Mannitol is commonly used to treat acute increases in intracranial pressure in patients with TBI, ICH, tumor, and CVA.
While there is currently no conclusive evidence of superiority, a growing body of literature suggests hypertonic saline (HTS) may be more favorable than mannitol for acute increases in ICP.
HTS is believed to work by:
osmotic effect
increasing cardiac output and MAP, thereby increasing cerebral oxygen delivery
improving microcirculatory flow
anti-inflammatory effects
When administering HTS, concentrations ranging from 1.5% - 23.4% can be used, titrating to a serum Na concentration of 145-155 and a serum osm > 350 mOsm/L.
References
Torre-Healy A, Marko NF, Weil RJ. Hyperosmolar therapy for intracranial hypertension. Neurocrit Care 2011.
