Comparative Evaluation of Efficacy of Mannitol and Hypertonic Saline (3%) for Treatment of Moderate to Severe Traumatic Brain Injury (TBI)

Abstract

Background: Intracranial Pressure of higher than 20 mm of Hg is considered Intracranial Hypertension. For years, Mannitol has been the go-to drug for its cure. However, it has many adverse effects. Therefore, other drugs are being considered for reducing Intracranial Pressure (ICP), and hypertonic saline (HTS) appears to be a good alternative. Methods: The reason for this study is to report any differences in results after using of mannitol or hypertonic saline for treating Intracranial Hypertension (IH) in patients who were in the tertiary care hospital to be treated of moderate or severe Traumatic Brain Injury (TBI). Methodology: All patients who had moderate or severe Traumatic Brain Injury (TBI) i.e, were reported at the hospital and had Glasgow Coma Score lesser than 13, were admitted in the hospital over the course of 2 months of the study will be included.  Patients will be randomized into 2 statistically comparable groups. Group A and Group B will be given the standard amount of mannitol and hypertonic saline (3%) and clinical result will be noted for both cases. Results: The results will be calculated by rate of improvement in Glasgow Coma Score (GCS) of both groups and then compared. Primary endpoint will be clinical improvement after 7 days. Conclusion: The rationale behind which drug of the two - mannitol or hypertonic saline solution (HS) - for treatment of people suffering Traumatic Brain Injury (TBI) to be primary varies considerably and there seems to be no protocol to determine which of these should be preferred. Most of the studies that have been done on the topic conclude that Hypertonic saline (HTS) seems to better suited for lowering Intracranial Pressure (ICP), regardless of its concentration. However, other than its apparent superiority in ICP reduction, it doesn’t seem to have any additional benefits, in relation to mortality.