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Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries.
J Neurosurg 2011; 114(2):545-8JN

Abstract

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.

Authors+Show Affiliations

Department of Neurosurgery, KAT National Hospital, Attica, Greece. nicksac2@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21087203

Citation

Sakellaridis, Nikolaos, et al. "Comparison of Mannitol and Hypertonic Saline in the Treatment of Severe Brain Injuries." Journal of Neurosurgery, vol. 114, no. 2, 2011, pp. 545-8.
Sakellaridis N, Pavlou E, Karatzas S, et al. Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries. J Neurosurg. 2011;114(2):545-8.
Sakellaridis, N., Pavlou, E., Karatzas, S., Chroni, D., Vlachos, K., Chatzopoulos, K., ... Karaouli, V. (2011). Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries. Journal of Neurosurgery, 114(2), pp. 545-8. doi:10.3171/2010.5.JNS091685.
Sakellaridis N, et al. Comparison of Mannitol and Hypertonic Saline in the Treatment of Severe Brain Injuries. J Neurosurg. 2011;114(2):545-8. PubMed PMID: 21087203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries. AU - Sakellaridis,Nikolaos, AU - Pavlou,Elias, AU - Karatzas,Stylianos, AU - Chroni,Despina, AU - Vlachos,Konstantinos, AU - Chatzopoulos,Konstantinos, AU - Dimopoulou,Eleni, AU - Kelesis,Christos, AU - Karaouli,Vasiliki, Y1 - 2010/11/19/ PY - 2010/11/20/entrez PY - 2010/11/23/pubmed PY - 2011/3/11/medline SP - 545 EP - 8 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 114 IS - 2 N2 - 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. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/21087203/Comparison_of_mannitol_and_hypertonic_saline_in_the_treatment_of_severe_brain_injuries_ L2 - https://thejns.org/doi/10.3171/2010.5.JNS091685 DB - PRIME DP - Unbound Medicine ER -