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Meta-Analysis
. 2023 Sep;90(9):899-906.
doi: 10.1007/s12098-023-04532-w. Epub 2023 May 25.

Hypertonic Saline vs. Mannitol in Management of Elevated Intracranial Pressure in Children: A Meta-Analysis

Nihar Ranjan Mishra  1 , Amit Agrawal  2 , Rashmi Ranjan Das  3
Affiliations
Meta-Analysis

Hypertonic Saline vs. Mannitol in Management of Elevated Intracranial Pressure in Children: A Meta-Analysis

Nihar Ranjan Mishra et al. Indian J Pediatr. 2023 Sep.

Abstract

Objective: To compare the efficacy and safety of two hyperosmolar agents (hypertonic saline vs. mannitol) used for the reduction of elevated intracranial pressure (ICP) in children.

Methods: A meta-analysis of randomized controlled trials (RCTs) was conducted and GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) of evidence was applied. Relevant databases were searched till 31st May 2022. Primary outcome was mortality rate.

Results: Of 720 citations retrieved, 4 RCTs were included in the meta-analysis (n = 365, male = 61%). Traumatic and non-traumatic cases of elevated ICP were included. There was no significant difference in the mortality rate between the two groups [relative risk (RR), 1.09; (95% confidence interval (CI), 0.74 to 1.6)]. No significant difference was found for any of the secondary outcomes, except serum osmolality (being significantly higher in mannitol group). Adverse events like shock and dehydration were significantly higher in the mannitol group, and hypernatremia in the hypertonic saline group. The evidence generated for primary outcome was of "low certainty", and for secondary outcomes, it varied from "very-low to moderate certainty".

Conclusions: There is no significant difference between hypertonic saline and mannitol used for the reduction of elevated ICP in children. The evidence generated for primary outcome (mortality rate) was of "low certainty", and for secondary outcomes, it varied from "very-low to moderate certainty". More data from high-quality RCTs are needed to guide any recommendation.

Keywords: 3% saline; CPP; Cerebral edema; GCS; ICP; Osmotic agent; Pediatric.

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References

    1. Melhem S, Shutter L, Kaynar A. A trial of intracranial pressure monitoring in traumatic brain injury. Crit Care. 2014;18:302. - DOI - PubMed - PMC
    1. Koenig MA. Cerebral edema and elevated intracranial pressure. Continuum (Minneap Minn). 2018;24:1588–602. - PubMed
    1. Kochanek PM, Tasker RC, Carney N, et al. Guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the Brain Trauma Foundation guidelines. Pediatr Crit Care Med. 2019;20:S1-82. - DOI - PubMed
    1. Miyoshi Y, Kondo Y, Suzuki H, Fukuda T, Yasuda H, Yokobori S. Japan resuscitation council (JRC) neuroresuscitation task force and the guidelines editorial committee. effects of hypertonic saline versus mannitol in patients with traumatic brain injury in prehospital, emergency department, and intensive care unit settings: a systematic review and meta-analysis. J Intensive Care. 2020;8:61.
    1. Kochanek PM, Adelson PD, Rosario BL, et al. Comparison of intracranial pressure measurements before and after hypertonic saline or mannitol treatment in children with severe traumatic brain injury. JAMA Netw Open. 2022;5:e220891. - DOI - PubMed - PMC

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