Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury.
OBJECTIVE
The aim of this pilot study was to compare the effects of equimolar doses of hypertonic saline and dextran solution (HSD, Rescueflow) with 20% mannitol solution for reduction of increased intracranial pressure.


METHODS
Prospective, randomized, controlled, crossover trial in the intensive care unit of a large teaching hospital.


METHODS
Academic hospital and tertiary referral center for neuroscience.


METHODS
Nine patients with an intracranial pressure of >20 mm Hg were recruited and received two treatments of each, HSD and 20% mannitol, in a randomized order.


METHODS
Equimolar, rapid intravenous infusions of either 200 mL of 20% mannitol or 100 mL of 7.5% saline and 6% dextran-70 solution (HSD) over 5 mins.


METHODS
Intracranial pressure, blood pressure, serum and urine sodium and osmolality, and urine output.


RESULTS
Treatments reduced intracranial pressure with both mannitol (median decrease, 7.5 mm Hg, 95% confidence interval, 5.8-11.8) and HSD (median decrease, 13 mm Hg; 95% confidence interval, 11.5-17.3). HSD caused a significantly greater decrease in intracranial pressure than mannitol (p = .044). HSD had a longer duration of effect than mannitol (p = .044).


CONCLUSIONS
When given in an equimolar, rapid, intravenous infusion, HSD reduces intracranial pressure more effectively than mannitol.
Battison
Claire
C
Intensive Care Unit, Western General Hospital, Edinburgh, UK.
Andrews
Peter J D
PJ
Graham
Catriona
C
Petty
Thomas
T
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000098:blood supply; D001929:Brain Edema / Q000188:drug therapy; D001930:Brain Injuries / Q000188:drug therapy*; D003422:Critical Care / Q000379:methods*; D018592:Cross-Over Studies; D003911:Dextrans / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy*; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D008353:Mannitol / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage* / Q000009:adverse effects; D012606:Scotland; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects
D003911:Dextrans; D012462:Saline Solution, Hypertonic; D008353:Mannitol