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Hypertonic Saline vs. Mannitol for Elevated Intercranial Pressure

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University of Cincinnati

Status and phase

Terminated
Phase 3

Conditions

Traumatic Brain Injury
Elevated Intracranial Pressure

Treatments

Drug: Hypertonic Saline
Drug: Mannitol

Study type

Interventional

Funder types

Other
Other U.S. Federal agency

Identifiers

NCT01111682
Shutter-2010-01

Details and patient eligibility

About

This study examines the role of osmotic agents in controlling brain swelling in brain injured individuals. Two osmotic agents -- mannitol and hypertonic saline -- are in common use, and they will be compared in the context of a randomized clinical trial. The goal is to determine if these agent differ in their ability to control episodes of brain swelling.

Full description

This single-center, randomized, open label trial will compare (i) 0.9% normal saline infusion and boluses of mannitol (control group) with (ii) 3% hypertonic saline, with intermittent boluses as needed, to treat elevated intracranial pressure (ICP) following severe traumatic brain injury.

Patients will be randomized to one of the two study arms following placement of an ICP monitor. Raised ICP will be defined as an ICP greater than 20 mmHG for 20 minutes or longer. In the event of such an event, the appropriate treatment will be administered.

The primary endpoint will be success in ICP control, operationalized as the proportion of time during which ICP is less than or equal to 20 mmHg during the first 120 hours following initiation of monitoring. Secondary endpoints include therapy intensity level, incidence of pre-determined severe adverse events, and long-term outcomes measured at 3 and 6 months post-injury.

Enrollment

5 patients

Sex

All

Ages

18 to 70 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • closed traumatic brain injury
  • either (i) GCS score 3-8 (inclusive), or (ii) GCS motor score of 5 or less AND abnormal admission CT scan showing intracranial pathology
  • hemodynamically stable with systolic blood pressure greater than 90 mmHg
  • at least 1 reactive pupil
  • age between 18y and 70y (inclusive)
  • INR less than 1.5

Exclusion criteria

  • actively on hypertonic saline or mannitol
  • hypernatremia (>145 meq/L)
  • anuric or with creatinine greater than or equal to 2.5
  • known seizure disorder
  • penetrating head trauma
  • suspected anoxic events
  • history of, or CT confirmation of, previous brain injury
  • any injury that, in the opinion of the Principal Investigator, has a high likelihood of death with the first 72 hours post-injury
  • any treatment, condition, or injury that contraindicates treatment with hypertonic saline

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

5 participants in 2 patient groups

Mannitol
Active Comparator group
Description:
0.9% normal saline infusion and boluses of mannitol
Treatment:
Drug: Mannitol
Hypertonic Saline
Active Comparator group
Description:
3% hypertonic saline continuous infusion, with intermittent boluses as needed
Treatment:
Drug: Hypertonic Saline

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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