To compare the effects of hypertonic saline and mannitol for treatment
of adults with elevated intracranial pressure: a systematic review and
meta-analysis of randomized controlled trails
Abstract
Aims: Currently, mannitol and hypertonic saline (HTS) are mostly used in
treatment of adult with elevated intracranial pressure (ICP). However,
there is no high-level evidence on the superiority of mannitol versus
HTS. Therefore, a systematic review and meta-analysis was performed to
compare effects of hypertonic saline and mannitol for treatment of
adults with elevated ICP. Methods: We performed a search on lots of
databases for eligible studies. Prospective randomized control trials
comparing HTS and mannitol in adults with elevated ICP were included,
and ICP monitoring should be applied. Primary outcome was change of ICP
values, and secondary outcomes were changes of cerebral perfusion
pressure (CPP), mean arterial pressure (MAP), heart rate, serum sodium,
serum osmolarity and hematocrit (HCT). Results: A total of ten studies
(384 patients, 1578 episodes) were included. A pooled result indicated
HTS reduced ICP more effectively than mannitol. At 0.5 h, 1 h, and 2 h
after intervention, results also showed a better efficiency of HTS than
mannitol. In addition, results indicated elevation of CPP, serum sodium
and serum osmolarity were all more in HTS group than in mannitol group.
And there were no statistical significance in changes of MAP, HCT and HR
between the two interventions. Conclusion: Our study indicated HTS had a
better efficiency in reduction of elevated ICP than mannitol in earlier
stage. Based on the current level of evidence of ICP control and effects
in other physiological indicators, HTS could be recommended as a
first-line agent for managing patients with elevated ICP.