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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
|January 27, 2007
PubMed
Summary

Mannitol may improve mortality for severe head injury when compared to pentobarbital but could worsen outcomes versus hypertonic saline. More research is needed on pre-hospital mannitol use.

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Pharmacology

Background:

  • Mannitol is used for acute brain swelling, but its long-term efficacy in severe head injury is uncertain.
  • Prolonged mannitol dosage may lead to increased intracranial pressure due to blood-brain barrier penetration.

Purpose of the Study:

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

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) updated in March 2006.
  • Searches included reference lists and author contact.
  • Included RCTs of mannitol in acute traumatic brain injury, comparing it to placebo, no drug, or different drugs; excluded cross-over and late-treatment trials.

Main Results:

  • Four RCTs were identified.
  • ICP-directed therapy showed a non-significant trend towards reduced mortality (RR 0.83).
  • Mannitol vs. pentobarbital showed no significant difference in mortality (RR 0.85), while mannitol vs. hypertonic saline suggested increased mortality (RR 1.25). Pre-hospital mannitol showed a trend towards increased mortality (RR 1.75).

Conclusions:

  • Mannitol may offer a mortality benefit over pentobarbital but could be detrimental compared to hypertonic saline.
  • ICP-directed treatment appears slightly more beneficial than standard care.
  • Insufficient data exists regarding the efficacy of pre-hospital mannitol administration.

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