Hypertonic Saline Bests Mannitol For Traumatic Brain Injury In Children: JAMA

Key findings of the study:

• Upon analysis, the researchers found that the bolus HTS decrease ICP and increase CPP (mean [SD] ICP, 1.03 [6.77] mm Hg; mean [SD] CPP, 1.25 [12.47] mm Hg), whereas mannitol increase CPP (mean [SD] CPP, 1.20 [11.43] mm Hg).
• They also found HTS was associated with a greater reduction in ICP compared with mannitol (unadjusted β, −0.85), but observed no association after adjustments (adjusted β, −0.5). They also observed no difference in CPP.
• However, when ICP was greater than 20 mm Hg, greater than 25 mm Hg, or greater than 30 mm Hg, they found that the HTS outperformed mannitol for each threshold in ICP reduction (>20 mm Hg: unadjusted β, −2.51; >25 mm Hg: unadjusted β, −3.88; >30 mm Hg: unadjusted β, −4.07).
• They noted that the results remained significant for ICP greater than 25 mm Hg in adjusted analysis.

The authors concluded, "In this comparative effectiveness research study, bolus HTS was associated with lower ICP and higher CPP, whereas mannitol was associated only with higher CPP. After adjustment for confounders, both therapies showed no association with ICP and CPP. During ICP crises, HTS was associated with better performance than mannitol."

For further information:

DOI:10.1001/jamanetworkopen.2022.0891

Keywords:

Hyperosmolar therapies, Mannitol, 3% hypertonic saline, intracranial pressure,cerebral perfusion pressure, Severe traumatic brain injury, Traumatic brain injury in children, TBI, ADAPT trial, JAMA Network Open.