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. |