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. Design. Prospective, randomized, controlled, crossover trial in the intensive care unit of a large teaching hospital. Setting: Academic hospital and tertiary referral center for neuroscience. Patients: 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. Intervention: 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. Measurements. Intracranial pressure, blood pressure, serum and urine sodium and osmolality, and urine output. Main 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). Conclusion. When given in an equimolar, rapid, intravenous infusion, HSD reduces intracranial pressure more effectively than mannitol.