases in lung and brain water content with continuous infusion of hypertonic saline may have therapeutic implication in the treatment of cerebral and pulmonary edema following ischemic stroke.

KW - Focal cerebral ischemia

KW - Hypertonic saline

KW - Osmotherapy

KW - Pulmonary edema

KW - Stroke

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