Comparing the Efficacy of Mannitol Versus Hypertonic Saline in Management of Raised Intracranial Pressure Using Ultrasonographic Measurement of the Optic Nerve Sheath Diameter

Mansour, Mostafa Saieed; Amria, Mahmoud Abdelhamed; Fathey, Yasser Ibrahim; Mahdy, Wafiya Ramadan

doi:10.21608/asja.2024.316125.1148

Comparing the Efficacy of Mannitol Versus Hypertonic Saline in Management of Raised Intracranial Pressure Using Ultrasonographic Measurement of the Optic Nerve Sheath Diameter

Document Type : Original Article

Authors

¹ Anaesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt.

² Anaesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt

10.21608/asja.2024.316125.1148

Abstract

Background: Increased intracranial pressure (ICP) often occurs due to traumatic brain injury (TBI), necessitating prompt management to prevent adverse outcomes. Osmotic agents like mannitol and hypertonic saline are commonly used, but their comparative efficacy remains uncertain.
This study aimed to compare the efficacy of mannitol 20% and hypertonic saline 3% in reducing intracranial pressure (ICP) and assess their impact on optic nerve sheath diameter (ONSD) measured by ultrasonography.
Methods: This prospective, randomized, double-blinded study compared mannitol 20% and hypertonic saline 3% in reducing ICP using ultrasonographic measurement of the optic nerve sheath diameter (ONSD). Fifty adult TBI patients with elevated ICP were enrolled, and clinical parameters were monitored.
Results: Both mannitol and hypertonic saline effectively reduced ICP, with no significant difference between groups (mean reduction: 15.5% for mannitol, 29.2% for hypertonic saline). hypertonic saline demonstrated a more sustained reduction in ONSD compared to mannitol, showing significant differences at various time points (p<0.05). Correlation analysis revealed significant associations between ONSD measurements and MAP (r= 0.754, p= 0.025), serum osmolarity (r= 0.721, p= 0.029), serum sodium (r= 0.778, p= 0.021), and length of ICU stay (r= 0.598, p= 0.069).
Conclusions: Mannitol and hypertonic saline are both effective in reducing ICP in TBI patients. Hypertonic saline may offer advantages in sustained ICP reduction, especially in severe TBI cases. Ultrasonographic measurement of ONSD proves valuable for monitoring ICP dynamics and predicting clinical outcomes. Further research is needed to optimize treatment strategies for managing elevated ICP in TBI.

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