S Arun Kumar1, Bhagavatula Indira Devi1, Madhusudan Reddy2, Dhaval Shukla3. 1. Department of Neurosurgery, NIMHANS, Bangalore, India. 2. Department of Neuroanesthesia, NIMHANS, Bangalore, India. 3. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India. neurodhaval@rediffmail.com.
Abstract
INTRODUCTION: 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. METHODS: 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 received3% 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. RESULTS: 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. CONCLUSION: Both mannitol and hypertonic saline were equally effective for treatment of raised intracranial pressure in children with severe traumatic brain injury.
RCT Entities:
INTRODUCTION: 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 hypertonicsaline in reducing intracranial pressure in children who sustained severe traumatic brain injury. METHODS: 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. RESULTS: The mean reduction in intracranial pressure in mannitol group was 7.13 mmHg and in hypertonicsaline 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 hypertonicsaline group, and the difference was not statistically significant, p = 0.69. CONCLUSION: Both mannitol and hypertonicsaline were equally effective for treatment of raised intracranial pressure in children with severe traumatic brain injury.
Authors: L F Marshall; S B Marshall; M R Klauber; M Van Berkum Clark; H Eisenberg; J A Jane; T G Luerssen; A Marmarou; M A Foulkes Journal: J Neurotrauma Date: 1992-03 Impact factor: 5.269
Authors: I R Chambers; P A Jones; T Y M Lo; R J Forsyth; B Fulton; P J D Andrews; A D Mendelow; R A Minns Journal: J Neurol Neurosurg Psychiatry Date: 2005-08-15 Impact factor: 10.154
Authors: Patrick M Kochanek; P David Adelson; Bedda L Rosario; James Hutchison; Nikki Miller Ferguson; Peter Ferrazzano; Nicole O'Brien; John Beca; Ajit Sarnaik; Kerri LaRovere; Tellen D Bennett; Akash Deep; Deepak Gupta; F Anthony Willyerd; Shiyao Gao; Stephen R Wisniewski; Michael J Bell Journal: JAMA Netw Open Date: 2022-03-01