Salt or sugar for your injured brain? A meta-analysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury

@article{Rickard2013SaltOS,
  title={Salt or sugar for your injured brain? A meta-analysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury},
  author={Annette C Rickard and J E Smith and Portia Newell and A Bailey and Anthony Kehoe and Clifford Mann},
  journal={Emergency Medicine Journal},
  year={2013},
  volume={31},
  pages={679 - 683}
}
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… 
Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials
TLDR
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 mannitol for the treatment of increased intracranial pressure in traumatic brain injury.
TLDR
Hypertonic saline is an effective alternative to mannitol for increased ICP, and Providers should consider the properties of each agent, adverse effects, and potential benefits when selecting a hyperosmotic agent.
A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury
TLDR
Clinical important differences in mortality, neurological outcomes, and ICP reduction were not observed between HTS or mannitol in the management of severe TBI, and HTS appears to lead to fewer ICP treatment failures.
Hypertonic Saline Versus Mannitol for Traumatic Brain Injury: A Systematic Review and Meta-analysis With Trial Sequential Analysis
TLDR
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 versus other intracranial pressure-lowering agents for people with acute traumatic brain injury.
TLDR
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 and mannitol in patients with traumatic brain injury
TLDR
3% hypertonic saline has a more sustained effect on intracranial pressure and can effectively increase cerebral perfusion pressure.
Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury.
TLDR
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.
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.
Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials.
TLDR
Based on the current level of evidence pertaining to mortality or control of intracranial pressure, hypertonic saline could not be recommended as a first-line agent for managing patients with severe traumatic brain injury.
Intravenous fluids in traumatic brain injury: what's the solution?
TLDR
In patients with TBI, intravenous fluids are integral to management; they may be both a source of harm and a potential therapy to limit secondary brain injury and refined usage may improve patient outcomes.
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TLDR
Acute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury and long-term outcome was better in terms of GOS in those receiving as compared to mannitol.
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Based on this retrospective analysis, 23.4% HTS is more efficacious than mannitol in reducing ICP and may become the agent of choice for the management of elevated ICP after TBI.
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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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TLDR
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