Efficacy Comparison of Mannitol and Hypertonic Saline  for Traumatic Brain Injury (TBI) Treatment

Arifianto, Muhammad Reza; Ma'ruf, Achmad Zuhro; Ibrahim, Arsyik

doi:10.15562/bmj.v5i3.281

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…[ 34 ] One of the main conservative therapies to reduce ICP for TBI patients is hyperosmolar therapy. [ 35 ] Currently, only 2 agents are used for this purpose: Mannitol and hypertonic saline (HTS). Both the fluids have no superiority among them, even though latest studies showed that HTS had more benefits than mannitol in reducing ICP.…”

Section: The Usage Of Hypertonic Sodium Lactate In Traumatic Brain Inmentioning

confidence: 99%

Role of hypertonic sodium lactate in traumatic brain injury management

Arifianto¹,

Ma'ruf²,

Ibrahim

et al. 2018

Asian J Neurosurg

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Traumatic brain injury (TBI) following increased intracranial pressure (ICP) is a neuroemergency case which should be managed promptly to prevent secondary brain injury. This will lead to a condition called cerebral energy dysfunction which is an important determinant factor toward worse outcome. Lactate, which was historically known as an end waste product, now is considered as an alternative cerebral energetic fuel. Hypertonic sodium lactate (HSL) is a promising hyperosmolar fluid which serves not only to decrease ICP but also to readily supply exogenous lactate to fulfill increased cerebral energy demand. Pioneer studies have shown the harmlessness and usefulness of HSL in treating pathological condition including TBI.

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Section: The Usage Of Hypertonic Sodium Lactate In Traumatic Brain Inmentioning

confidence: 99%

Role of hypertonic sodium lactate in traumatic brain injury management

Arifianto¹,

Ma'ruf²,

Ibrahim

et al. 2018

Asian J Neurosurg

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“…Injured cells tend to have dysfunctional transport mechanism within plasma membrane. This leads to sodium and calcium accumulation in cytoplasm that eventually leads to cellular edema [2] .…”

Section: Introductionmentioning

confidence: 99%

“…Hyperosmolar fluid administration, such as mannitol or hypertonic saline, has been proven to be 955 effective in reducing ICP. While some studies favored hypertonic saline over mannitol, however it is still difficult to prove the superiority between the two fluids because of the heterogeneity of the studies; so, which is more effective remains a matter of debate [2] .…”

Section: Introductionmentioning

confidence: 99%

Original Article: Hypertonic Saline Versus Mannitol Therapy in Traumatic Brain Injured Patients Guiding by Transcranial Doppler Pulsatile Index in Zagazig University Hospital

Salem¹,

Othman²,

Abdel-Razek

et al. 2018

The Medical Journal of Cairo University

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Background: Hyperosmolar therapy is the primary medical management strategy for brain edema and raised intracranial pressure. The role of osmotic therapy with either mannitol or hypertonic saline is based on the principle that these agents will help to remove water from brain tissue across an intact blood brain barrier. There is a debatation regarding the efficacy of hypertonic saline (HTS) versus mannitol in traumatic brain injury when are given in equiosmolar doses. Patients and Methods:An interventional study carried out at trauma and surgical critical care units in Zagazig University Hospital during the period from march 2016 to march 2017. It included ninety patients with different ages, sexes and Glasgow coma scale. The patients were randomly selected from the trauma and surgical critical care units, provided that the patients not received hyperosmolar drug before admission The patients were classified into three groups (thirty patients for each group) as the following: Group A: Included those who are treated with 20% mannitol. Group B: Included those who are treated with 3% hypertonic saline. Group C: Included those who are treated with 3% hypertonic saline alternating with 20% mannitol. Transcranial Doppler parameters especially pulsatility index were observed in the patients before every drug dose and 30 min after giving. Then we observed the change in value of cranial Doppler pulsatility index with subsequently interpretation of values.Results: There was no significant difference in equiosmolar dose (2ml/kg/6h) between mannitol 20% and hypertonic saline 3% in reducing noninvasive intracranial pressure (nICP) and pulsatility index (PI). Also, there were no significant differences in GCS at the end of treatment and GOS at one month from admission and decrease nICP between the two agents. Conclusion:This study recommends that in absence of contraindications, no superiority of hypertonic saline 3% over mannitol 20% as hyperosmolar therapy in TBI patients as the both are equally effective in reducing ICP and neurological outcome.

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Effects of two different doses of 3% hypertonic saline with mannitol during decompressive craniectomy following traumatic brain injury: A prospective, controlled study

Bhatnagar

Bhateja²,

Jeenger³

et al. 2021

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: The current study was designed to compare the effects of two different doses of 3% hypertonic saline with mannitol on intraoperative events during decompressive craniectomy in traumatic brain injury (TBI). Primary outcome measures included assessment of intraoperative brain relaxation, hemodynamic variables, and serum electrolytes. Effect on the postoperative outcome, in terms of the Glasgow coma scale (GCS), length of stay in the ICU, and mortality were the secondary outcome measures. Material and Methods: Ninety patients with TBI undergoing craniotomy were enrolled. Patients were assigned to receive 300 mL (328 mOsm) of mannitol (n = 26, M) only or 300 mL of mannitol with 150 mL (482 mOsm) of 3% HS (n = 35, HS1) or with 300 mL (636 mOsm) of 3% HS (n = 29, HS2). Brain relaxation was assessed and if required, a rescue dose of mannitol (150 mL) was given. GCS was assessed preoperatively, 24 h postoperatively, and at the time of discharge from the ICU and total duration of stay was noted. Results: Acceptable brain relaxation was observed in 89.66% (n = 26, HS2) and 80% (n = 28, HS1) patients as compared to 46.1% (n = 12, M) patients (P < 0.001) with significantly less number of patients requiring rescue doses of mannitol in groups HS1 and HS2(n = 7 and 3, respectively) as compared to group M (n = 14) (P < 0.05). There was a significant improvement in GCS at 24 h and at the time of discharge from the ICU in patients with a severe head injury in group HS2 (P = 0.029). In patients with moderate head injury there was a significant improvement in GCS at the time of discharge among all the three groups (P < 0.05). Conclusion: Increasing osmotic load by addition of 3% HS to mannitol provides better intraoperative brain relaxation than mannitol alone during decompressive craniectomy. An addition of 300mL 3% HS was found to be more effective in improving GCS in patients with severe TBI.

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Efficacy Comparison of Mannitol and Hypertonic Saline for Traumatic Brain Injury (TBI) Treatment

Cited by 3 publications

References 16 publications

Role of hypertonic sodium lactate in traumatic brain injury management

Role of hypertonic sodium lactate in traumatic brain injury management

Original Article: Hypertonic Saline Versus Mannitol Therapy in Traumatic Brain Injured Patients Guiding by Transcranial Doppler Pulsatile Index in Zagazig University Hospital

Effects of two different doses of 3% hypertonic saline with mannitol during decompressive craniectomy following traumatic brain injury: A prospective, controlled study

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