Role of Furosemide in Cerebral edema

Role of Furosemide in Cerebral edema

An Evidence Based Medicine Approach.

From the experimental study using rat by M. Gaab et al,

The diuretic effect is insufficient to establish an osmotic gradient, and its general dehydrating effect does not acutely influence the ICP. The absence of effect on the experimental tissue edema would not appear to commend furosemide as basic therapy for cases of traumatic cerebral edema. [M. Gaab, O. E. Knoblich, J. Schupp et al]

Summary from “Medical management of cerebral edema by Ahmed Raslan and Anish Bhardwaj, Neurosurg Focus 22 (5):E12, 2007

1) The role is controversial especially when used alone

2) Combining it with mannitol will produce profound diuresis but the efficacy and optimum duration of this treatment remain unknown

3) Risk of serious volume depletion is substantial hence need rigorous attention to systemic hydration status.

4) May compromised the cerebral perfusion

5) Acetazolamide, a carbonic anhydrase inhibitor that acts as a weak diuretic and modulates CSF production, does not have a role in cerebral edema that results from acute brain injuries

From the experimental rat study by By Kokila Thenuwara et al, "Effect of Mannitol and Furosemide on Plasma Osmolality and Brain Water", Anesthesiology 2002; 96:416–21

1) One mechanism by which these changes might occur is via a reduction in brain water content

2) Furosemide alone did not affect plasma osmolality or brain water at any dose.

3) Furosemide produced marked loss of body water or body weight without alteration of brain water, indicating that reduction of peripheral water content alone may not affect brain water

4) Furosemide enhanced the effect of mannitol on plasma osmolality, resulting in a greater reduction of brain water content

5) The mechanism by which furosemide affects mannitol induced change in plasma osmolality is not clear

My conclusion is

1) Using of furosemide alone is not beneficial and has no effect in reducing brain edema

2) Furosemide may be add to the mannitol therapy but require intensive monitoring of systemic body fluid.

3) Using of alternative like hypertonic saline are more beneficial than furosemide.