Comparison of Equiosmolar Dose of Hyperosmolar Agents in Reducing Intracranial Pressure-a Randomized Control Study in Pediatric Traumatic Brain Injury

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2019 Mar 18

PMID 30879126

Citations 12

Authors

S Arun Kumar

Bhagavatula Indira Devi

Madhusudan Reddy

Dhaval Shukla

Affiliations

Soon will be listed here.

Abstract

Introduction: There are no comparative studies available for hyperosmolar therapy in children. The present study is a prospective open label randomized control trial to compare the effect of equiosmolar doses of mannitol and hypertonic saline in reducing intracranial pressure in children who sustained severe traumatic brain injury.

Methods: This is a prospective open-label randomized controlled trial. Thirty children aged less than or equal to 16 years with severe traumatic brain injury and raised intracranial pressure as measured by ventricular catheter insertion were enrolled. Sixteen children received 20% mannitol, and 14 children received 3% saline as 2.5 ml/kg bolus for episodes of intracranial pressure above cutoff value for age. The mean reduction in intracranial pressure and Glasgow outcome scale at 6 months after injury was measured.

Results: The mean reduction in intracranial pressure in mannitol group was 7.13 mmHg and in hypertonic saline group was 5.67 mmHg, and the difference was not statistically significant, p = 0.33. The incidence of death or survival in vegetative state was 23.07% in mannitol group and 16.66% in hypertonic saline group, and the difference was not statistically significant, p = 0.69.

Conclusion: Both mannitol and hypertonic saline were equally effective for treatment of raised intracranial pressure in children with severe traumatic brain injury.

Citing Articles

Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury.

Chong S, Zhu Y, Wang Q, Caporal P, Roa J, Chamorro F JAMA Netw Open. 2025; 8(3):e250438.

PMID: 40067302 PMC: 11897838. DOI: 10.1001/jamanetworkopen.2025.0438.

Management of severe traumatic brain injury in pediatric patients: an evidence-based approach.

Carlotti A, do Amaral V, de Carvalho Canela Balzi A, Johnston C, Regalio F, Cardoso M Neurol Sci. 2024; 46(2):969-991.

PMID: 39476094 DOI: 10.1007/s10072-024-07849-2.

Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN).

Lal B, Khanna R, Sood V, Alam S, Nagral A, Ravindranath A Hepatol Int. 2024; 18(5):1343-1381.

PMID: 39212863 DOI: 10.1007/s12072-024-10720-3.

Hypertonic Saline Versus Other Intracranial-Pressure-Lowering Agents for Patients with Acute Traumatic Brain Injury: A Systematic Review and Meta-analysis.

Bernhardt K, McClune W, Rowland M, Shah A Neurocrit Care. 2023; 40(2):769-784.

PMID: 37380894 PMC: 10959781. DOI: 10.1007/s12028-023-01771-9.

Hypertonic Saline vs. Mannitol in Management of Elevated Intracranial Pressure in Children: A Meta-Analysis.

Mishra N, Agrawal A, Das R Indian J Pediatr. 2023; 90(9):899-906.

PMID: 37225962 DOI: 10.1007/s12098-023-04532-w.

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