Effects of hypertonic saline versus mannitol in patients with traumatic brain injury in prehospital, emergency department, and intensive care unit settings: a systematic review and meta-analysis

Abstract

Background: Intracranial pressure control has long been recognized as an important requirement for patients with severe traumatic brain injury. Hypertonic saline has drawn attention as an alternative to mannitol in this setting. The aim of this study was to assess the effects of hypertonic saline versus mannitol on clinical outcomes in patients with traumatic brain injury in prehospital, emergency department, and intensive care unit settings by systematically reviewing the literature and synthesizing the evidence from randomized controlled trials. Methods: We searched the MEDLINE database, the Cochrane Central Register of Controlled Trials, and the Igaku Chuo Zasshi (ICHUSHI) Web database with no date restrictions. We selected randomized controlled trials in which the clinical outcomes of adult patients with traumatic brain injury were compared between hypertonic saline and mannitol strategies. Two investigators independently screened the search results and conducted the data extraction. The primary outcome was all-cause mortality. The secondary outcomes were 90-day and 180-day mortality, good neurological outcomes, reduction in intracranial pressure, and serum sodium level. Random effects estimators with weights calculated by the inverse variance method were used to determine the pooled risk ratios.

Congenital nephrogenic diabetes insipidus and the trauma injured brain: A case report

“…Despite this there is insufficient evidence to make recommendations on the use of osmotic agents in TBI. Furthermore, the side effects of these drugs may have deleterious effects -especially in patients with already high urine outputs and sodium abnormalities like nephrogenic diabetes insipidus [8][9][10][11][12]. With desmopressin, mannitol and hypertonic saline demonstrating more harm than benefit in this condition, the treatment strategy hinges upon careful fluid management.…”

Terapi Hiperosmolar dalam Tatalaksana Cedera Otak Traumatis

“…Sebelas studi lain menyimpulkan bahwa manitol dan saline hipertonis efektif menurunkan TIK, dalam konsentrasi ekuimolar menghasilkan efek yang sebanding pada penurunan TIK, perbaikan tekanan perfusi serebral, penurunan angka kematian, relaksasi otak, dan hemodinamika sistemik. [1][2][3][12][13][14][15][16][17][18][19] Studi Tatro, et al, menghasilkan tidak ada perbedaan signifikan secara statistik pada…”

“…21 Manitol telah menjadi agen osmotik 'gold standard' yang direkomendasikan selama hampir satu abad, tetapi timbul kekhawatiran dilematis karena menyebabkan hipotensi, terutama pada pasien hipovolemik, serta fenomena rebound dengan peningkatan TIK, bersama dengan toksisitas ginjal karena peningkatan osmolalitas serum. 3,17 Osmolaritas serum sebaiknya dipertahankan kurang dari 320 mOsm untuk menghindari efek samping terapi, seperti hipovolemia, hiperosmolaritas, dan gagal ginjal. 21 Selama beberapa dekade terakhir, saline hipertonis telah menjadi alternatif, dan penelitian terbaru menunjukkan efektivitas yang bisa diperbandingkan.…”

Comparative Evaluation of Efficacy of Mannitol and Hypertonic Saline (3%) for Treatment of Moderate to Severe Traumatic Brain Injury (TBI)

“…Mannitol transports fluid into the intravascular compartment and being a diuretic, it results in diuresis, which may lead to hypovolemia [31]. It may also lead to renal toxicity given the increased serum osmolality [32]. Decreasing efficacy has also been reported with consecutive doses [33].…”