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Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials.
Neurosurg Rev. 2019 Jun; 42(2):499-509.NR

Abstract

Hyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. We conducted a systematic search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Wan Fang Data, VIP Data, SinoMed, and China National Knowledge Infrastructure (CNKI) databases. Studies were included or not based on the quality assessment by the Jadad scale and selection criteria. Twelve RCTs with 438 patients were enrolled for the meta-analysis. The comparison of HS and mannitol indicated that they were close in field of improving function outcome (RR = 1.17, 95% CI 0.89 to 1.54, p = 0.258) and reducing intracranial pressure (MD = - 0.16, 95% CI: - 0.59 to 0.27, p = 0.473) and mortality (RR = 0.78, 95% CI 0.53 to 1.16, p = 0.216). The pooled relative risk of successful ICP control was 1.06 (95% CI: 1.00 to 1.13, p = 0.044), demonstrating that HS was more effective than mannitol in ICP management. Both serum sodium (WMD = 5.30, 95% CI: 4.37 to 6.22, p < 0.001) and osmolality (WMD = 3.03, 95% CI: 0.18 to 5.88, p = 0.037) were increased after injection of hypertonic saline. The results do not lend a specific recommendation to select hypertonic saline or mannitol as a first-line for the patients with elevated ICP caused by TBI. However, for the refractory intracranial hypertension, hypertonic saline seems to be preferred.

Authors+Show Affiliations

College of Medicine, Shantou University, Shantou, Guangdong, China.College of Medicine, Shantou University, Shantou, Guangdong, China.Transforming Medical Center, Second Affiliated Hospital of Medical College of Shantou University, North Dongxia Rd, Shantou, 515041, Guangdong, China.Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Changping Rd, Shantou, 515041, Guangdong, China. hwxu@qq.com.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

29905883

Citation

Gu, Jiajie, et al. "Hypertonic Saline or Mannitol for Treating Elevated Intracranial Pressure in Traumatic Brain Injury: a Meta-analysis of Randomized Controlled Trials." Neurosurgical Review, vol. 42, no. 2, 2019, pp. 499-509.
Gu J, Huang H, Huang Y, et al. Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. Neurosurg Rev. 2019;42(2):499-509.
Gu, J., Huang, H., Huang, Y., Sun, H., & Xu, H. (2019). Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. Neurosurgical Review, 42(2), 499-509. https://doi.org/10.1007/s10143-018-0991-8
Gu J, et al. Hypertonic Saline or Mannitol for Treating Elevated Intracranial Pressure in Traumatic Brain Injury: a Meta-analysis of Randomized Controlled Trials. Neurosurg Rev. 2019;42(2):499-509. PubMed PMID: 29905883.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. AU - Gu,Jiajie, AU - Huang,Haoping, AU - Huang,Yuejun, AU - Sun,Haitao, AU - Xu,Hongwu, Y1 - 2018/06/15/ PY - 2018/03/18/received PY - 2018/06/04/accepted PY - 2018/05/05/revised PY - 2018/6/16/pubmed PY - 2019/8/3/medline PY - 2018/6/16/entrez KW - Hypertonic saline KW - Intracranial hypertension KW - Intracranial pressure KW - Mannitol KW - Meta-analysis KW - Traumatic brain injury SP - 499 EP - 509 JF - Neurosurgical review JO - Neurosurg Rev VL - 42 IS - 2 N2 - Hyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. We conducted a systematic search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Wan Fang Data, VIP Data, SinoMed, and China National Knowledge Infrastructure (CNKI) databases. Studies were included or not based on the quality assessment by the Jadad scale and selection criteria. Twelve RCTs with 438 patients were enrolled for the meta-analysis. The comparison of HS and mannitol indicated that they were close in field of improving function outcome (RR = 1.17, 95% CI 0.89 to 1.54, p = 0.258) and reducing intracranial pressure (MD = - 0.16, 95% CI: - 0.59 to 0.27, p = 0.473) and mortality (RR = 0.78, 95% CI 0.53 to 1.16, p = 0.216). The pooled relative risk of successful ICP control was 1.06 (95% CI: 1.00 to 1.13, p = 0.044), demonstrating that HS was more effective than mannitol in ICP management. Both serum sodium (WMD = 5.30, 95% CI: 4.37 to 6.22, p < 0.001) and osmolality (WMD = 3.03, 95% CI: 0.18 to 5.88, p = 0.037) were increased after injection of hypertonic saline. The results do not lend a specific recommendation to select hypertonic saline or mannitol as a first-line for the patients with elevated ICP caused by TBI. However, for the refractory intracranial hypertension, hypertonic saline seems to be preferred. SN - 1437-2320 UR - https://www.unboundmedicine.com/medline/citation/29905883/Hypertonic_saline_or_mannitol_for_treating_elevated_intracranial_pressure_in_traumatic_brain_injury:_a_meta_analysis_of_randomized_controlled_trials_ L2 - https://dx.doi.org/10.1007/s10143-018-0991-8 DB - PRIME DP - Unbound Medicine ER -