الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
TBI represents a significant medical problem, affecting over 10 million people in the global population annually. Morbidity and mortality following TBI is associated with the complications of the initial injury in addition to post-event intracranial processes such as elevated intracranial pressure (ICP) and brain edema. Consequently, appropriate therapeutic interventions are required to reduce brain tissue damage and improve cerebral perfusion.
Most patients with acute TBI are first evaluated in the ED before undergoing surgery or being transferred to a neuro-ICU. As a result, emergency physicians typically manage acute TBI and make initial decisions regarding hyperosmolar therapy for confirmed or presumed ICP elevation.
Mannitol and hypertonic saline (HS) solutions are commonly used hyperosmolar agents despite a lack of high-quality clinical trials. Predicated on fluid shifts and the Monro-Kellie Doctrine, both agents are believed to lower ICP predominantly by creating an osmolar gradient that leads to mobilization of fluid from the brain to the intravascular compartment.
This study was carried out on randomly selected 60 adult patients who were admitted to the Emergency Medicine department, Alexandria Main University Hospital with the diagnosis of mild to moderate traumatic brain injury (GCS ˃ 8). Injury was detected on Computed Tomography (CT) of the brain directly after admission and conservative treatment was recommended by the neurosurgeon.
All enrolled patients (n=60) were randomly assigned into 2 groups; Mannitol group (n=30) and Hypertonic saline (HS) group (n=30). All patients were followed up during 24 hrs continuously clinically using GCS, vital signs, laboratory (Na, K levels, hemoglobin and platelets count).
Results showed that, HS group showed a better course of improvement in terms of progress than mannitol group (86.7% Vs 20% respectively, p <0.001). The course of improvement was measured according to GCS after 24 hrs from admission. HS group showed an increased mean of GCS than mannitol group (14.03 Vs 12.13, p =0.002).
In conclusion, 3% HS was found to be safe, more effective than 20% mannitol in the treatment of increased intracranial pressure due to brain oedema in patients with mild to moderate traumatic brain injuries in the emeregency department setting. HS was not associated with profound hypernatremia or hemodynamic instability.