A pilot study evaluating the effect of mannitol and hypertonic saline solutions in the treatment of increased intracranial pressure in 2 cats and 1 dog naturally affected by traumatic brain injury.

Objective: To compare the effect of iso-osmolar doses of 18% mannitol and 3% NaCl solutions in decreasing intracranial pressure (ICP) during severe traumatic brain injury (TBI). Series Summary: Animals with TBI, a Modified Glasgow Coma Scale score ≤ 8 after hemodynamic stabilization and brain Magnetic Resonance Imaging positive for intracranial hypertension (ICH) were enrolled. Subjects were randomly treated with iso-osmolar doses of 18% mannitol or 3% NaCl. Direct ICP and cerebral perfusion pressure (CPP) were recorded both before treatment and for 120 minutes following drug administration. Three patients met the inclusion criteria. Case 1: received 3% NaCl without any response to therapy; a refractory posttraumatic hypertension was suspected. Case 2 was treated with 3% NaCl. ICP decreased by 40.7% and CPP rose by 15% and their values were better than pretreatment until T6. Case 3 received 18% mannitol. ICP dropped by 19% , and CPP rose to normal value but later ICP rose higher than pretreatment values, and CPP had a slight decrease and then rose gradually to normal ranges until the end of the study. New Information Provided: both drugs decreased ICP and ameliorated CPP but the duration of ICP reduction after 3% NaCl seemed greater and prolonged. Further studies in a larger and homogeneous population are warranted to confirm these findings.