A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury

@article{Burgess2016ASR,
  title={A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury},
  author={Sarah V Burgess and Riyad Abu-Laban and Richard S. Slavik and Erik N. Vu and Peter J. Zed},
  journal={Annals of Pharmacotherapy},
  year={2016},
  volume={50},
  pages={291 - 300}
}
Objective: To comparatively evaluate hypertonic sodium (HTS) and mannitol in patients following acute traumatic brain injury (TBI) on the outcomes of all-cause mortality, neurological disability, intracranial pressure (ICP) change from baseline, ICP treatment failure, and serious adverse events. Data Sources: PubMed, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and WHO ICTRP (World Health Organization International Clinical Trials Registry Platform) were… 
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Hypertonic Saline Versus Mannitol for Traumatic Brain Injury: A Systematic Review and Meta-analysis With Trial Sequential Analysis
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There are indications that HS might be superior to mannitol in the treatment of TBI-related raised ICP, however, there are insufficient data to reach a definitive conclusion, and further studies are warranted.
Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials
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The results do not lend a specific recommendation to select hypertonic saline or mannitol as a first-line for the patients with elevated ICP caused by TBI, however, for the refractory intracranial hypertension, hypertoni saline seems to be preferred.
Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury.
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The comparative efficacy and safety of hypertonic saline versus other ICP-lowering agents in the management of acute TBI was assessed, with concerns about missing data for important outcomes.
Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury.
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To assess the comparative efficacy and safety of hypertonic saline versus other intracranial pressure-lowering agents in the management of acute traumatic brain injury, six randomised controlled trials were searched.
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The choice of early osmotherapy in severe TBI patients may affect survival, or simply reflect clinician beliefs about their different roles, and warrants controlled investigation.
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Sugar or Salt (“SOS”): a protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension
TLDR
The Sugar or Salt Trial is a UK randomised, allocation concealed open label multicentre pragmatic trial designed to determine the clinical and cost-effectiveness of hypertonic saline (HTS) compared with mannitol in the management of patients with severe TBI.
Osmotic Therapy in Traumatic Brain Injury
TLDR
A sufficiently powered, multicenter, randomized controlled trial focusing on hypertonic saline and mannitol in severe TBI patients is necessary to determine whether a particular hyperosmolar agent independently contributes to a superior neurological outcome.
Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature
TLDR
Mannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion, which combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics.
Hyperosmolar therapy for acute brain injury: study protocol for an umbrella review of meta-analyses and an evidence mapping
TLDR
This study protocol outlines an umbrella review of meta-analyses which will investigate the benefits and harms of hyperosmolar therapy routinely used for the management of acute brain injury in the intensive care.
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There is a trend favouring the use of hypertonic sodium solutions in patients with TBI, and the evidence shows that both agents effectively lower ICP.
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The findings suggest that hypertonic saline may be superior to the current standard of care and argue for a large, multicenter, randomized trial to definitively establish the first-line medical therapy for intracranial hypertension.
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A greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP.
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