Hyperosmolar Resuscitation in Severe Traumatic Brain Injury: Comparative Insights into Mannitol and Hypertonic Saline

DOI

10.2991/978-94-6239-836-8_13How to use a DOI?

Keywords

Severe traumatic brain injury; mannitol; hypertonic saline

Abstract

Severe traumatic brain injury (sTBI) is a significant neurocritical condition associated with elevated morbidity and death rates stemming from heightened intracranial pressure (ICP) and the onset of secondary brain injury. Hyperosmolar resuscitation has emerged as a principal approach for managing ICP, with mannitol and hypertonic saline (HTS) being the predominant medications utilised in contemporary neurocritical care. This paper aims to evaluate the efficacy and safety of mannitol in comparison to hypertonic saline for patients suffering from severe traumatic brain injury, grounded in the most recent evidence and clinical protocols. The research utilised a systematic literature review methodology adhering to PRISMA criteria, with literature searches performed in the PubMed, Scopus, and Cochrane Library databases, encompassing papers from 2020 to 2026. The examined literature encompassed randomised controlled trials, cohort studies, systematic reviews, meta-analyses, and neurocritical care protocols pertaining to hyperosmolar treatment in severe traumatic brain injury. The compilation of evidence indicated that both agents were successful in lowering ICP; nevertheless, hypertonic saline generally exhibited a quicker onset of ICP reduction, a prolonged duration of ICP management, and superior preservation of cerebral perfusion pressure and haemodynamic stability relative to mannitol. Mannitol continues to be an efficient acute osmotherapy drug; however, it is increasingly linked to the hazards of hypotension, hypovolaemia, and renal impairment. This evaluation emphasises that the choice of hyperosmolar treatment must be tailored according to haemodynamic parameters, cerebral perfusion status, and patient safety considerations to enhance neurocritical care in cases of severe traumatic brain injury.

Copyright

© 2026 The Author(s)

Open Access

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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TY  - CONF
AU  - Apriliani Khaira
AU  - Joandre Fauza
AU  - Cut Hafidzah Usrah
PY  - 2026
DA  - 2026/11/11
TI  - Hyperosmolar Resuscitation in Severe Traumatic Brain Injury: Comparative Insights into Mannitol and Hypertonic Saline
BT  - Proceedings of the3rd Malikussaleh International Conference on Health and Disaster Medicine 2026  (MICOHEDMED 2026)
PB  - Atlantis Press
SP  - 135
EP  - 148
SN  - 2468-5739
UR  - https://doi.org/10.2991/978-94-6239-836-8_13
DO  - 10.2991/978-94-6239-836-8_13
ID  - Khaira2026
ER  -