title: 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.
abstract: 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.
authors.affiliation: Intensive Care Unit, Western General Hospital, Edinburgh, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Battison
authors.forename: Peter J D
authors.initials: PJ
authors.lastname: Andrews
authors.forename: Catriona
authors.initials: C
authors.lastname: Graham
authors.forename: Thomas
authors.initials: T
authors.lastname: Petty
mesh_terms: 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
chemical_list: D003911:Dextrans; D012462:Saline Solution, Hypertonic; D008353:Mannitol