Use of mannitol and NaCl hypertonic saline solutions in the treatment of traumatic intracranial hypertension: an integrative review

Abstract

Moderate and severe traumatic brain injuries are the leading causes of death in industrialized countries, which can bring unfavorable neurological results to individuals due to the elevation of intracranial pressure (ICP). Among the therapeutic measures for intracranial hypertension (ICH) resulting from these traumas, osmotherapy through mannitol or hypertonic saline solution is the first-line treatment for this syndrome. To analyze the scientific production on the use of mannitol and hypertonic saline solution of NaCl at concentrations of 3% and 10% in patients with traumatic intracranial hypertension. Integrative review, the search for articles was performed in the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS); National Library of Medicine, United States (MEDLINE); Scientific Electronic Library Online (SciELO); PubMed and ScienceDirect, with the association of the descriptors traumatic brain injury; saline solution, hypertonic and mannitol, using the boolean AND operator between them. Ten studies were selected and analyzed, in which 70% of them were original articles and 30% were clinical trials, from the period of 2016 to maio 2023. In addition, all selected articles have a quantitative character on the use of mannitol and 3% and 10% NaCl hypertonic saline solution in the treatment of traumatic intracranial hypertension. Osmotherapy is effective in the management of traumatic intracranial hypertension. There was no statistically relevant difference in efficacy and clinical outcomes between 3% and 10% hypersaline solutions and mannitol. Further investigation is needed to consolidate standardized protocols for administering the hyperosmolar agents in question.