Effect of three different mannitol 20% doses on cerebral edema and consciousness levels in traumatic brain injury

Abstract

Diffuse Axonal Injury (DAI) is the most common type of head injury among head trauma types. Mannitol 20% has an important role in the treatment of decreasing intracranial pressure (ICP) as hyperosmolar agent. The aim of the present study was to evaluate three doses of 20% mannitol on brain edema reduction level and consciousness increase in patients with brain edema and diffuse axonal lesions associated with cerebral edema and shift of more than 5 mm. Thirty DAI patients admitted with GCS<8 and cerebral edema and midline shift >5mm were randomly studied in three groups (10 patients in each group): groups I, II, and III received mannitol with doses of 0.5g/kg, 1g/kg and 1.5g/kg, respectively. GCS and the shift midline change were compared and analyzed during hospitalization and 48 hours after admission. GCS was increased at 48h after admission in all three groups, but the difference was not significant (P=0.08). Cerebral edema and brain shift between first and second group and first and third groups was significant (P<0.001). However, this difference was not significant between groups II and III (P=0.99). Our study demonstrated that in DAI increasing dose of mannitol from 0.5g/kg to 1.5g/kg did not significantly increase consciousness during 48h after hospitalization. By increasing dose of mannitol from 0.5g/kg to 1g/kg and 1.5g/kg, the level of edema decreased significantly.