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Comparison of equiosmolar dose of hyperosmolar agents in reducing intracranial pressure-a randomized control study in

S Arun Kumar1, Bhagavatula Indira Devi1, Madhusudan Reddy2

  • 1Department of Neurosurgery, NIMHANS, Bangalore, India.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|March 18, 2019
PubMed

Insights

Equiosmolar doses of mannitol and hypertonic saline equally reduce intracranial pressure in children with severe traumatic brain injury. Both treatments showed similar outcomes for reducing intracranial pressure and improving patient survival.

Area of Science:

  • Pediatric critical care medicine
  • Neurotrauma management
  • Pharmacological interventions for intracranial pressure

Background:

  • Hyperosmolar therapy is crucial for managing elevated intracranial pressure (ICP) in pediatric severe traumatic brain injury (TBI).
  • Limited comparative studies exist on equiosmolar hyperosmolar agents in pediatric populations.
  • This study addresses the need for evidence comparing mannitol and hypertonic saline in children with TBI.

Purpose of the Study:

  • To prospectively compare the efficacy of equiosmolar doses of mannitol and 3% hypertonic saline in reducing intracranial pressure in children with severe TBI.
  • To evaluate the impact of these treatments on neurological outcomes at 6 months post-injury.

Main Methods:

  • A prospective, open-label, randomized controlled trial was conducted.
  • Thirty pediatric patients (≤16 years) with severe TBI and elevated ICP were enrolled.
  • Patients received either 20% mannitol or 3% hypertonic saline (2.5 ml/kg bolus) for ICP management.

Main Results:

  • The mean reduction in intracranial pressure was 7.13 mmHg for mannitol and 5.67 mmHg for hypertonic saline (p=0.33), showing no statistically significant difference.
  • The incidence of death or persistent vegetative state was 23.07% with mannitol and 16.66% with hypertonic saline (p=0.69), also not statistically significant.

Conclusions:

  • Equiosmolar mannitol and hypertonic saline demonstrate comparable effectiveness in managing elevated intracranial pressure in pediatric severe TBI.
  • Both agents are equally suitable for clinical use in this patient population, with similar impacts on mortality and long-term outcomes.
Abstract

Keywords:
Hypertonic salineMannitol

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