Mannitol Versus Hypertonic Saline Solution in the Treatment of Elevated Intracranial Pressure
Mannitol Versus Hypertonic Saline Solution in the Treatment of Elevated Intracranial Pressure
The purpose of this study is to determine whether mannitol is as effective as hypertonic
 saline solution in the treatment of elevated intracranial pressure in patients with brain
 injury.
Elevation of intracranial pressure (ICP) to more than 20 mmHg plays a major role in the
 worsening of the neurological status through the impairment of brain perfusion. In an effort
 to reduce the intensity and the time spent with increased ICP, infusion of mannitol has been
 the recommended first-line agent for years. The growing interest in the use of hypertonic
 saline solutions (HSS) in this clinical setting has, however, challenged the use of mannitol.
 Because mannitol and HSS may differ regarding their clinically relevant mechanisms of action,
 there is a need to determine which osmotic compound could be the most appropriate in patients
 with elevated ICP. We conduct thus a parallel, randomized controlled trial comparing the
 effects of an equimolar infusion of 20% mannitol or 7.45% HSS without colloid in patients
 with elevated ICP. The primary end point of this trial is the magnitude of ICP and of
 cerebral perfusion pressure (CPP) changes following treatment during a study period of 120
 min.
Inclusion Criteria:

 -  age 18 or older

 -  sustained elevated intracranial pressure to more than 20 mmHg for more than 10 min

 -  mechanically ventilated in stable conditions for more than 2 hours prior to the study

 -  serum osmolality ranged between 280 and 320 mOsm/kg

 Exclusion Criteria:

 -  imminent cranial or extracranial surgery

 -  leakage or drainage of cerebral spinal fluid

 -  unstable respiratory and hemodynamic conditions

 -  oliguric renal failure

 -  anemia

 -  use of mannitol or HSS in the previous 6 hours

 -  concomitant use of thiopentone