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A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management.
Ann Pharmacother. 2016 Apr; 50(4):291-300.AP

Abstract

OBJECTIVE

To comparatively evaluate hypertonic sodium (HTS) and mannitol in patients following acute traumatic brain injury (TBI) on the outcomes of all-cause mortality, neurological disability, intracranial pressure (ICP) change from baseline, ICP treatment failure, and serious adverse events.

DATA SOURCES

PubMed, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and WHO ICTRP (World Health Organization International Clinical Trials Registry Platform) were searched (inception to November 2015) using hypertonic saline solutions, sodium chloride, mannitol, osmotic diuretic, traumatic brain injury, brain injuries, and head injury. Searches were limited to humans. Clinical practice guidelines and bibliographies were reviewed.

STUDY SELECTION AND DATA EXTRACTION

Prospective, randomized trials comparing HTS and mannitol in adults (≥16 years) with severe TBI (Glasgow Coma Scale score ≤8) and elevated ICP were included. ICP elevation, ICP reduction, and treatment failure were defined using study definitions.

DATA SYNTHESIS

Of 326 articles screened, 7 trials enrolling a total of 191 patients met inclusion criteria. Studies were underpowered to detect a significant difference in mortality or neurological outcomes. Due to significant heterogeneity and differences in reporting ICP change from baseline, this outcome was not meta-analyzed. No difference between HTS and mannitol was observed for mean ICP reduction; however, risk of ICP treatment failure favored HTS (risk ratio [RR] = 0.39; 95% CI = 0.18-0.81). Serious adverse events were not reported.

CONCLUSIONS

Based on limited data, clinically important differences in mortality, neurological outcomes, and ICP reduction were not observed between HTS or mannitol in the management of severe TBI. HTS appears to lead to fewer ICP treatment failures.

Authors+Show Affiliations

University of British Columbia, Vancouver, BC, Canada.University of British Columbia, Vancouver, BC, Canada VCHRI Centre for Clinical Epidemiology and Evaluation, Vancouver, BC, Canada.University of British Columbia, Vancouver, BC, Canada Interior Health, Kelowna, BC, Canada.University of British Columbia, Vancouver, BC, Canada British Columbia Emergency Health Services, Vancouver, BC, Canada.University of British Columbia, Vancouver, BC, Canada peter.zed@ubc.ca.

Pub Type(s)

Comparative Study
Journal Article
Review
Systematic Review

Language

eng

PubMed ID

26825644

Citation

Burgess, Sarah, et al. "A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management." The Annals of Pharmacotherapy, vol. 50, no. 4, 2016, pp. 291-300.
Burgess S, Abu-Laban RB, Slavik RS, et al. A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management. Ann Pharmacother. 2016;50(4):291-300.
Burgess, S., Abu-Laban, R. B., Slavik, R. S., Vu, E. N., & Zed, P. J. (2016). A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management. The Annals of Pharmacotherapy, 50(4), 291-300. https://doi.org/10.1177/1060028016628893
Burgess S, et al. A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management. Ann Pharmacother. 2016;50(4):291-300. PubMed PMID: 26825644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management. AU - Burgess,Sarah, AU - Abu-Laban,Riyad B, AU - Slavik,Richard S, AU - Vu,Erik N, AU - Zed,Peter J, Y1 - 2016/01/29/ PY - 2016/1/31/entrez PY - 2016/1/31/pubmed PY - 2016/11/1/medline KW - emergency medicine KW - hypertonic saline KW - intracranial pressure KW - mannitol KW - trauma KW - traumatic brain injury SP - 291 EP - 300 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 50 IS - 4 N2 - OBJECTIVE: To comparatively evaluate hypertonic sodium (HTS) and mannitol in patients following acute traumatic brain injury (TBI) on the outcomes of all-cause mortality, neurological disability, intracranial pressure (ICP) change from baseline, ICP treatment failure, and serious adverse events. DATA SOURCES: PubMed, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and WHO ICTRP (World Health Organization International Clinical Trials Registry Platform) were searched (inception to November 2015) using hypertonic saline solutions, sodium chloride, mannitol, osmotic diuretic, traumatic brain injury, brain injuries, and head injury. Searches were limited to humans. Clinical practice guidelines and bibliographies were reviewed. STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized trials comparing HTS and mannitol in adults (≥16 years) with severe TBI (Glasgow Coma Scale score ≤8) and elevated ICP were included. ICP elevation, ICP reduction, and treatment failure were defined using study definitions. DATA SYNTHESIS: Of 326 articles screened, 7 trials enrolling a total of 191 patients met inclusion criteria. Studies were underpowered to detect a significant difference in mortality or neurological outcomes. Due to significant heterogeneity and differences in reporting ICP change from baseline, this outcome was not meta-analyzed. No difference between HTS and mannitol was observed for mean ICP reduction; however, risk of ICP treatment failure favored HTS (risk ratio [RR] = 0.39; 95% CI = 0.18-0.81). Serious adverse events were not reported. CONCLUSIONS: Based on limited data, clinically important differences in mortality, neurological outcomes, and ICP reduction were not observed between HTS or mannitol in the management of severe TBI. HTS appears to lead to fewer ICP treatment failures. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/26825644/A_Systematic_Review_of_Randomized_Controlled_Trials_Comparing_Hypertonic_Sodium_Solutions_and_Mannitol_for_Traumatic_Brain_Injury:_Implications_for_Emergency_Department_Management_ L2 - http://journals.sagepub.com/doi/full/10.1177/1060028016628893?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -