23.4% sodium chloride versus mannitol for the reduction of intracranial pressure Hayley A. Tatro, James C. McMillen, Leslie A. Hamilton, A. Shaun Rowe University of Tennessee Medical Center (Critical Care) - Knoxville, TN
Background/Purpose: Severe traumatic brain injuries represent one-third of deaths due to trauma in the United States. Intracranial pressure (ICP) monitoring is recommended because elevated ICP is associated with poor outcomes. Mannitol or hypertonic saline (HTS) are recommended to treat elevated ICPs, however current guidelines do not recommend a preferred agent. Previous studies have compared mannitol to HTS with inconclusive results, however no studies have compared 23.4% HTS to mannitol. Therefore, the goal of this study is to determine the difference in reduction of ICP after infusion of 23.4% sodium chloride 30 mL versus 0.5 g/kg 20% mannitol.
Methodology: This study was approved by the University of Tennessee Medical Center Institutional Review Board. The electronic medical record was used to identify patients admitted to the trauma/surgical intensive care unit between August 30, 2016, and August 30, 2018 with a severe traumatic brain injury. Patients were included if they were at least 16 years old, were initiated on the Severe Traumatic Brain Injury Adult Pathway, had an ICP monitor or external ventricular drain (EVD) in place, and if they received 0.5 g/kg mannitol and/or 23.4% sodium chloride 30 mL. The primary objective is absolute reduction in ICP 60 minutes after hyperosmolar therapy.
Presentation Objective: To determine if there is a difference in effectiveness of intracranial pressure reduction between 23.4% sodium chloride and 0.5 g/kg mannitol
Self-Assessment: What is the importance of monitoring and treating an elevated intracranial pressure?