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Related Experiment Videos

Mannitol for acute traumatic brain injury.

A Wakai1, I Roberts, G Schierhout

  • 1St Vincent's Hospital, Department of Emergency Medicine, Dublin 4, Ireland. wakai@indigo.ie

The Cochrane Database of Systematic Reviews
|October 20, 2005
PubMed
Summary

High-dose mannitol may improve outcomes for severe head injuries. Conventional doses may be less effective, and mannitol

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Pharmacology

Background:

  • Mannitol's efficacy in acute brain swelling is known, but its role in severe head injury management is unclear.
  • Prolonged mannitol dosage may lead to increased intracranial pressure due to blood-brain barrier passage.

Purpose of the Study:

  • To evaluate different mannitol therapy regimens for severe head injury.
  • To compare mannitol with other intracranial pressure (ICP)-lowering agents.
  • To assess mannitol's effectiveness at various stages post-traumatic brain injury.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) of mannitol in acute traumatic brain injury.
  • Searches updated in April 2005, including reference lists and author contact.
  • Data extraction and quality assessment by independent reviewers; relative risks (RR) and 95% confidence intervals (CI) calculated.

Main Results:

  • High-dose mannitol reduced mortality (RR=0.56) and death/severe disability (RR=0.58) in comatose patients with severe head injury compared to conventional doses.
  • ICP-directed therapy showed a small benefit over standard care (RR=0.83 for death).
  • Mannitol showed potential benefit versus pentobarbital (RR=0.85 for death) but potential harm versus hypertonic saline (RR=1.25 for death).

Conclusions:

  • High-dose mannitol appears preferable to conventional doses for acute severe head injury management.
  • Mannitol may improve mortality compared to pentobarbital but could be detrimental versus hypertonic saline.
  • Insufficient data exist on pre-hospital mannitol administration effectiveness.

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