Which osmotic diuretic is most commonly used to decrease ICP?

Mannitol is the osmotic diuretic most commonly used to decrease intracranial pressure (ICP). It functions by increasing the osmolarity of the blood, which draws fluid out of the brain and into the bloodstream, thereby reducing cerebral edema and lowering ICP. This mechanism is particularly beneficial in situations where there's an acute rise in pressure within the skull, such as after traumatic brain injury or in cases of cerebral hemorrhage.

Other diuretics listed don’t have the same osmotic effect as Mannitol. For instance, Lasix (furosemide) is a loop diuretic that promotes diuresis through a different mechanism by inhibiting sodium reabsorption in the kidneys; it is primarily used for managing fluid overload conditions, rather than directly targeting ICP. Hydrochlorothiazide is a thiazide diuretic that also works through renal mechanisms and does not exhibit the properties necessary to effectively decrease ICP. Therefore, Mannitol remains the preferred choice due to its specific action on osmotic gradients and its rapid effect in critically elevated ICP situations.