A. Vats et al., Is hypertonic saline an effective alternative to mannitol in the treatmentof elevated intracranial pressure in pediatric patients?, J INTENS C, 14(4), 1999, pp. 184-188
Hypertonic saline (HS) has been suggested as an osmotic agent to control el
evated intracranial pressure (ICP). Mannitol is the most commonly used osmo
tic agent, and no previous study has compared the effectiveness of HS to ma
nnitol. Using a concurrent: cohort design, we propose that HS and mannitol
are similarly effective in controlling intracranial hypertension. Twenty-fi
ve patients received a total of 82 doses of HS at a dose of 5 ml/kg for the
treatment of elevated ICI! Significant reductions in ICP were noted at 30
(p < 0.05), 60, and 120 (p < 0.01) minutes following the administration of
HS, and cerebral perfusion pressure (CPP) increased significantly at 60 and
120 minutes (p < 0.05). There was no significant change in heart rate (HR)
or mean arterial pressure (MAP). Eighteen patients received a total of 56
doses of mannitol for the treatment of elevated ICP. Significant reductions
in ICP were seen at 60 and 120 minutes (p < 0.01) after the administration
of mannitol. No significant changes were noted in CPI: HR, or MAP Both HS
and mannitol produced significant and sustained reductions In ICP. HS, howe
ver, results in significant and sustained increases in CPP. HS reduces elev
ated ICP in a similar manner to mannitol. The avoidance of hemodynamic inst
ability with the use of HS makes it an attractive alternative to mannitol i
n the management of increased ICP. These pilot data suggest that a randomiz
ed trial to compare the efficacy of HS to mannitol in pediatric patients wi
th increased ICP is necessary.