effect of hyperosmolar combined solution of mannitol 15% plus 3.5% nacl solution on cerebral edema in patients with traumatic brain injury

Background and aim: craniocerebral trauma is one of the vital public health problems and causes elevated intracranial pressure (icp) and low cerebral perfusion pressure. methods and materials/patients: in this work, 15% hyperosmolar solution colloid-mannitol and 3.5% crystalloid-sodium chloride (nacl) were used simultaneously. both have the same mechanism of action creating an osmotic gradient between the blood-brain barrier and brain tissue. in a single-center, randomized open clinical study, 35 patients were treated in the intensive care unit (icu) with isolated traumatic brain injury aged 18 to 65 years with depression of consciousness (4-12 points on the glasgow coma scale [gcs]), and abnormal computed tomography (ct) data of the head on admission. results: the data demonstrated the positive effect of mannitol 15% + nacl 3.5% on icp and cerebral blood flow. at 20-25 minutes after administration of a bolus of mannitol 15% + nacl 3.5%, icp decreased (stage 2) below 20 mm hg, reaching an average of 18.1±0.72 mm hg, which was a 33.2% decrease from baseline. conclusion: combined use of mannitol 15% + nacl 3.5% in the treatment of intracranial hypertension (ich) in patients with isolated craniocerebral 3.5±0.2 ml/kg can be recommended in patients with baseline hypovolemia and hyponatremia.