Beneficial effects of hypertonic mannitol in acute ischemia—reperfusion injuries in humans

Acute ischemia-reperfusion of extremities is characterized by edema, compartment syndrome and neuromuscular dysfunction. Intravenous hypertonic mannitol has been shown to be of benefit in several experimental models. The authors' 5-year experience with the use of hypertonic mannitol and the treatment of acute ischemia reperfusion injuries in humans has been reviewed. Some 186 patients with acute arterial occlusion following thromboembolism (149) and trauma (37) were treated. Hypertonic mannitol (25g intravenous bolus followed by 5–10g intravenous/h) was given perioperatively. Length of preoperative ischemia varied from 1 to 24 h. Some 57.5% of patients had preoperative neuromuscular dysfunction. Following revascularization, limb salvage was obtained in 97.7% of surviving patients and neuromuscular dysfunction improved in 89%. Overall, 15% required fasciotomy. The mortality rate was 3.2%. These data suggest that hypertonic mannitol may have some protective effect in acute ischemia-reperfusion injuries of human extremities. It may decrease the need for fasciotomy and minimize neuromuscular dysfunction.