Comparative study between Mannitol versus Hypertonic saline continuous infusion versus Hypertonic saline boluses in treatment of edema of traumatic brain injury

ABSTRACT

Background: Severe brain edema that is not successfully treated can lead to progressive intracranial hypertension, cerebral ischemia, brain herniation, and progression to death. Many studies have shown that hypertonic saline may be effective in treatment of all kinds of cerebral edema and intracranial hypertension caused by various causes, including traumatic brain injury.

Methods: The current study was carried out on 90 adult patients aged ≥ 16 years admitted to Alexandria Main University Hospital with brain edema due to traumatic brain injury with GCS ≤ 12. patients were divided into 3 groups: Group I (30 patients): for patients who received mannitol 20%.Group II (30 patients): for patients who received hypertonic saline 3% continuous infusion. Group III (30 patients): for patients who received hypertonic saline 3% boluses.The efficacy of treatment was assessed radiologically by serial CT brain and clinically by GCS of patients.

Results: After two days of treatment, CT brain findings revealed that mannitol was effective in 70% of patients in group I, HTS infusion was effective in 76.7% of patients in group II and HTS boluses was effective in 83.3% of patients in group III without statistical significant difference between them. GCS improved significantly in all groups after 48 hours of treatment. The main side effect of mannitol treatment was hypovolemia. The main side effects of HTS were Hypernatremia, hyperchloremia and hyperchloremic metabolic acidosis. Patients who received HTS spent fewer days in ICU than patients who received mannitol; also, there was a tendency for a higher survival rate in HTS groups in comparison to mannitol group but with no statistical significance.

Conclusions: HTS is a promising treatment of brain edema due to TBI. There are side effects recorded in patients treated with mannitol and HTS. No significant difference as regarding survival rate and length of ICU stay between mannitol and HTS treatment

Key words – Mannitol, Hypertonic saline continuous infusion, hypertonic saline boluses, brain edema.

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