Efficiency of hypertonic saline hydroxyethyl starch versus mannitol in the treatment of increased intracranial pressure in neurosurgical patients -a randomized clinical trial / 中国生化药物杂志

ABSTRACT

Objective To compare the efficacy and safety of 7.2%hypertonic saline hydroxyethyl starch 200/0.5(HES) and 15% mannitol in the treatment of increased intracranial pressure( ICP) .Methods 112 neurosurgical patients at risk of increased ICP were randomized divided into 2 group to receive either HES or 15% mannitol at a defined infusion rate, which was stopped when ICP was<15 mmHg.Results Of the 112 patients, 58 patients received HES and 54 received mannitol 15%.In eight patients, ICP did not exceed 20 mmHg in treatment was not necessary.Both drugs decreased ICP below 15 mmHg (P<0.0001);HES within 6.0(1.2~15.0) min(all results are presented as median (minimum-maximum range) and mannitol within 8.7(4.2~19.9) min(P<0.0002).HES caused a greater decrease in ICP than mannitol (57% vs 48%; P<0.01).The cerebral perfusion pressure was increased from 60 (39~78) mmHg to 72 (54 ~85) mmHg by infusion with HES (P<0.0001) and from 61(47 ~71) mmHg to 70(50 ~79) mmHg with mannitol ( P <0.0001 ).The mean arterial pressure was increased by 3.7% during the infusion of HES but was not altered by mannitol.There were no clinically relevant effects on electrolyte concentrations and osmolarity in the blood.The mean effective dose to achieve an ICP below 15 mmHg was 1.4 (0.3~3.1) mL/kg for HES and 1.8(0.45~6.5) mL/kg for mannitol (P<0.05).Conclusion HES is more effective than mannitol 15% in the treatment of increased ICP.A dose of 1.4 mL/kg of HES can be recommended as effective and safe.The advantage of HES might be explained by local osmotic effects, because there are no clinically relevant differences in hemodynamic clinical chemistry parameters;efficacy.