Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 28 , ISSUE 7 ( July, 2024 ) > List of Articles


Advancing the Management of Nontraumatic Brain Injuries with Hypertonic Saline and Mannitol

Rajesh Mohan Shetty

Keywords : Brain Injuries, Hyperotonic solutions, Mannitol

Citation Information : Shetty RM. Advancing the Management of Nontraumatic Brain Injuries with Hypertonic Saline and Mannitol. Indian J Crit Care Med 2024; 28 (7):634-636.

DOI: 10.5005/jp-journals-10071-24756

License: CC BY-NC 4.0

Published Online: 29-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


PDF Share
  1. Barman A, Chatterjee A, Bhide R. Cognitive impairment and rehabilitation strategies after traumatic brain injury. Indian J Psychol Med 2016;38(3):172–181. DOI: 10.4103/0253-7176.183086.
  2. Mckee AC, Daneshvar DH. The neuropathology of traumatic brain injury. Handb Clin Neurol 2015;127:45–66. DOI: 10.1016/B978-0-444-52892-6.00004-0.
  3. Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: Management protocol and clinical results. J Neurosurg 1995;83(6): 949–962. DOI: 10.3171/jns.1995.83.6.0949.
  4. Harutjunyan L, Holz C, Rieger A, Menzel M, Grond S, Soukup J, et al. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients–A randomized clinical trial. Critical Care 2005;9(5):R530–540. DOI: 10.1186/cc3767.
  5. Weed LH, McKibben PS. Experimental alteration of brain bulk. Am J Physiol 1919;48:531–555. DOI: 10.1152/AJPLEGACY.1919.48.4.531.
  6. Wise BL, Chater N. The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal fluid pressure. J Neurosurg 1962;19:1038–1043. DOI: 10.3171/jns.1962.19.12.1038.
  7. Worthley LI, Cooper DJ, Jones N. Treatment of resistant intracranial hypertension with hypertonic saline: Report of two cases. J Neurosurg 1988;68(3):478–481. DOI: 10.3171/jns.1988.68.3.0478.
  8. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 2017;80(1):6–15. DOI: 10.1227/NEU.0000000000001432.
  9. American College of Surgeons Trauma Quality Improvement Program. Best practices in the management of Traumatic Brain Injury. American College of Surgeons. 2015. Available from:
  10. Cook AM, Jones GM, Hawryluk GW, Mailloux P, McLaughlin D, Papangelou A, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocrit Care 2020;32(3): 647–666. DOI: 10.1007/s12028-020-00959-7.
  11. Choudhury A, Ravikant, Bairwa M, Jithesh G, Kumar S, Kumar N. Efficacy of intravenous 20% mannitol vs 3% hypertonic saline in reducing intracranial pressure in nontraumatic brain injury: A systematic review and meta-analysis. Indian J Crit Care Med 2024;28(7):686–695.
  12. Bereczki D, Mihálka L, Szatmári S, Fekete K, Di Cesar D, Fülesdi B, et al. Mannitol use in acute stroke: Case fatality at 30 days and 1 year. Stroke 2003;34(7):1730–1735. DOI: 10.1161/01.STR.0000078658. 52316.E8.
  13. Schwimmbeck F, Voellger B, Chappell D, Eberhart L. Hypertonic saline versus mannitol for traumatic brain injury: A systematic review and meta-analysis with trial sequential analysis. J Neurosurg Anesthesiol 2021;33(1):10–20. DOI: 10.1097/ANA.0000000000000644.
  14. Zornow MH, Scheller MS, Shackford SR. Effects on hypertonic lactated Ringer's solution on intracranial pressure and cerebral water content in a model of traumatic brain injury. J Trauma 1989;29(4):484–488. DOI: 10.1097/00005373-198904000-00011.
  15. Alnemari AM, Krafcik BM, Mansour TR, Gaudin D. A comparison of pharmacologic therapeutic agents used for the reduction of intracranial pressure after traumatic brain injury. World Neurosurg 2017;106:509–529. DOI: 10.1016/j.wneu.2017.07.009.
  16. Battison C, Andrews PJ, Graham C, Petty T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med 2005;33(1):196–202. DOI: 10.1097/01.ccm.0000150269.65485.a6.
  17. Tatro HA, McMillen JC, Hamilton LA, Rowe AS. 23.4% sodium chloride versus mannitol for the reduction of intracranial pressure in patients with traumatic brain injury: A single-center retrospective cohort study. Ann Pharmacother 2021;55(8):988–994. DOI: 10.1177/1060028020982379.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.