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👻 Mannital vs Hypertonic Saline for ICP Management - #MEDSHED
🥗 Elevated intracranial pressures can be from traumatic brain injuries and other neurologic abnormalities resulting in cerebral edema. Both mannitol and hypertonic saline effectively reduce intracranial pressure.
When compared to either, there has been no proven difference in improved clinical outcomes or mortality. However, current evidence leans towards hypertonic saline being associated with a more rapid and sustained control of ICP.
🌊 Mannitol
Mechanism: osmotic diuresis, reduces blood viscosity that transiently increases cerebral blood flow and subsequent reduction in cerebral blood volume
Mannitol 20% 0.5 - 2 gm infused at 0.5 g over 30 - 60 minutes
Monitoring: Volume depletion/dehydration, AKI, shock
👾 Hypertonic saline
Mechanism: increases osmolarity of blood, draws water from brain (decreases overall ICP)
Sodium chloride 3% 250 - 500 mL IV piggyback, 23.4% 30 mL slow IV push
Monitoring: Hypernatremia, extravasation/tissue necrosis
Peripheral administration has shown to be safe in critically ill patients, central line preferred
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References
Mishra et al. Indian J Pediatr. 2023 Sep;90(9):899-906.
Miyoshi et al. J Intensive Care. 2020 Aug 12;8:61.
"Mannitol." Lexicomp, Wolters Kluwer,
"Sodium chloride preparations." Lexicomp, Wolters Kluwer,
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