Hypertonic saline versus mannitol in treatment of diffuse brain edema in patients with moderate and severe traumatic brain injury
Bibliographic record
Abstract
ABSTRACT Background: Hyperosmolar therapy is the primary medical management strategy for brain edema and raised intracranial pressure. Objective: The aim of the work was to compare between Hypertonic saline 3% and Mannitol 20% in the treatment of diffuse brain edema after traumatic brain injury. Methods: A sample of 40 patients with diffuse brain edema after traumatic brain injury was included and divided into two groups; Group A: 20 patients were treated with hypertonic saline 3%, Group B: 20 patients were treated with mannitol 20%. Results: hypertonic saline 3% was significantly better than mannitol 20% in treatment of brain edema according to CT brain criteria; mannitol 20% significantly increases serum creatinine levels more than hypertonic saline 3%. Moreover, both improves Glasgow Coma Scale (GSC) but significantly more with hypertonic saline 3% Conclusion: hypertonic saline 3% improves GCS better than mannitol 20% in treating diffuse brain edema after traumatic brain injury with less adverse effects. Key words: Hypertonic saline, Mannitol, Brain edema, Traumatic brain injury. REFERENCES Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation-An Interdisciplinary Journal. 2007 Jan 1; 22 (5):341-54. Bruns J, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia. 2003 Oct 1; 44 (s10):2-10. Donkin JJ, Vink R. Mechanisms of cerebral edema in traumatic brain injury: therapeutic developments. Current opinion in neurology 2010; 23 (3):293-9. Fink ME. Osmotherapy for intracranial hypertension: mannitol versus hypertonic saline. Continuum: Lifelong Learning in Neurology 2012; 18 (3, Critical Care Neurology):640-54. Thrane AS, Thrane VR, Nedergaard M. Drowning stars: reassessing the role of astrocytes in brain edema. Trends in neurosciences. 2014 Nov 30;37(11):620-8. Papadopoulos MC, Verkman AS. Aquaporin water channels in the nervous system. Nature Reviews Neuroscience. 2013 Apr 1;14(4):265-77. Grände PO, Romner B. Osmotherapy in brain edema: a questionable therapy. Journal of neurosurgical anesthesiology. 2012 Oct 1; 24 (4):407-12. Kumasaka K, Eisenstadt R, Murcy M, Gong W, Browne K, Shenghui L, Sims C, Allen S, Smith DH, Pascual J. osmotherapy in repeated doses alters ongoing blood brain barrier-mediated inflammation after TBI. In journal of neurotruama 2013 Aug 1 (Vol. 30, No. 15, pp. A141-A141). New Rochlle, NY 10801 USA: Mary Ann Liebert, Inc. Sorani MD, Manley GT. Dose–response relationship of mannitol and intracranial pressure: a metaanalysis 2008. Suys T, Quintard H, Patet C, Oddo M. Effect of osmotherapy with mannitol or hypertonic saline on cerebral oxygenation and metabolism in patients with intracranial hypertension after severe brain injury. Critical Care. 2015;19 (Suppl 1):P447. Mortazavi MM, Romeo AK, Deep A, Griessenauer CJ, Shoja MM, Tubbs RS, et al. Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis. Journal of neurosurgery 2012;116(1):210-21. Tong W, Zheng P, Xu J-f, Guo Y-j, Zeng J-s, Yang W-j, et al. Early CT signs of progressive hemorrhagic injury following acute traumatic brain injury. Neuroradiology 2011;53(5):305-9. Sayer NA. Traumatic Brain Injury and Its Neuropsychiatric Sequelae in War Veterans. Annual review of medicine 2012; 63:405-19. Cottenceau V, Masson F, Mahamid E, Petit L, Shik V, Sztark F, et al. Comparison of effects of equiosmolar doses of mannitol and hypertonic saline on cerebral blood flow and metabolism in traumatic brain injury. Journal of neurotrauma 2011;28(10):2003-12. Mutschler M, Paffrath T, Wölfl C, Probst C, Nienaber U, Schipper I, et al. The ATLS classification of hypovolaemic shock: A well established teaching tool on the edge. Injury 2014;45:S35-S8. Lingaiah, Estari Mamidala and P. Nagaraja Rao (2016). Modulatory effect of Cassia auriculata plant extraction on glucose metabolism in alloxan induced diabetic Wistar rats. The Ame J Sci & Med Res, 1(2); 212-220. doi:10.17812/ajsmr1213. Fazekas AS, Funk GC, Klobassa DS, Rüther H, Ziegler I, Zander R, Semmelrock HJ. Evaluation of 36 formulas for calculating plasma osmolality. Intensive care medicine. 2013 Feb 1; 39 (2):302-8. Wu X, Hu J, Zhuo L, Fu C, Hui G, Wang Y, et al. Epidemiology of traumatic brain injury in eastern China, 2004: a prospective large case study. J Trauma. 2008;64 (5):1313-9. Abbassy MA. Patterns of head injuries due to road traffic accidents: a statistical study: Alexandria University, Faculty of Medicine; 2012. Manninen PH, Lam AM, Gelb AW, Brown SC. The effect of high-dose mannitol on serum and urine electrolytes and osmolality in neurosurgical patients. Canadian journal of anaesthesia. 1987 Sep 1;34(5):442-6. Malik Z, Mir S, Naqash I, Sofi K, Wani A. A prospective, randomized, double blind study to compare the effects of equiosmolar solutions of 3% hypertonic saline and 20% mannitol on reduction of brain-bulk during elective craniotomy for supratentorial brain tumor resection. Anesthesia: Essays and Researches 2014;8(3):388. Diringer MN. The Evolution of the Clinical Use of Osmotic Therapy in the Treatment of Cerebral Edema. In Brain Edema XVI 2016 (pp. 3-6). Springer International Publishing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".