Related Experiment Video
Updated: Aug 20, 2026

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on
Claire Battison1, Peter J D Andrews, Catriona Graham
1Intensive Care Unit, Western General Hospital, Edinburgh, UK.
Objective:
The aim of this pilot study was to compare the effects of equimolar doses of hypertonic saline and dextran solution (HSD, Rescueflow) with 20% mannitol solution for reduction of increased intracranial pressure.
Design:
Prospective, randomized, controlled, crossover trial in the intensive care unit of a large teaching hospital.
Setting:
Academic hospital and tertiary referral center for neuroscience.
Patients:
Nine patients with an intracranial pressure of >20 mm Hg were recruited and received two treatments of each, HSD and 20% mannitol, in a randomized order.
Intervention:
Equimolar, rapid intravenous infusions of either 200 mL of 20% mannitol or 100 mL of 7.5% saline and 6% dextran-70 solution (HSD) over 5 mins.
Measurements:
Intracranial pressure, blood pressure, serum and urine sodium and osmolality, and urine output.
Main Results:
Treatments reduced intracranial pressure with both mannitol (median decrease, 7.5 mm Hg, 95% confidence interval, 5.8-11.8) and HSD (median decrease, 13 mm Hg; 95% confidence interval, 11.5-17.3). HSD caused a significantly greater decrease in intracranial pressure than mannitol (p = .044). HSD had a longer duration of effect than mannitol (p = .044).
Conclusion:
When given in an equimolar, rapid, intravenous infusion, HSD reduces intracranial pressure more effectively than mannitol.
Related Concept Videos
Increased Intracranial Pressure l: Introduction
Increased Intracranial Pressure ll: Pathophysiology
Cerebral Edema l: Introduction
Cerebral Edema ll: Pathophysiology

