title: Comparison of effects of equiosmolar doses of mannitol and hypertonic saline on cerebral blood flow and metabolism in traumatic brain injury.
abstract: The potential superiority of hypertonic saline (HTS) over mannitol (MTL) for control of intracranial pressure (ICP) following traumatic brain injury (TBI) is still debated. Forty-seven severe TBI patients with increased ICP were prospectively recruited in two university hospitals and randomly treated with equiosmolar infusions of either MTL 20% (4 mL/kg; n=25 patients) or HTS 7.5% (2 mL/kg; n=22 patients). Serum sodium, hematocrit, ICP, arterial blood pressure, cerebral perfusion pressure (CPP), shear rate, global indices of cerebral blood flow (CBF) and metabolism were measured before, and 30 and 120 min following each infusion during the course of illness. Outcome was assessed at 6 months. Both HTS and MTL effectively and equally reduced ICP levels with subsequent elevation of CPP and CBF, although this effect was significantly stronger and of longer duration after HTS and correlated with improved rheological blood properties induced by HTS. Further, effect of HTS on ICP appeared to be more robust in patients with diffuse brain injury. In contrast, oxygen and glucose metabolic rates were left equally unaffected by both solutions. Accordingly, there was no significant difference in neurological outcome between the two groups. In conclusion, MTL was as effective as HTS in decreasing ICP in TBI patients although both solutions failed to improved cerebral metabolism. HTS showed an additional and stronger effect on cerebral perfusion of potential benefit in the presence of cerebral ischemia. Treatment selection should therefore be individually based on sodium level and cerebral hemodynamics.
authors.affiliation: Service d'Anesthésie Réanimation 1, Hôpital Pellegrin, CHU de Bordeaux, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Cottenceau
authors.forename: Francoise
authors.initials: F
authors.lastname: Masson
authors.forename: Eugenia
authors.initials: E
authors.lastname: Mahamid
authors.forename: Laurent
authors.initials: L
authors.lastname: Petit
authors.forename: Venyamin
authors.initials: V
authors.lastname: Shik
authors.forename: Francois
authors.initials: F
authors.lastname: Sztark
authors.forename: Menashe
authors.initials: M
authors.lastname: Zaaroor
authors.forename: Jean Francois
authors.initials: JF
authors.lastname: Soustiel
mesh_terms: D000328:Adult; D000368:Aged; D001809:Blood Viscosity; D001923:Brain Chemistry / Q000187:drug effects; D001930:Brain Injuries / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D012462:Saline Solution, Hypertonic; D008353:Mannitol