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Objective: Efficacy on intracranial pressure of hypertonic saline 7.5% and mannitol 20% in treatment of increased intracranial pressure of patients with severe brain injury. Subject and method: Case study, comparative clinical trial in 100 patients with severe brain injury have increased intracranial pressure. Treated at surgical resuscitation of Sait Paul Hospital from October 2010 to December 2014. Record the evolution of intracranial pressure and comparison between the two osmotic agents before and after the 30, 60, 90, 120, 180, 240, 300 and 360 minutes. Result: Hypertonic saline 7.5% and mannitol have been shown to reduce intracranial pressure in patients with severe brain injury. Mannitol reduced the intracranial pressure earlier (60 minutes) compared to saline 7.5% (90 minutes). However, hypertonic saline 7.5% has been shown to reduce intracranial pressure for longer. Both solutions have been shown to be very effective in treating increased intracranial hypertension (88% mannitol and 90% hypertonic saline 7.5%). However, there is no difference in efficacy between the two groups. Conclusion: Hypertonic saline 7.5% and mannitol are all effective in reducing intracranial pressure in patients with severe head injury, there was no difference in effectiveness between the two groups.