A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury

Burgess, Sarah; Abu‐Laban, Riyad B.; Slavik, Richard S; Vu, Erik; Zed, Peter J.

doi:10.1177/1060028016628893

Cited by 83 publications

(47 citation statements)

References 42 publications

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“…Clinical use of HTS has been introduced for prehospital intravascular volume restoration in patients with severe haemorrhage and is increasingly used for the treatment of brain oedema and h-ICP [9,10]. Recent guidelines suggest the use of HTS as a second-line therapy in cases where mannitol fails to reduce ICP [8].…”

Section: Introductionmentioning

confidence: 99%

“…Recent guidelines suggest the use of HTS as a second-line therapy in cases where mannitol fails to reduce ICP [8]. Despite hyperosmolar solutions being routinely used in neurosurgical and neurocritical care (NCC) patients for brain relaxation and ICP management [8][9][10][11][12][13][14], there is scanty information on the time course of their haemodynamic effects.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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AIMOsmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic haemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients. METHODA database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting. The primary end-points were alterations of cardiac output (CO) and other haemodynamic variables, while the impact of osmotic agents on intracranial pressure, brain relaxation, plasma osmolality, electrolyte levels and urinary output constituted secondary outcomes. RESULTSEight studies, enrolling 182 patients in total, were included. HTS exerted a more profound cardiac output augmentation than mannitol, but no distinct difference between groups occurred. Central venous pressure, stroke volume and stroke volume variation were favourably affected by both osmotic agents, whilst the reported changes in blood pressure were inconclusive. HTS infusion yielded a larger intracranial pressure reduction than mannitol but had an equivalent effect on brain relaxation. Mannitol presented a more potent diuretic effect than HTS. Effect on serum osmolality was alike in both osmotic agents, but contrary to HTS-promoted hypernatraemia, mannitol use induced transient hyponatraemia. CONCLUSIONSMannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion. This effect combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Osmotherapy with either mannitol or hypertonic saline (HTS) is the recommended first-line medical intervention for optimizing cerebral perfusion through brain relaxation.• Mannitol has long been used as osmotic agent for ensuring brain relaxation in neurosurgical patients undergoing craniotomy, but the clinical benefit of mannitol infusion in acute brain injury setting, has not yet been proven according to evidence-based medicine.• Recent guidelines suggest the use of HTS as a second-line therapy in case mannitol fails to reduce intracranial pressure, in patients sustaining traumatic brain injury. WHAT THIS STUDY ADDS• Both mannitol and HTS induce an increase in cardiac output, which is more pronounced after HTS than mannitol administration.• Mannitol and HTS infusion are associated with a trend towards to mean arterial pressure and heart rate reduction.• Both osmotic agents induced an intracranial pressure reduction and brain relaxation, an effect that seems to be more prominent in HTS-treated patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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“…However, these meta-analyses are limited, as there are several differences noted between studies (dosage used, when neurological and mortality outcomes were assessed, HSS formulas, unblinded trials, etc.). Furthermore, a randomized controlled trial with sufficient power is needed to make definite conclusions about the use and effectiveness of each drug [10,11]. Another method of ICP reduction is decompressive craniectomy, where a portion of the skull is removed to expand the area around the swelling brain [12].…”

Section: Traumatic Brain Injury: Definition Prognosis and Current Trmentioning

confidence: 99%

Src Family Kinase Inhibitors and their Role in the Treatment of Traumatic Brain Injuries

Groves¹,

Allen²

2016

J Trauma Treat

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Traumatic brain injury (TBI) leads to a broad spectrum of neurological deficits, including cognitive impairments that are irreversible and significantly influence quality of life even after recovery from physical disabilities. Clinically, there is no standardized procedure for treating secondary TBI, as each case is symptomatic. Src family kinase (SFK) inhibitors, a relatively new treatment regarding TBI, have so far been neuroprotective against secondary damage in non-human models. Immediately after TBI, there is increased expression of NR2A and NR2B. SFKs regulate NR2 subunits of NMDARs through tyrosine phosphorylation. Synthetic inhibitors of SFKs may help reduce the cognitive dysfunction seen after TBI by binding to SFKs and inhibiting the tyrosine phosphorylation of NMDARs, thereby preventing excitotoxicity within neurons that leads to cell death.

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“…This systematic review wrote that the data which were currently used were still limited due to the high heterogeneity of each study. 34 A review by Boone et al, also found that because of the heterogeneity among studies, the superiority between hypertonic saline and mannitol in reducing ICP in patients TBI could ORIGINAL ARTICLE not be concluded. 35 Studies regarding comparison of effectivity of mannitol and hypertonic saline in lowering intracranial pressure for TBI patient were summarized in Table 1.…”

mentioning

confidence: 99%

“…34 This review involved seven well-publicized trials until November 2015. The failure rate of ICP-lowering therapy was less found in the hypertonic saline group.…”

mentioning

confidence: 99%

Efficacy Comparison of Mannitol and Hypertonic Saline for Traumatic Brain Injury (TBI) Treatment

Arifianto¹,

Ma'ruf²,

Ibrahim³

2016

Bali Med J.

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Traumatic Brain Injury (TBI) case is commonly found in the emergency room. TBI accompanied by increased intracranial pressure (ICP) is a neurological emergency that requires prompt and appropriate management. Hyperosmolar fluid is the main treatment in the initial management of increased ICP. Mannitol and hypertonic saline are hyperosmolar fluids which are generally used. There is no specific recommendation regarding the choice between the two fluids. From the current studies indicate that both fluids are equally effective in reducing ICP. Regarding the superiority between the two fluids, it is difficult to determine because of the heterogeneity of the studies that exist. Therefore, clinicians should choose between hyperosmolar fluids based on indications and contraindications exist in TBI patients.

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A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury

Abstract: Based on limited data, clinically important differences in mortality, neurological outcomes, and ICP reduction were not observed between HTS or mannitol in the management of severe TBI. HTS appears to lead to fewer ICP treatment failures.

Cited by 83 publications

References 42 publications

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Src Family Kinase Inhibitors and their Role in the Treatment of Traumatic Brain Injuries

Efficacy Comparison of Mannitol and Hypertonic Saline for Traumatic Brain Injury (TBI) Treatment

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