Effect of Hyperosmolar Combined Solution of Mannitol 15% Plus 3.5% NaCl Solution on Cerebral Edema in Patients With Traumatic Brain Injury

Background and Aim: Craniocerebral trauma is one of the vital public health problems and causes elevated intracranial pressure (ICP) and low cerebral perfusion pressure. Methods and Materials/Patients: In this work, 15% hyperosmolar solution colloid-mannitol and 3.5% crystalloid-sodium chloride (NaCl) were used simultaneously. Both have the same mechanism of action creating an osmotic gradient between the blood-brain barrier and brain tissue. In a single-center, randomized open clinical study, 35 patients were treated in the intensive care unit (ICU) with isolated traumatic brain injury aged 18 to 65 years with depression of consciousness (4-12 points on the Glasgow coma scale [GCS]), and abnormal computed tomography (CT) data of the head on admission. Results: The data demonstrated the positive effect of mannitol 15% + NaCl 3.5% on ICP and cerebral blood flow. At 20-25 minutes after administration of a bolus of mannitol 15% + NaCl 3.5%, ICP decreased (stage 2) below 20 mm Hg, reaching an average of 18.1±0.72 mm Hg, which was a 33.2% decrease from baseline. Conclusion: Combined use of mannitol 15% + NaCl 3.5% in the treatment of intracranial hypertension (ICH) in patients with isolated craniocerebral 3.5±0.2 mL/kg can be recommended in patients with baseline hypovolemia and hyponatremia.