Mannitol for acute traumatic brain injury

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Mannitol therapy for raised intracranial pressure (ICP) may have a beneficial effect on mortality when compared with pentobarbital treatment, but it may have a detrimental effect on mortality compared with hypertonic saline. ICP-directed treatment shows a small beneficial effect compared to treatment directed by neurological signs and physiological indicators.

Mannitol is sometimes effective in reversing acute brain swelling, but its effectiveness in the ongoing management of severe head injury remains unclear. There is evidence that, in prolonged dosage, mannitol may pass from the blood into the brain, where it might cause increased ICP. This review assesses the effects of different mannitol therapy regimens, of mannitol compared with other ICP-lowering agents, and to quantify the effectiveness of mannitol administration given at other stages following acute traumatic brain injury.

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