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Out‐of‐hospital Administration of Mannitol to Head‐injured Patients Does Not Change Systolic Blood Pressure
Author(s) -
Sayre Michael R.,
Daily Stephen W.,
Stern Susan A.,
Storer Daniel L.,
Loveren Harry R.,
Hurst James M.
Publication year - 1996
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1996.tb03528.x
Subject(s) - medicine , blood pressure , glasgow coma scale , anesthesia , mannitol , placebo , head injury , vital signs , surgery , chemistry , alternative medicine , organic chemistry , pathology
Objective: To determine the effect of out‐of‐hospital mannitol administration on systolic blood pressure (BP) in the head‐injured multiple‐trauma patient. Methods: This was a prospective, randomized, double‐blind, placebo‐controlled clinical trial involving a university‐based helicopter air medical service and level‐1 trauma center hospital. Endotracheally intubated head‐trauma victims with Glasgow Coma Scale (GCS) scores < 12 were enrolled from November 22, 1991, to November 20, 1992, if evaluated by the participating aeromedical transport team within 6 hours of injury. Patients were excluded if they were <18 years old, had already received mannitol or another diuretic, were potentially pregnant, or were receiving CPR. All patients were intubated prior to study drug (mannitol [1 g/ kg] or normal saline) use. Pulse and BP were measured every 15 minutes for 2 hours following study drug administration. Results: A total of 44 patients were enrolled. After exclusion of 3 patients who did not meet all inclusion criteria, there were 20 patients in the mannitol group and 21 patients in the placebo group. The groups were similar at baseline in age, pulse, systolic BP (baseline mannitol: 124 ± 47 mm Hg; placebo: 128 ± 32 mm Hg), GCS score, and Injury Severity Scale score. Systolic BP did not change significantly throughout the observation period in either group. This study had 83% power to detect a mean systolic BP drop to <90 mm Hg. Conclusion: Out‐of‐hospital administration of mannitol did not significantly change systolic BP in this group of head‐injured multiple‐trauma patients.