Comparison of equiosmolar dose of hyperosmolar agents in reducing intracranial pressure—a randomized control study in pediatric traumatic brain injury

  • S Arun Kumar
  • Bhagavatula Indira Devi
  • Madhusudan Reddy
  • Dhaval ShuklaEmail author
Original Article



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.


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.


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.


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


Mannitol Hypertonic saline 


Compliance with ethical standards

The study received prior approval by the Institutional Ethics Committee and informed consent was obtained from patients’ legal relative. This trial was registered with Clinical Trials Registry of India (REF/2015/03/008696).

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryNIMHANSBangaloreIndia
  2. 2.Department of NeurosurgeryNIMHANSBangaloreIndia
  3. 3.Department of NeuroanesthesiaNIMHANSBangaloreIndia
  4. 4.Department of NeurosurgeryNational Institute of Mental Health and NeurosciencesBangaloreIndia

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