• Claire Battison, Peter J D Andrews, Catriona Graham, and Thomas Petty.
• Intensive Care Unit, Western General Hospital, Edinburgh, UK.
• Crit. Care Med. 2005 Jan 1;33(1):196-202; discussion 257-8.

ObjectiveThe aim of this pilot study was to compare the effects of equimolar doses of hypertonic saline and dextran solution (HSD, Rescueflow) with 20% mannitol solution for reduction of increased intracranial pressure.DesignProspective, randomized, controlled, crossover trial in the intensive care unit of a large teaching hospital.SettingAcademic hospital and tertiary referral center for neuroscience.PatientsNine patients with an intracranial pressure of >20 mm Hg were recruited and received two treatments of each, HSD and 20% mannitol, in a randomized order.InterventionEquimolar, rapid intravenous infusions of either 200 mL of 20% mannitol or 100 mL of 7.5% saline and 6% dextran-70 solution (HSD) over 5 mins.MeasurementsIntracranial pressure, blood pressure, serum and urine sodium and osmolality, and urine output.Main ResultsTreatments reduced intracranial pressure with both mannitol (median decrease, 7.5 mm Hg, 95% confidence interval, 5.8-11.8) and HSD (median decrease, 13 mm Hg; 95% confidence interval, 11.5-17.3). HSD caused a significantly greater decrease in intracranial pressure than mannitol (p = .044). HSD had a longer duration of effect than mannitol (p = .044).ConclusionWhen given in an equimolar, rapid, intravenous infusion, HSD reduces intracranial pressure more effectively than mannitol.

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