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المستخلص
Elevated intracranial pressure (ICP) represents the most important cause of morbidity and mortality in patients suffering from severe traumatic head injury. Early management of the elevated intracranial pressure is advantageous in preventing 2ry brain insults and improving outcome.
Infusion of hyperosmolar solutions is one of the basic modality in treating critical elevation of the intracranial pressure. Mannitol 20% was used for decades as a reference solute in treating intracranial hypertension but it has limitations especially when used in polytraumatic hypotensive patients.
Hypertonic saline 7.5% is efficient in decreasing the intracranial pressure to the same extent as mannitol but for longer duration of action. Hypertonic saline 7.5% also improves cardiac performance and restores intravascular volume so used as small volume resuscitation.
This study aimed to compare the effect of 2ml/kg hypertonic saline 7.5% versus 2ml/kg mannitol 20% in cerebral and hemodynamics resuscitation in severely head injured patients with increased intracranial pressure .
In order to perform this study, 56 patients who were admitted to intensive care unit in Suez Canal University hospital with severe head injury and Glasgow coma scale (GCS) <9 and raised intracranial pressure > 18 were allocated randomly into two groups.
Group (A) 28 patients received a bolus dose infusion of 2ml/kg mannitol 20% within 10 minutes
Group (B) 28 patients received a bolus dose infusion of 2ml /kg hypertonic saline7.5% within 10 minutes.
All patients were mechanically ventilated to insure arterial blood oxygenation >95% and PaCo2 30-35 mmHg and received sedo-analgesia regimen (morphine–midazolam) to properly adapt mechanical ventilation.
Extradural catheter tip pressure transducers was inserted by neurosurgeon, central venous catheter and urinary catheter were also inserted.
Measurements of hemodynamic variables (HR, BP, CVP) and cardiac output variables (CI, SVI, EF) were assessed at different time intervals after infusion of the tested solution.
Continuous monitoring of ICP, urine output and blood electrolytes were also evaluated .Number of additional doses of the tested solution was also recorded.
Results showed the efficacy of hypertonic saline 7.5% in reducing ICP to the same extent when compared to mannitol and for longer duration of action.
Hypertonic saline 7.5% has the advantages of maintaining hemodynamics and improving cardiac performance.
We recommended that hypertonic saline 7.5% should take place of mannitol in early management of severe head trauma patients with increased intracranial pressure especially when hemodynamic instability is present.