title: Out-of-hospital administration of mannitol to head-injured patients does not change systolic blood pressure.
abstract: OBJECTIVE
  To determine the effect of out-of-hospital mannitol administration on systolic blood pressure (BP) in the head-injured multiple-trauma patient.
  
  
  METHODS
  This was a prospective, randomized, double-blind, placebo-controlled clinical trial involving a university-based helicopter air medical service and level-1 trauma center hospital. Endotracheally intubated head-trauma victims with Glasgow Coma Scale (GCS) scores < 12 were enrolled from November 22, 1991, to November 20, 1992, if evaluated by the participating aeromedical transport team within 6 hours of injury. Patients were excluded if they were < 18 years old, had already received mannitol or another diuretic, were potentially pregnant, or were receiving CPR. All patients were intubated prior to study drug (mannitol [1 g/kg] or normal saline) use. Pulse and BP were measured every 15 minutes for 2 hours following study drug administration.
  
  
  RESULTS
  A total of 44 patients were enrolled. After exclusion of 3 patients who did not meet all inclusion criteria, there were 20 patients in the mannitol group and 21 patients in the placebo group. The groups were similar at baseline in age, pulse, systolic BP (baseline mannitol: 124 +/- 47 mm Hg; placebo: 128 +/- 32 mm Hg), GCS score, and Injury Severity Scale score. Systolic BP did not change significantly throughout the observation period in either group. This study had 83% power to detect a mean systolic BP drop to < 90 mm Hg.
  
  
  CONCLUSIONS
  Out-of-hospital administration of mannitol did not significantly change systolic BP in this group of head-injured multiple-trauma patients.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati Medical Center, OH 45267-0769, USA. michael.sayre@oa.uc.edu
authors.forename: M R
authors.initials: MR
authors.lastname: Sayre
authors.forename: S W
authors.initials: SW
authors.lastname: Daily
authors.forename: S A
authors.initials: SA
authors.lastname: Stern
authors.forename: D L
authors.initials: DL
authors.lastname: Storer
authors.forename: H R
authors.initials: HR
authors.lastname: van Loveren
authors.forename: J M
authors.initials: JM
authors.lastname: Hurst
mesh_terms: D000328:Adult; D017732:Air Ambulances; D001794:Blood Pressure / Q000187:drug effects*; D006259:Craniocerebral Trauma / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004234:Diuretics, Osmotic / Q000627:therapeutic use*; D004311:Double-Blind Method; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008353:Mannitol / Q000627:therapeutic use*; D009104:Multiple Trauma / Q000150:complications*; D011446:Prospective Studies; D013599:Systole; D013997:Time Factors
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol