Home⇛The PCMC Journal⇛vol. 18 no. 2 (2022)

Efficacy of 20% Mannitol versus 3% hypertonic saline in decreasing intracranial pressure in the pediatric age group: A systematic review.

Tracy Anne P Victorino-Rivera | Marilyn H Ortiz

Discipline: medicine by specialism

 

Abstract:

Objective: This systematic review aimed to assess the available data on the efficacy of 20% mannitol and 3% hypertonic saline in achieving the primary outcome of decreasing intracranial hypertension in the pediatric age group. Secondary outcomes such as GCS scores, hospital stay, discharge and disabilities were also considered. Method: Search done through PubMed/MEDLINE, Cochrane Central Registry of Clinical Trials (CENTRAL) and EMBASE yielded 280 studies. Results: Of 280 studies reviewed, 7 studies with a total of 1,892 pediatric patients met the eligibility criteria: 3 RCTs and 4 retrospective studies. From these, two randomized controlled studies showed statistically significant evidence that 3% hypertonic saline was superior to 20% mannitol in reducing increased intracranial pressure (ICP) while two other studies had results that were insufficient to establish statistical significance. Relative risk of mortality was comparable in both groups. There was a low risk of bias for randomized trials and fair to high quality retrospective studies. Heterogeneity was present as number of outcome measures varied among studies. Conclusion: This review showed that while both agents effectively decreased intracranial pressure, 3% hypertonic saline showed better results compared with 20% mannitol. Due to the limited number and heterogeneity of studies, a pooled analysis of the effects in ICP could not be done. Larger prospective controlled studies using 20% mannitol and 3% hypertonic saline in the treatment of increased ICP in the pediatric age group are needed to render valid affirmations.



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