Abstract: Objective To compare the effects of 15% hypertonic saline and 20% mannitol in doses of similar osmotic burden for
treatment of intracranial hypertension in patients with severe traumatic brain injury. Methods We used an alternating
treatment protocol to compare the effects of hypertonic saline with that of mannitol given for episodes of increased intracranial
pressure (ICP) in patients with severe brain injury. Standard guidelines for the management of severe traumatic brain injury
were followed. For episodes of increased ICP, 20% mannitol (2 ml/kg, infused for over 20 min) and 15% saline (0.42 ml/kg,
administered as a bolus via a central venous catheter) of similar osmotic burden were given alternately, with the choice of
agent for the initial hypertensive event determined on a randomized basis. Reduction of ICP and duration of the action were
recorded after each event. Results The data were collected from 33 patients with 237 hypertensive events. The mean decrease
in ICP was 8.7 mm Hg at 28.7±9.3 min after mannitol treatment as compared with 9.3 mm Hg at 23.6±7.1 min after treatment
with hypertonic saline (P>0.05). The mean duration of the effect was 270 min for mannitol and 318 min for hypertonic saline (P>
0.05). Conclusion Treatment with 15% hypertonic saline and 20% mannitol in doses of similar osmotic burden produces
similar effects in management of increased ICP in patients with severe traumatic brain injury in terms of the time of action
onset, maximum ICP reduction, and duration of action.