An equiosmolar study on early intracranial physiology and long term outcome in severe traumatic brain injury comparing mannitol and hypertonic saline

Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations

“…Nine RCTs were found, comparing different hyperosmolar fluids administered as infusion boluses to treat elevated ICP: six studies were performed in TBI patients [35,38,[61][62][63][64], two studies with an heterogeneous population of TBI and SAH patients [65,66] and one study with AIS patients [57]. Eight studies compared MAN to HTS [35,38,57,62], and one study compared MAN to HTL [61]. Evidence from all these RCTs (besides one [57]) was equally rated.…”

“…One study (n=9 in a crossover design, single-centre) found that 7.5% HTS/6% dextran vs. 20% MAN yielded a greater ICP reduction at 60 min (-5 mmHg 95%-CI -10.8 to -3], p 0.014) [65], while four other studies (n=20 [38], n=47 [35], n=38 [62], n=29 [63]) found that 7.5%, 3%, 15% HTS and 20% MAN were equally effective in reducing ICP. One study (n=9) investigating ICP reduction using 7.5% HTS/6% dextran and 20% MAN, did not compare the two groups with formal statistical tests and received a very low evidence grading [57].…”

Therapeutic effect of intensive glycemic control therapy in patients with traumatic brain injury

“…TBI is related to a stress response including hyperglycemia, which has been shown to worsen the neurological outcome during cerebral ischemia and hypoxia. [ 23 – 25 ] Studies on moderate to severe TBI patients indicate that, higher initial and postoperative glucose levels will lead to higher intracerebral lactate levels and worse outcome, especially for those with the glucose levels of greater than 160 to 200 mg/dL. [ 26 – 28 ] The mechanisms by which hyperglycemia exerts the harmful effect are complex.…”

Management of intracranial hypertension: Recent advances and future directions

“…Comparison of 500mOsm of mannitol with 1000mOsm of HTS is not worth to draw a conclusion on. A study by Jagannatha AT et al, 72 however, did compare equiosmolar concentration of mannitol with HTS and found physiological advantages of HTS over mannitol (significantly less increase in ICP, greater slope of fall in ICP after a bolus dose) but it did not translate into long term benefit in terms of ICP control or mortality.Secondly, there is lack of good quality evidence. Most of the studies conducted were not RCTs, the meta-analysis and systemic reviews did not include any large scale trials and the studies have a lot of heterogeneity.…”