Document Detail

Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries.
MedLine Citation:
PMID:  21087203     Owner:  NLM     Status:  MEDLINE    
OBJECT: The purpose of this study was to compare the effects of mannitol and hypertonic saline in doses of similar osmotic burden for the treatment of intracranial hypertension in patients with severe traumatic brain injury.
METHODS: The authors used an alternating treatment protocol to compare the effect of hypertonic saline with that of mannitol given for episodes of increased intracranial pressure in patients treated for severe head injury at their hospital during 2006-2008. Standard guidelines for the management of severe traumatic brain injury were followed. Elevated intracranial pressure (ICP) was treated either with mannitol or hypertonic saline. Doses of similar osmotic burden (mannitol 20%, 2 ml/kg, infused over 20 minutes, or saline 15%, 0.42 ml/kg, administered as a bolus via a central venous catheter) were given alternately to the individual patient with severe brain injury during episodes of increased pressure. The dependent variables were the extent and duration of reduction of increased ICP. The choice of agent for treatment of the initial hypertensive event was determined on a randomized basis; treatment was alternated for every subsequent event in each individual patient. Reduction of ICP and duration of action were recorded after each event. Results obtained after mannitol administration were statistically compared with those obtained after hypertonic saline administration.
RESULTS: Data pertaining to 199 hypertensive events in 29 patients were collected. The mean decrease in ICP obtained with mannitol was 7.96 mm Hg and that obtained with hypertonic saline was 8.43 mm Hg (p = 0.586, equal variances assumed). The mean duration of effect was 3 hours 33 minutes for mannitol and 4 hours 17 minutes for hypertonic saline (p = 0.40, equal variances assumed).
CONCLUSIONS: No difference between the 2 medications could be found with respect to the extent of reduction of ICP or duration of action.
Nikolaos Sakellaridis; Elias Pavlou; Stylianos Karatzas; Despina Chroni; Konstantinos Vlachos; Konstantinos Chatzopoulos; Eleni Dimopoulou; Christos Kelesis; Vasiliki Karaouli
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-11-19
Journal Detail:
Title:  Journal of neurosurgery     Volume:  114     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-02     Completed Date:  2011-03-10     Revised Date:  2012-02-08    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  545-8     Citation Subset:  AIM; IM    
Department of Neurosurgery, KAT National Hospital, Attica, Greece.
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MeSH Terms
Brain Injuries / complications,  drug therapy*
Diuretics, Osmotic / therapeutic use
Intracranial Hypertension / drug therapy*,  etiology
Intracranial Pressure / drug effects
Mannitol / therapeutic use*
Saline Solution, Hypertonic / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Diuretics, Osmotic; 0/Saline Solution, Hypertonic; 69-65-8/Mannitol
Comment In:
J Neurosurg. 2012 Jan;116(1):256-7; author reply 257   [PMID:  22035273 ]
J Neurosurg. 2011 Feb;114(2):543; discussion 544   [PMID:  21087201 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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