Comparison of equiosmolar dose of hyperosmolar agents in reducing intracranial pressure—a randomized control study in pediatric traumatic brain injury
There are no comparative studies available for hyperosmolar therapy in children. The present study is a prospective open label randomized control trial to compare the effect of equiosmolar doses of mannitol and hypertonic saline in reducing intracranial pressure in children who sustained severe traumatic brain injury.
This is a prospective open-label randomized controlled trial. Thirty children aged less than or equal to 16 years with severe traumatic brain injury and raised intracranial pressure as measured by ventricular catheter insertion were enrolled. Sixteen children received 20% mannitol, and 14 children received 3% saline as 2.5 ml/kg bolus for episodes of intracranial pressure above cutoff value for age. The mean reduction in intracranial pressure and Glasgow outcome scale at 6 months after injury was measured.
The mean reduction in intracranial pressure in mannitol group was 7.13 mmHg and in hypertonic saline group was 5.67 mmHg, and the difference was not statistically significant, p = 0.33. The incidence of death or survival in vegetative state was 23.07% in mannitol group and 16.66% in hypertonic saline group, and the difference was not statistically significant, p = 0.69.
Both mannitol and hypertonic saline were equally effective for treatment of raised intracranial pressure in children with severe traumatic brain injury.
KeywordsMannitol Hypertonic saline
Compliance with ethical standards
The study received prior approval by the Institutional Ethics Committee and informed consent was obtained from patients’ legal relative. This trial was registered with Clinical Trials Registry of India (REF/2015/03/008696).
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 1.White H, Cook D, Venkatesh B (2006) The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth Analg 102:1836–1846. https://doi.org/10.1213/01.ane.0000217208.51017.56 CrossRefGoogle Scholar
- 3.Kochanek PM, Carney N, Adelson PD et al (2012) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents—second edition. Pediatr Crit Care Med 13(Suppl 1):S1–S82. https://doi.org/10.1097/PCC.0b013e31823f435c
- 4.Bell MJ, Adelson PD, Hutchison JS, Kochanek PM, Tasker RC, Vavilala MS, Beers SR, Fabio A, Kelsey SF, Wisniewski SR (2013) Differences in medical therapy goals for children with severe traumatic brain injury—an international study. Pediatr Crit Care Med 14:811–818. https://doi.org/10.1097/PCC.0b013e3182975e2f CrossRefGoogle Scholar
- 6.Marshall LF, Marshall SB, Klauber MR et al (1992) The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 9(Suppl 1):S287–S292Google Scholar
- 7.Avellino A, Carson Sr B (2005) Increased intracranial pressure. In: Maria B (ed) Current Management in Child Neurology, 3rd ed. BC Decker, Connecticut, pp 563–568Google Scholar
- 14.Yildizdas D, Altunbasak S, Celik U, Herguner O (2006) Hypertonic saline treatment in children with cerebral edema. Indian Pediatr 43:771–779Google Scholar
- 16.Gu J, Huang H, Huang Y, Sun H, Xu H (2018) Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. Neurosurg Rev. https://doi.org/10.1007/s10143-018-0991-8
- 17.Harutjunyan L, Holz C, Rieger A, Menzel M, Grond S, Soukup J (2005) Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients - a randomized clinical trial [ISRCTN62699180]. Crit Care 9:R530–R540. https://doi.org/10.1186/cc3767 CrossRefGoogle Scholar