Original Article: Hypertonic Saline Versus Mannitol Therapy in Traumatic Brain Injured Patients Guiding by Transcranial Doppler Pulsatile Index in Zagazig University Hospital

Abstract
Background: Hyperosmolar therapy is the primary medical management strategy for brain edema and raised intracranial pressure. The role of osmotic therapy with either mannitol or hypertonic saline is based on the principle that these agents will help to remove water from brain tissue across an intact blood brain barrier. There is a debatation regarding the efficacy of hypertonic saline (HTS) versus mannitol in traumatic brain injury when are given in equiosmolar doses.
Patients and Methods: An interventional study carried out at trauma and surgical critical care units in Zagazig University Hospital during the period from march 2016 to march 2017. It included ninety patients with different ages, sexes and Glasgow coma scale. The patients were randomly selected from the trauma and surgical critical care units, provided that the patients not received hyperosmolar drug before admission The patients were classified into three groups (thirty patients for each group) as the following: Group A: Included those who are treated with 20% mannitol. Group B: Included those who are treated with 3% hypertonic saline. Group C: Included those who are treated with 3% hypertonic saline alternating with 20% mannitol. Transcranial Doppler parameters especially pulsatility index were observed in the patients before every drug dose and 30 min after giving. Then we observed the change in value of cranial Doppler pulsatility index with subsequently interpretation of values.
Results: There was no significant difference in equiosmolar dose (2ml/kg/6h) between mannitol 20% and hypertonic saline 3% in reducing noninvasive intracranial pressure (nICP) and pulsatility index (PI). Also, there were no significant differences in GCS at the end of treatment and GOS at one month from admission and decrease nICP between the two agents.
Conclusion: This study recommends that in absence of contraindications, no superiority of hypertonic saline 3% over mannitol 20% as hyperosmolar therapy in TBI patients as the both are equally effective in reducing ICP and neurological outcome.