2013/06/28 by Annette Rickard, Jason Smith, Paul Newell +3 · 2 citations
Medicine · Biochemistry, Genetics and Molecular Biology · #Traumatic Brain Injury and Neurovascular Disturbances #S100 Proteins and Annexins #Trauma, Hemostasis, Coagulopathy, Resuscitation #Medicine #Traumatic brain injury #Tonicity #Mannitol #Intracranial pressure #Anesthesia #Hypertonic saline #Sodium #Meta-analysis #Internal medicine
paper · doi:10.1136/emermed-2013-202679
openalex publication_date 2013/06/28 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
BACKGROUND: Rising intracranial pressure (ICP) is a poor prognostic indicator in traumatic brain injury (TBI). Both mannitol and hypertonic sodium solutions are used to treat raised ICP in patients with TBI. OBJECTIVE: This meta-analysis compares the use of mannitol versus hypertonic sodium solutions for ICP control in patients with TBI. DATA SOURCES AND STUDY ELIGIBILITY: Randomised clinical trials in adults with TBI and evidence of raised ICP, which compare the effect on ICP of hypertonic sodium solutions and mannitol. METHODS: The primary outcome measure is the pooled mean reduction in ICP. Studies were combined using a Forest plot. RESULTS: Six studies were included, comprising 171 patients (599 episodes of raised ICP). The weighted mean difference in ICP reduction, using hypertonic sodium solutions compared with mannitol, was 1.39 mm Hg (95% CI -0.74 to 3.53). LIMITATIONS: Methodological differences between studies limit the conclusions of this meta-analysis. CONCLUSIONS: The evidence shows that both agents effectively lower ICP. There is a trend favouring the use of hypertonic sodium solutions in patients with TBI.