Effects of different hypertonic resuscitations on traumatic brain injuries and cranioencephalic trauma: A single centre, retrospective analysis

Abstract

Purpose: To compare the efficacies of 3 % (w/v) hypertonic saline, 20 % (w/v) mannitol, and 10 % (w/v) mannitol plus 10 % (v/v) glycerol in the management of intracranial hypertension.Methods: Patients with intracranial pressure > 20 mmHg received 3 % (w/v) hypertonic saline (HT cohort, n = 78) or 20 % w/v mannitol (MT cohort, n = 82) or 10 % (w/v) mannitol plus 10 % (v/v) glycerol (MG cohort, n = 73) until intracranial pressure was reduced below 15 mmHg. Neurologic outcomes, hemodynamic parameters, and clinical biochemistry were evaluated as indices of intracranial pressure and pathological parameters.Results: Serum sodium levels and serum osmolarity were significantly increased by 3 % (w/ v) hypertonic saline, relative to the other hypertonic resuscitations. At the end of 1 h observation period, 60 (77 %), 36 (44 %), and 41 (56 %) of patients from HT, MT, and MG cohorts, respectively, had their cerebral perfusion pressure successfully maintained at > 70 mmHg. At the end of 1 h observation period, intracranial pressure ≤ 20 mmHg was successfully maintained in 78 (100 %), 81 (99 %), and 73 (100 %) patients from HT, MT, and MG cohorts, respectively. The mean values of arterial pressure of patients in HT, MT, and MG cohorts were increased after 1 h, 15 min, and 30 min of interventions, respectively.Conclusion: These results indicate that 3 % (w/v) hypertonic saline was the most rapid and most effective resuscitation for the management of intracranial hypertension in traumatic brain injuries or cranioencephalic trauma.