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DOI: 10.1055/s-0045-1810105
Preventing Osmotherapy Inertia: A Reassessment-Based Strategy to Reduce Unnecessary Osmotic Therapy in Neurocritical Care
Hyperosmolar therapies like mannitol and hypertonic saline are commonly employed to treat elevated intracranial pressure (ICP) in traumatic brain injury (TBI), subarachnoid hemorrhage, and malignant cerebral edema.[1] [2] Once begun, however, these therapies are continued automatically—despite changes in clinical context or risk-to-benefit balance. This practice, which we call “osmotherapy inertia,” can lead to iatrogenic injury by creating persistent osmotic imbalance, electrolyte disturbances, or rebound cerebral edema.[3] Contemporary neurocritical care has a goal-oriented, personally directed style and frequent reassessment of therapy.[4] The present article suggests an easily implemented reassessment algorithm, a daily evaluation algorithm, and a “STOP criteria” checklist for facilitating safe osmotherapy reduction.
Publication History
Article published online:
09 August 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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