Elevated ICP is a life-threatening condition that occurs due to traumatic brain injury (TBI), stroke, intracranial hemorrhage, or space-occupying lesions. If left untreated, increased ICP can lead to brain herniation and death. The primary objective of ICP management is to reduce pressure while maintaining adequate cerebral perfusion. Various therapeutic strategies, including hyperventilation, cerebrospinal fluid drainage, and pharmacological agents, have been employed to control ICP. Among these, mannitol, an osmotic diuretic, is widely used in neurocritical care due to its ability to decrease ICP through plasma expansion and osmotic dehydration of brain tissue. However, concerns exist regarding its optimal dosage, duration of use, and potential side effects such as rebound intracranial hypertension and electrolyte disturbances (Smith, 2019; Wilson et al., 2017).

Mannitol has been extensively studied in clinical settings, with various studies reporting its effectiveness in acute brain injuries. Despite its widespread use, the debate continues regarding its superiority over hypertonic saline and other alternative therapies. Some studies suggest that mannitol may induce transient hypotension, thereby compromising cerebral perfusion in specific patient populations. Thus, a deeper understanding of its hemodynamic effects is required to optimize its therapeutic application (Fisher et al., 2018; Roberts, 2015).

In addition to its osmotic effect, mannitol is believed to exert neuroprotective properties by reducing oxidative stress and stabilizing the blood-brain barrier. These mechanisms may contribute to its beneficial effects beyond simple osmotic dehydration. However, further research is needed to clarify its long-term impact on neurological recovery (Brain Trauma Foundation, 2016; WHO Guidelines on Neurocritical Care, 2021).

This study aims to evaluate the effectiveness of mannitol in reducing ICP in patients with acute brain injuries and analyze the associated complications to provide insights into its safe and optimal use. By assessing patient outcomes and adverse effects, this research seeks to contribute to existing knowledge and guide clinical decision-making in neurocritical care (Andrews et al., 2017; Fisher et al., 2018).

• Study Design: A prospective observational study conducted at a tertiary care hospital over a period of 12 months.
• Patients: 50 patients diagnosed with elevated ICP were included based on clinical and radiological criteria.
• Inclusion Criteria: Patients aged 18-65 years with documented elevated ICP (≥ 20 mmHg) due to head trauma, stroke, or intracranial hemorrhage.
• Exclusion Criteria: Patients with renal failure, severe hypotension, dehydration, or known hypersensitivity to mannitol were excluded.
• Intervention: Patients received intravenous mannitol (20% solution) at a dose of 0.5-1 g/kg over 20 minutes, repeated every 4-6 hours as needed.
• Assessment: ICP was measured using invasive intracranial monitoring (external ventricular drain) and non-invasive methods like transcranial Doppler ultrasonography.
• Outcome Measures: Reduction in ICP, improvement in neurological status (Glasgow Coma Scale - GCS), and occurrence of adverse effects such as electrolyte imbalance and hemodynamic instability were recorded (Adams et al., 2020; Smith, 2019).

Table 1: Patient Demographics and Clinical Characteristics

• ICP Reduction: A significant decrease in ICP was observed within 30-60 minutes post-mannitol administration, with an average reduction of 7-10 mmHg (Brain Trauma Foundation, 2016).
• Neurological Improvement: 70% of patients demonstrated improvement in GCS scores within 24 hours, indicating positive clinical outcomes (Roberts, 2015).
• Adverse Effects: 20% of patients experienced transient hypotension, while 15% had mild-to-moderate electrolyte disturbances, primarily hyponatremia and hypokalemia. These were managed with appropriate fluid and electrolyte corrections (Wilson et al., 2017).

Mortality: The overall mortality rate in the study group was 12%, primarily among patients with severe TBI and refractory ICP elevation. No mortality was directly attributed to mannitol administration (Fisher et al., 2018).

The findings of this study indicate that mannitol effectively reduces ICP and improves neurological function in patients with acute brain injuries. The osmotic gradient created by mannitol administration facilitates fluid movement from the brain parenchyma into the intravascular space, reducing cerebral edema and ICP. The rapid onset of action makes it a valuable first-line therapy in neurocritical care settings (Smith, 2019; WHO Guidelines on Neurocritical Care, 2021).

Despite its effectiveness, there remains a risk of adverse effects. The study findings highlight the need for careful monitoring, particularly in patients with compromised cardiovascular status. The transient hypotension observed in some patients could impact cerebral perfusion, necessitating adjunctive measures such as volume resuscitation or the use of alternative osmotic agents (Andrews et al., 2017; Fisher et al., 2018).

Comparing these results with previous studies, mannitol continues to demonstrate efficacy, but its long-term benefits over hypertonic saline remain debatable. Further randomized controlled trials are needed to compare treatment outcomes and refine guidelines for its clinical use (Brain Trauma Foundation, 2016; Roberts, 2015).

Mannitol remains a valuable therapeutic agent for the management of elevated ICP, demonstrating significant efficacy in reducing intracranial pressure and improving neurological status. However, close monitoring for adverse effects and individualized patient management are essential to maximize benefits while minimizing complications (Adams et al., 2020).

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