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

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To compare the efficacy and safety of two hyperosmolar agents (hypertonic saline vs. mannitol) used for the reduction of elevated intracranial pressure (ICP) in children.

Methods

A meta-analysis of randomized controlled trials (RCTs) was conducted and GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) of evidence was applied. Relevant databases were searched till 31st May 2022. Primary outcome was mortality rate.

Results

Of 720 citations retrieved, 4 RCTs were included in the meta-analysis (n = 365, male = 61%). Traumatic and non-traumatic cases of elevated ICP were included. There was no significant difference in the mortality rate between the two groups [relative risk (RR), 1.09; (95% confidence interval (CI), 0.74 to 1.6)]. No significant difference was found for any of the secondary outcomes, except serum osmolality (being significantly higher in mannitol group). Adverse events like shock and dehydration were significantly higher in the mannitol group, and hypernatremia in the hypertonic saline group. The evidence generated for primary outcome was of “low certainty”, and for secondary outcomes, it varied from “very-low to moderate certainty”.

Conclusions

There is no significant difference between hypertonic saline and mannitol used for the reduction of elevated ICP in children. The evidence generated for primary outcome (mortality rate) was of “low certainty”, and for secondary outcomes, it varied from “very-low to moderate certainty”. More data from high-quality RCTs are needed to guide any recommendation.

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Authors and Affiliations

  1. Department of Pediatrics, All India Institute of Medical Sciences, Kalyani, West Bengal, India

    Nihar Ranjan Mishra

  2. Department of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India

    Amit Agrawal

  3. Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India

    Rashmi Ranjan Das

Authors
  1. Nihar Ranjan Mishra
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  2. Amit Agrawal
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  3. Rashmi Ranjan Das
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Contributions

NRM and RRD contributed to the development of the study protocol; AA and NRM searched the database, reviewed the literature, and generated data extraction forms; RRD and NRM analyzed the data; AA and NRM wrote the first draft; all co-authors critically reviewed the paper and approved the submitted version. RRD will act as guarantor for this manuscript.

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Correspondence to Rashmi Ranjan Das.

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Mishra, N.R., Agrawal, A. & Das, R.R. Hypertonic Saline vs. Mannitol in Management of Elevated Intracranial Pressure in Children: A Meta-Analysis. Indian J Pediatr 90, 899–906 (2023). https://doi.org/10.1007/s12098-023-04532-w

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  • DOI: https://doi.org/10.1007/s12098-023-04532-w

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