OUT-OF-HOSPITAL ADMINISTRATION OF MANNITOL TO HEAD-INJURED PATIENTS DOES NOT CHANGE SYSTOLIC BLOOD-PRESSURE

Objective: To determine tile effect of out-of-hospital mannitol admini stration on systolic blood pressure (BP) in the head-injured multiple- trauma patient. Methods: This was a prospective, randomized, double-bl ind, placebo-controlled clinical trial involving a university-based he licopter air medical service and level-1 trauma center hospital. Endot racheally intubated head-trauma victims with Glasgow Coma Scale (GCS) scores < 12 were enrolled from November 22, 1991, to November 20, 1992 , if evaluated by the participating aeromedical transport team within 6 hours of injury. Patients were excluded if they were < 18 years old, had already received mannitol or another diuretic, were potentially p regnant, or were receiving CPR, All patients were intubated prior to s tudy drug (mannitol [1 g/kg] or normal saline) use, Pulse and BP were measured every 15 minutes fur 2 hours following study drug administrat ion. Results: A total of 44 patients were enrolled. After exclusion of 3 patients who did not meet all inclusion criteria, there were 20 pat ients in the mannitol group and 21 patients in the placebo group. The groups were similar at baseline in age, pulse, systolic BP (baseline m annitol: 124 +/- 47 mm Hg; placebo. 128 +/- 32 mm Hg), GCS score, and Injury Severity Scale score, Systolic BP did not change significantly throughout the observation period in either group. This study had 83% power to detect a mean systolic BP drop to < 90 mm Hg. Conclusion: Out -of-hospital administration of mannitol did not significantly change s ystolic BP in this group of head-injured multiple-trauma patients.