Hypertonic Saline in Clinical Improvement of Patients Afflicated with Stroke (Double Blind Clinical Trial)

  Introduction : Various treatments are used to reduce cerebral edema in stroke patients that show signs of RICP. Mannitol is used as the first line of standard therapy in the control of RICP in the acute phase. Presently most of the researches are focused on the use of hypertonic saline in the treatment of cerebral edema and recent studies have shown that it can replace serum mannitol and may have several therapeutic advantages which needs more research for verification. The aim of this study is comparing the therapeutic effect of 20% serum mannitol with 5% hypertonic saline on the clinical improvement of patients afflicted with brain stroke that showed signs of raised intracranial pressure (RICP). Materials & Methods: The study was performed as a double-blind randomized clinical trial. The data was gathered in two parts, one consisting of the demographic information of a hundred patients that admitted in the intensive care unit (ICU) and the other of the clinical (patients with signs of RICP) and paraclinical information (confirmed by findings CT Scan) of the two groups of patients that were respectively treated with mannitol and hypertonic saline. Finally, the data were analyzed using the SPSS. Results: From 100 patients, 54 were male and 46 were female with an average age of 69.66 ± 10.5. The demographic, clinical and paraclinical information obtained showed no significant difference. In the group treated by mannitol all the patients died, while in the group treated by hypertonic saline 28% of the patients were discharged in good clinical condition which showed a significant difference in the mortality rate. The changes of the vital indexes in all the patients of the group treated with hypertonic saline irrespective of the final outcome, showed a more significant therapeutic stability. Also, in comparison the survival days of the patients treated with hypertonic saline was twice that of those treated with mannitol. Conclusion: Hypertonic saline is much more effective than mannitol in the improvement of the clinical status of stroke patients and the survival days of patients treated with slow infusion of hypertonic saline is more than that of those treated with mannitol. This subject could be most effective in family of patients for cope with now and future conditions. Also in patients with GCS ≥ 8 , and in comparison to mannitol, hypertonic saline has a more positive effect on the final outcome.