Title: Mannitol Vs Hypertonic Saline in the Treatment of Increased Intracranial Pressure in Traumatic Brain Injury Patients
Authors: Jagadeesh Babu. K, Ramakrishna
DOI: http://dx.doi.org/10.18535/jmscr/v4i8.12
Abstract
Medical management of increased intracranial pressure should include sedation, drainage of cerebrospinal fluid, and osmotherapy with either mannitol or hypertonic saline. The aim of this study is to compare the effects of equimolar doses of 20% mannitol solution and of 7.45% hypertonic saline solution (HS) in elevated intracranial pressure of traumatic brain injury patients. This study was conducted at Mamatha medical college, it includes 20 patients divided into 2 groups; mannitol group (M), and Hypertonic saline(HS)group. A single equimolar infusion (255 mOsm dose) of either 231 ml of 20% mannitol (M)or 100 ml of 7.45% hypertonic saline (HS) administered for 20min. Intracranial pressure, arterial blood pressure, cerebral perfusion pressure,brain tissue oxygen tension, serum sodium and osmolality, and urine output were measured at T0,30,60,90,120 min. The two drugs were efficient in reducing ICP. At 60 mins after the start of theinfusion, ICP was reduced by 44% ±17% of baseline values (mean ± SD) in the mannitol group vs. 33% ±12% of baseline values in the HS group. The CPP was elevated significantly in mannitol group compared to base line values whereas slight elevation was seen in HS group. Significantly greater increase inurine output notice in mannitol than HS, although there was no difference in the vascular filling requirement between the two treatments. HS caused a significant elevation of serum sodium and chlorideat 120 mins after the start of the infusion. It was concluded that equimolar dose of both drugs were effective in treatment of elevated intracranial pressure.
Keywords-Mannitol, hypertonic saline, intracranial pressure, traumatic brain injury.
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