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Table 15.14 Dimethyl Sulfoxide for the Acute Management of Intracranial Pressure Post ABI

Author Year

Country

Research Design

PEDro

Sample Size

Methods

Outcomes

Karaca et al. (1991)

Turkey & Canada

Case Series

N=10

Population: TBI; Mean GCS=6.

Intervention: Patients received intravenous infusion of 28% DMSO (1.2 g/kg), every 6 hr for 1-10 days. Monitoring occurred for 10 days and outcomes were assessed at 6 days and 3 mo.

Outcome Measures: Intracranial Pressure (ICP), Neurological assessment.

1.        All patients showed a reduction in ICP after 24 hr and 7 had normal ICP after 6 days.

2.        Reductions in ICP were seen within the first 30 min, however the effect was not sustained and most patients required maintenance doses for 2-10 days to minimize fluctuations in ICP.

3.        Neurological assessment at 6d days showed 2 patients with severe neurological deficits, 2 with moderate impairments, and 6 patients with mild to no deficit.

4.        At 3 mo, 1 patient remained severely impaired and 7 patients showed mild to no deficit.

Kulah et al. (1990)

Turkey

Case Series

N=10

Population: TBI; Mean Time Post Injury=6hr; GCS Range≤6.

Intervention: Patients received intravenous infusion of DMSO up to 7 days.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Mean Arterial Pressure (MAP).

1.        Three patients died due to uncontrolled ICP.

2.        In most cases DMSO reduced ICP within 10min with a parallel increase CPP, but had no effect on MAP.

3.        DMSO caused only a temporary decrease in ICP, as continuous infusions did not prevent the ICP from returning to elevated baseline levels.

Marshall et al. (1984)

USA

Case Series

N=5

Population: ABI; GCS<7.

Intervention: Patients received rapid intravenous infusion of 10% or 20% DMSO at a dose of 1 g/kg, with an upper dose limit of 8 g/kg/day.

Outcome Measures: Intracranial Pressure (ICP), Complications.

 

1.        All patients showed satisfactory control of elevated ICP (ICP<25 mmHg, >15 min) within min (2-24 min).

2.        Despite initial improvements in ICP, an ultimate loss of ICP control occurred.

3.        Most patients experienced significant hypernatremia as a side effect.