Role of hypertonic saline and mannitol in the management of raised intracranial pressure in children: A randomized comparative study

Abstract

Objective:To compare the efficacy and side effects of 3% hypertonic saline and mannitol in the management of raised intracranial pressure in children.Design:Prospective randomized study.Setting:Pediatric intensive care unit (PICU) in a tertiary care hospital.Subject:200 patients with raised intracranial pressure.Materials and Methods:Patients were randomized into two statistically comparable groups; Group A (n = 98) was treated with mannitol while Group B (n = 100) was treated with 3% hypertonic saline. Group C (n = 2) included those members of Group A in whom serum osmolality ≥320 mosmol/kg and were then treated with 3% hypertonic saline. Both Drugs were given at a loading dose of 5 ml/kg stat followed by 2 ml/kg in every 6 h(both have same osmolarity) for two days in their respective groups. Besides monitoring, blood pressure (NIBP), mean arterial pressure (pre and post 30 min of drug), serum sodium, chloride and osmolality were measured. Intracranial pressure was assessed indirectly by measuring mean arterial ressure “MAP”. Student paired ‘t’ test was applied.Results:Decrease in MAP was highly significant (P<0.001) at 0 h in males 0,6 h in females, and moderately significant at 12,36 h in females and significant(P<0.05) at 6,24,42 h in males of Group B. Decrease in coma hours was a highly significant finding (P<0.001) in Group B. In Group B, serum sodium and chloride increased significantly but remained within acceptable limits. There was no difference in osmolality and mortality (fisher Z).Conclusion:Mannitol has several side effects, 3% hypertonic saline is a safe and effective alternative in managing cerebral edema.

Formulating a Stable Mannitol Infusion while Maintaining Hyperosmolarity

“…Mannitol is exclusively eliminated renally (indeed, this is a key feature of its therapeutic mechanism) and therefore is not suitable for patients with renal insufficiency [17]. With NaCl, associated side effects include myelinolysis and electrolyte imbalances [26]. In addition, the optimum administration protocol of NaCl is not well understood although research is ongoing [27].…”

Perbandingan NaCl 3% dan Manitol pada Cedera Kepala Akibat Trauma di Ruang Rawat Intensif Anak

“…Penelitian lain yang dilakukan terhadap anak dengan peningkatan tekanan intrakranial yang dirawat di ruang rawat intensif, ditunjukkan adanya peningkatan kadar natrium dan klorida pada kelompok yang mendapatkan salin hipertonis 3%, tetapi masih dalam rentang kadar yang bisa diterima. 10 Pada penelitian ini hipernatremia hanya didapati pada satu pasien untuk masing-masing kelompok. Gangguan elektrolit yang terbanyak dijumpai adalah hiponatremia.…”

Managing children with raised intracranial pressure: part two (brain tumours and intracranial bleeds)

“…Patients should be nursed with a head-up tilt of 30˚. Intravenous mannitol or hypertonic saline can be used to reduce intracranial pressure, with evidence suggesting that 3% saline is safer and of equal efficacy to mannitol (Upadhyay et al 2010), although it is less widely available. Practitioners may prefer to consult the regional specialists before administration of 3% saline.…”