Hypertonic Saline Solution versus Mannitol in Children with Intracranial Hypertension: A Systematic Review and Meta-Analysis
Artur Menegaz de Almeida1, Paloma Oliveira1, Patricia Viana2, Sergio Araujo3, Helen Oliveira1, Julyana Dantas4, Amanda Rodrigues5, Acza Silva1, Ana Vitoria Cordeiro Rocha6, Carlos Alberto Campello Jorge1, Amanda Godoi7, Isabela Reis Marques8, Jessica Garcia1, Antonia Barreiros1, Ana Toguchi9, Gabriel Marinheiro Dos Santos-Bezerra10, Allan Polverini11
1Federal University of Mato Grosso, 2Extremo Sul Catarinense University, 3Hans Dieter Schmidt Regional Hospital, 4Federal University of Rio Grande do Norte, 5Positivo University, 6University of Miami, 7Cardiff University School of Medicine, 8Universitat Internacional de Catalunya, 9São Camilo University, 10Universidade Federal do Ceará, Campus Sobral, 11Hospital de Amor de Barretos - Fundação Pio XII
Objective:
We aimed to perform a systematic review and meta-analysis on the efficacy of hypertonic saline (HS) versus mannitol (MAN), as hyperosmolar agents, in children with elevated intracranial pressure.
Background:

Hyperosmolar therapy may reduce intracranial hypertension (IH) and act as a lifesaving method in critically ill patients with IH. There is no established superiority of either HS or MAN, the most frequently used agents, in pediatric patients.


Design/Methods:

PubMed, Embase, and Cochrane databases were searched for studies and abstracts published up to October 1st, 2022. Studies were excluded if boluses of HS or MAN were held in patients undergoing elective procedures. The outcomes of interest were mortality; changes in intracranial pressure (ICP); and changes in cerebral perfusion pressure (CPP).


Results:

Six studies with 819 patients were included. The mean patient age ranged from 9 months to 13.5 years. Mortality was not significantly different between the HS (15.6%) and the MAN (21.6%) groups (risk ratio [RR] 0.66; 95% confidence interval [CI] 0.44,0.99; p=0.05). There were also no significant changes in ICP (standardized mean difference -0.25; 95% CI -0.90,0.40; p=0.45) or CPP (standardized mean difference 0.20; 95% CI -0.29,0.68; p=0.42) between patients treated with HS or MAN. 


Conclusions:

In this meta-analysis including 819 children with elevated intracranial pressure, there was no difference in mortality, ICP, or CPP between patients treated with HS or MAN. 


10.1212/WNL.0000000000202875