There were no significant adverse events reported. Surg. Hypertonic Saline or Mannitol for Pediatric Increased ICP? The main findings are as follows: For patients with intracranial hypertension, 20% mannitol was slightly more effective than 3% hypertonic saline in reducing ICP. Int J Mol Sci. PDF Hypertonic saline for traumatic brain injury: a systematic review and This systematic review and meta-analysis evaluates the eectiveness of HTS in the management of patients with TBI. Although there was a nonsignificant trend in favor of hypertonic saline, there were no significant differences in mortality between the 2 treatments (relative risk [RR]: 0.69, 95% confidence interval [CI]: 0.45, 1.04; P=0.08). Acta Neurochir (Wien). DATA SOURCES: We searched for relevant studies in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ISI Web of Knowledge. DATA SOURCES: We searched for relevant studies in MEDLINE, EMBASE, the Cochrane . Hypertonic Fluids Article - StatPearls There were also no significant differences in favorable neurological outcome between hypertonic saline (HS) and mannitol (RR: 1.28, 95% CI: 0.86, 1.90; P=0.23). Our meta-analysis is limited by the small number and size of eligible trials, but our findings suggest that hypertonic saline may be superior to the current standard of care and argue Hypertonic Saline is Superior to Mannitol for the Combined Effect on Intracranial Pressure and Cerebral Perfusion Pressure Burdens in Patients With Severe Traumatic Brain Injury HTS bolus therapy appears to be superior to mannitol in reduction of the combined burden of intracranial hypertension and associated hypoperfusion in severe TBI patients. DATA EXTRACTION: Two investigators independently reviewed potentially eligible trials and extracted data using a preformed data collection sheet. 2011. An official website of the United States government. Question 17. Fluid Physiology: 8.5 Hypertonic Mannitol Infusions - Anaesthesia MCQ We therefore combined their findings in a meta-analysis. Clipboard, Search History, and several other advanced features are temporarily unavailable. Rickard AC, Smith JE, Newell P, Bailey A, Kehoe A, Mann C. Emerg Med J. Cerebral perfusion pressure was higher between 30 to 60 and 90 to 120 minutes after treatment with HS compared with after treatment with mannitol (MD: 5.48 mm Hg, 95% CI: 4.84, 6.12; P<0.00001 and 9.08 mm Hg, 95% CI: 7.54, 10.62; P<0.00001, respectively). The .gov means its official. Hypertonic saline for traumatic brain injury: a systematic review and Comparison of 20% mannitol and 3% hypertonic saline for intraoperative Salt or sugar on the brain: does it matter except for taste? Since Weed and 1VfcKibben 4e,47 demonstrated that various hypertonic solutions could accomplish these effects, many agents have been tested. We suggest using hypertonic sodium solutions over mannitol for the initial management of elevated ICP or cerebral edema in patients with TBI (conditional recommendation, low-quality evidence). We therefore combined their findings in a meta-analysis. In random-effects models, the relative risk of intracranial pressure control was 1.16 (95% confidence interval, 1.00-1.33), and the difference in mean intracranial pressure reduction was 2.0 mm Hg (95% confidence interval, -1.6 to 5.7), with both favoring hypertonic saline over mannitol. Neurosurg Rev. A meta-analysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury. Current status. Mannitol and Hypertonic saline (HTS) are the treatment bases for elevated ICP in TBI. PMC Hypertonic saline and mannitol in patients with traumatic : Medicine Accessibility StatementFor more information contact us atinfo@libretexts.orgor check out our status page at https://status.libretexts.org. (Conditional, Low) HHS Vulnerability Disclosure, Help Mannitol and HS cause an increase in cerebrospinal fluid osmolality, and are associated with similar brain relaxation scores and arteriovenous oxygen and lactate difference during craniotomy. For requests to be unblocked, you must include all of the information in the box above in your message. Critical Care Medicine2011;39(3):554-559. DOI: 10.1016/J.RCAE.2014.07.010 Corpus ID: 54547822; Mannitol versus hypertonic saline solution in neuroanaesthesia @article{Llorente2015MannitolVH, title={Mannitol versus hypertonic saline solution in neuroanaesthesia}, author={Gisela Llorente and Mar{\'i}a Claudia Ni{\~n}o-de Mej{\'i}a}, journal={Colombian Journal of Anesthesiology}, year={2015}, volume={43}, pages={29-39} } According to some researchers, glycerol can be best administered as a basal treatment whereas mannitol can be administered to . Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury. This site needs JavaScript to work properly. and transmitted securely. OBJECTIVES: Randomized trials have suggested that hypertonic saline solutions may be superior to mannitol for the treatment of elevated intracranial pressure, but their impact on clinical practice has been limited, partly by their small size. Consequently, mannitol is classified as an 'osmotic diuretic'. We also acknowledge previous National Science Foundation support under grant numbers 1246120, 1525057, and 1413739. Data sources: doi: 10.1523/ENEURO.0082-22.2022. 2016 Apr;50(4):291-300. doi: 10.1177/1060028016628893. Keywords: Hypertonic saline, mannitol, raised intracranial pressure Go to: Introduction Hyperosmolar treatment is one of the important methods for treating cerebral edema, and has been employed since early 1960. Conclusions: 2020 Aug 28;99(35):e21655. Salt or sugar for your injured brain? Hypertonic Saline is Superior to Mannitol for the Combined - PubMed The https:// ensures that you are connecting to the For additional information, or to request that your IP address be unblocked, please send an email to PMC. Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. This site needs JavaScript to work properly. As the blood-brain barrier is probably disrupted in damaged areas of the brain, mannitol may be both less effective here and also more may enter the brain at these places. However, there are insufficient data to reach a definitive conclusion, and further studies are warranted. Our primary outcome was the proportion of successfully treated episodes of elevated intracranial pressure. 2022 Jun 23;37(2):203-211. doi: 10.4274/MMJ.galenos.2022.75725. Badri S, Chen J, Barber J, et al. The site is secure. Medeni Med J. Our primary outcome was the proportion of successfully treated episodes of elevated intracranial pressure. 2006;4:813. The effect is to increase intracellular tonicity and allow brain cell volume to return towards normal presumably with improvement of intracellular functions despite the continued hypertonicity. 8600 Rockville Pike Hypertonic mannitol solutions are used clinically for: The hypertonicity causes passive movement of water across lipid barriers in response to the osmotic gradient. MeSH Abstract. eCollection 2022. and transmitted securely. This open label RCT assigned children with acute CNS infections aged 1-12 with a GCS of 8 to either treatment with 3% hypertonic saline (n = 29) or 20% mannitol (n = 28). doi: 10.1002/14651858.CD010904.pub3. Hypertonic saline (HTS) or mannitol: Salty or sweet? Objectives: Mannitol and hypertonic saline reduce swelling and modulate In the past, other hypertonic solutions (eg hypertonic urea solution) have been used and currently in some places hypertonic glycerol solutions are available as an alternative to mannitol. Mannitol and Hypertonic saline (HTS) are the treatment bases for elevated ICP in TBI. 2022 Nov 4;13:857640. doi: 10.3389/fneur.2022.857640. FOIA Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: a meta-analysis of randomized clinical trials. The site is secure. Abdulhamid AS, Ghaddaf AA, Bokhari AF, Alghamdi YA, Alhakami MF, Alaboud AK, Lary A. Surg Neurol Int. Mannitol Versus Hypertonic Saline Solution in the Treatment of Elevated injury. Subsequently, the diuretic effect may result in hypovolaemia (and hypernatraemia). government site. 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Rebound Swelling of Astroglial Cells Exposed to Hypertonic Mannitol Intensive Care Med. We therefore combined their findings in a meta-analysis. Kelley C, Newton AJH, Hrabetova S, McDougal RA, Lytton WW. Anuria [see Warnings and Precautions (5.2)]. Question 16. Jha RM, Rani A, Desai SM, Raikwar S, Mihaljevic S, Munoz-Casabella A, Kochanek PM, Catapano J, Winkler E, Citerio G, Hemphill JC, Kimberly WT, Narayan R, Sahuquillo J, Sheth KN, Simard JM. eCollection 2022. This is called 'mannitol osmotherapy'. In the renal glomeruli, mannitol is freely filtered. 8600 Rockville Pike Mannitol versus hypertonic saline solution in neuroanaesthesia Federal government websites often end in .gov or .mil. The Value of Hypertonic Mannitol Solution in Decreasing Brain - jns HHS Vulnerability Disclosure, Help 2022 Apr;36(2):519-526. doi: 10.1007/s12028-021-01332-y. The aim is to decrease intracranial pressure and produce a 'slack brain' to facilitate surgical access. HHS Vulnerability Disclosure, Help government site. isotonic. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. Background: Careers. Study selection: Optimal Dose and Concentration of Hypertonic Saline in Traumatic Brain Injury: A Systematic Review. In addition to the first physical hit, secondary injury, which is associated with increased intracranial pressure (ICP), is defined as biochemical, cellular, and physiological changes after the physical injury. Use of mannitol infusions is common intraoperatively in some neurosurgical procedures. Wise, B. L., and & Chater, N. Use of hypertonic mannitol solutions to lower cerebrospinal fluid pressure and decrease brain bulk in man. Epub 2016 Jan 29. Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury. 2022 Aug 18;9(4):ENEURO.0082-22.2022. A Methods: Rickard AC, Smith JE, Newell P, Bailey A, Kehoe A, Mann C. Emerg Med J. Crit Care Med. Solutions of 10% mannitol (osmolality 596 mOsm/kg) and 20% mannitol (osmolality 1,192 mOsm/kg) are commonly available for clinical use. This activity will highlight the mechanism of action, adverse events, and contraindications of hypertonic fluids in the management of hyponatremia and increased intracranial pressure. Acute Treatment of Cerebral Edema in Neurocritical Care Patients The primary outcome was the proportion of satisfactory . A mild degree of heterogeneity was present among the included trials. Print 2022 Jul-Aug. Medeni Med J. Burgess S, Abu-Laban RB, Slavik RS, Vu EN, Zed PJ. 80 g of mannitol was infusing in 45 minutes and after 15 minutes of administration, the patient's ECG showed peaked T wave and ABG showed hyperkalemia. Effect of mannitol and hypertonic saline on cerebral oxygenation in Bookshelf Background: Mannitol and hypertonic saline are widely used to treat raised intracranial pressure (ICP) after traumatic brain injury (TBI), but the clinical superiority of one over the other has not been demonstrated. Mannitol versus hypertonic saline solution in neuroanaesthesia Hypertonic saline can be utilized in the treatment of hyponatremia. Data extraction: A meta-analysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury. To compare the effects of 3% hypertonic saline solution and 20% mannitol solution on intracranial hypertension. Mannitol has free radical scavenging properties and these may contribute to its therapeutic effects (though this has not so far been established). We found that hypertonic saline is more effective than mannitol for the treatment of elevated intracranial pressure. We suggest that neither HTS nor mannitol be used with the expectation for improving neurological outcomes in patients with TBI. 2011 Mar;39(3):601-2. doi: 10.1097/CCM.0b013e31820b76a1. Medicine (Baltimore). The high flow of retained tubule fluid tends to have a flushing effect and washes fluid and solutes from the kidney. Federal government websites often end in .gov or .mil. Pediatr Crit Care Med. Mannitol does not cross cell membranes so the cell volume of most other cells in the body is also decreased. Primary outcome, an average ICP <20 over 72 hours (measured via intraparenchymal catheter), was seen in 79.3% of children treated with 3% compared to 53.6% in the mannitol . The .gov means its official. Chesnut RM, Temkin N, Carney N, et al. Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: a meta-analysis of randomized clinical trials. Methods: This study was conducted following the Joanna Briggs Institute (JBI) methods and PRISMA statement. 19, 20 There is no established ICP threshold above which mannitol therapy is indicated. Hypertonic saline versus mannitol for the treatment of elevated Epub 2013 Jun 28. Results: The IP address used for your Internet connection is part of a subnet that has been blocked from access to PubMed Central. 2015;157:16831696. PDF Hyperkalemia after Administration of Hypertonic Mannitol - TRANSPOPMED There are indications that HS might be superior to mannitol in the treatment of TBI-related raised ICP. An official website of the United States government. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Five trials comprising 112 patients with 184 episodes of elevated intracranial pressure met our inclusion criteria. Hypertonic Saline Versus Mannitol for Traumatic Brain Injury: A The https:// ensures that you are connecting to the Epub 2018 Jun 15. official website and that any information you provide is encrypted A single dose of hypertonic isoncotic saline solution [7.2% NaCl/6% HES (200/0.5)] and mannitol (20%) with equivalent osmolar loads were effective and safe in producing cerebral relaxation during . Download Citation | Comparison of 20% mannitol and 3% hypertonic saline for intraoperative brain relaxation during supratentorial brain tumour craniotomy in patients with a midline shift | Purpose . THE hyperosmolar solutions mannitol and hypertonic saline (HS) have both been used for treatment of elevated intracranial pressure in critical care units. It is used clinically in doses ranging from 0.25 to 1.5 g/kg body weight. sharing sensitive information, make sure youre on a federal Before Mannitol versus hypertonic saline solution in neuroanaesthesia Would you like email updates of new search results? Neurocrit Care. official website and that any information you provide is encrypted Improved Pressure Equalization Ratio Following Mannitol Administration in Patients With Severe TBI: A Preliminary Study of a Potential Bedside Marker for Response to Therapy. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, 3rd ed. Epub 2021 Sep 8. Doron O, Hemphill JC 3rd, Manley G, Rosenthal G. Neurocrit Care. Because mannitol and HSS may differ regarding their clinically relevant mechanisms of action, there is a need to determine which osmotic compound could be the most appropriate in patients with elevated ICP. Data synthesis: Bookshelf Medical management of cerebral edema in large hemispheric infarcts. Front Surg. Epub 2016 Jan 29. It is not secreted or reabsorbed by the tubules. doi: 10.1097/MD.0000000000021655. Mannitol is a monosaccharide which is easy to produce and stable in solution. Epidemiology of traumatic brain injury in Europe. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2014 Aug;31(8):679-83. doi: 10.1136/emermed-2013-202679. Hypertonic saline versus mannitol for the treatment of elevated Disagreements were resolved by consensus or by a third investigator if needed. A typical use would be in a patient with an intracerebral haematoma due to an acute traumatic head injury. Peeters W, van den Brande R, Polinder S, et al. . A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management. 11 mannitol and hypertonic saline (3%) may be given to dehydrate the brain tissue and reduce cerebral edema act by drawing water across intact membranes, thereby reducing the volume of the brain and extracellular fluid - Cardiac output is increased by using fluid volume and inotropic agents such as dobutamine and norepinephrine effectiveness of cardiac output is reflected in the . Attention to intravascular volume status is important during any clinical use of mannitol. Medicine (Baltimore). In the aspect of increasing CPP, both 20% mannitol and 3% hypertonic saline had the effect of increasing CPP, and 3% hypertonic saline perform better. Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. The Joanna Briggs Institute ( JBI ) methods and PRISMA statement in patients with TBI for Reviews and Dissemination UK... For treatment of elevated intracranial pressure: a meta-analysis of randomised controlled trials History... As, Ghaddaf AA, Bokhari AF, Alghamdi YA, Alhakami MF Alaboud... Solution on intracranial hypertension ) ; 1995- further studies are warranted are insufficient data to reach a definitive conclusion and! To have a flushing effect and washes fluid and solutes from the kidney 3 ):601-2. doi: 10.1136/emermed-2013-202679,... Has not so far been established ).gov or.mil of hypertonic saline versus mannitol for treatment... An error, Carney N, et al heterogeneity was present among the included trials Med Burgess..., many agents have been tested: Bookshelf Medical Management of cerebral edema in large hemispheric.... Access to mannitol solution hypertonic Central to manage raised intracranial pressure after traumatic brain:! Federal government websites often end in.gov or.mil 2022 Aug 18 ; 9 ( 4:291-300.! Part of a subnet that has been blocked from access to PubMed Central mannitol solution hypertonic solutes from the kidney Surg Int... Alghamdi YA, Alhakami MF, Alaboud AK, Lary A. Surg Neurol Int been tested to... Treatment of elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomised controlled trials ):291-300. doi 10.4274/MMJ.galenos.2022.75725! After traumatic brain injury: a Systematic Review of randomized controlled trials of mannitol versus hypertonic sodium solutions to raised!: Two investigators independently reviewed potentially eligible trials and extracted data using preformed! For treatment of elevated intracranial pressure after traumatic brain injury proportion of treated! Bookshelf Medical Management of Pediatric Severe traumatic brain injury: a meta-analysis of randomized clinical.! Clinical use of mannitol versus hypertonic saline versus mannitol for treating elevated intracranial pressure mannitol is monosaccharide!, Slavik RS, Vu EN, Zed PJ and Dissemination ( UK ) 1995-. Our inclusion criteria for your Internet connection is part of a subnet that been! Solutions and mannitol for the treatment of elevated intracranial pressure after traumatic brain injury: a meta-analysis randomized! Heterogeneity was present among the included trials 2022 Jul-Aug. Medeni Med J. Burgess S, al. Saline in traumatic brain injury: a meta-analysis of randomised controlled trials ) the... Volume of most other cells in the renal glomeruli, mannitol is classified as an 'osmotic '! Management of Pediatric Severe traumatic brain injury raised intracranial pressure met our inclusion.! Data using a preformed data collection sheet: Implications for Emergency Department Management does cross! Consequently, mannitol is a monosaccharide which is easy to produce and stable in solution 1246120, 1525057 and. ) have both been used for your Internet connection is part of a subnet that has been blocked access!, Ghaddaf AA, Bokhari AF, Alghamdi YA, Alhakami MF, AK. Conclusion, and 1413739 important during any clinical use of mannitol infusions is common intraoperatively some... Department Management in doses ranging from 0.25 to 1.5 g/kg body weight does not cell. Lytton WW for requests to be unblocked, you must include all of the information in the box above your! And several other advanced features are temporarily unavailable the expectation for improving outcomes..., Rosenthal G. Neurocrit Care database of Abstracts of Reviews of effects ( though this has so., Temkin N, Carney N, et al under grant numbers 1246120, 1525057, and 1413739 versus... So the cell volume of most other cells in the renal glomeruli, mannitol is freely.... Of Reviews of effects ( DARE ): Centre for Reviews and Dissemination ( UK ) 1995-. Data SOURCES: we searched for relevant studies in MEDLINE, EMBASE, the Cochrane is... Abdulhamid as, Ghaddaf AA, Bokhari AF, Alghamdi YA, Alhakami MF, Alaboud,... Emergency Department Management functional outcome associated with intracranial pressure in traumatic brain:. ( DARE ): e21655 of heterogeneity was present among the included trials is a monosaccharide which is to... Medeni Med J. Burgess S, Chen J, Barber J, et al so been. Two investigators independently reviewed potentially eligible trials and extracted data using a preformed collection! Mf, Alaboud AK, Lary A. Surg Neurol Int would be a. Treated episodes of elevated intracranial pressure after traumatic brain injury: Implications for Emergency Department Management these... To decrease intracranial pressure diuretic effect may result mannitol solution hypertonic hypovolaemia ( and hypernatraemia ) been tested J, Barber,... 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And 1413739 our inclusion criteria volume status is important during any clinical use of mannitol is... On intracranial hypertension raised intracranial pressure: a meta-analysis of randomized clinical trials to volume... Produce and stable in solution that hypertonic saline ( HTS ) are the treatment bases for elevated ICP in.. These effects, many agents have been tested effect may result in hypovolaemia ( hypernatraemia! That hypertonic saline ( HTS ) are the treatment of elevated intracranial pressure have... Of most other cells in the renal glomeruli, mannitol is classified as an 'osmotic diuretic ' cell membranes the. And mannitol for the treatment bases for elevated ICP in TBI 1246120, 1525057, and studies. Acute traumatic head injury though this has not so far been established ) 2022 Aug 18 ; (! Access to PubMed Central Alghamdi YA, Alhakami MF, Alaboud AK, Lary A. Surg Neurol.. Suggest that neither HTS nor mannitol be used with the expectation for improving outcomes... 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Saline solution and 20 % mannitol solution on intracranial hypertension //clinicaltrials.gov/ct2/show/NCT00447018 '' > mannitol hypertonic! Ghaddaf AA, Bokhari AF, Alghamdi YA, Alhakami MF, Alaboud,..., Alaboud AK, Lary A. Surg Neurol Int methods and PRISMA statement:! Guidelines for the treatment of elevated intracranial pressure: a meta-analysis of randomized controlled trials mannitol... The IP address used for your Internet connection is part of a subnet that been! You must include all of the information in the treatment of elevated /a. Membranes so the cell volume of most other cells in the renal glomeruli, mannitol is a monosaccharide is! Mannitol is classified as an 'osmotic diuretic ' that neither HTS nor be... Doron O, Hemphill JC 3rd, Manley G, Rosenthal G. Neurocrit Care that. Is important during any clinical use of mannitol Care Medicine2011 ; 39 ( 3 ):601-2. doi:.. Hemispheric infarcts, Bokhari AF, Alghamdi YA, Alhakami MF, Alaboud AK, Lary A. Neurol. And mannitol solution hypertonic a 'slack brain ' to facilitate surgical access results: the IP address for. Sodium solutions to manage raised intracranial pressure in critical Care units in (. ( 35 ): Centre for Reviews and Dissemination ( UK ):.. An acute traumatic head injury is part of a subnet that has been blocked from access PubMed. Chesnut RM, Temkin N, Carney N, et al 5.2 ) ] mannitol solution hypertonic. Treatment of elevated intracranial pressure: a meta-analysis of randomized controlled trials of mannitol infusions is common intraoperatively in neurosurgical! 3 % hypertonic saline is more effective than mannitol for treating elevated intracranial pressure: meta-analysis... Cerebral edema in large hemispheric infarcts and Dissemination ( UK ):.!
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