20% Mannitol Versus 3% Hypertonic Saline in Children With Ra
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Mannitol is a commonly used osmotherapy agent in raised intracranial pressure. However, the side effects of mannitol are significant. In traumatic brain injury (adult and pediatric), hypertonic saline (3%) shows varied results in comparison with 20% mannitol. Researchers compared the effect of 3% hypertonic saline versus 20% mannitol on raised intracranial pressure in pediatric acute CNS infections.

Children 1–12 years old, with raised intracranial pressure and modified-Glasgow Coma Scale scores less than or equal to 8, were enrolled. Patients were randomly assigned to 20%-mannitol (n = 28), 0.5 gram/kg/dose versus 3%-hypertonic saline (n = 29), 10 mL/kg loading followed by 0.5-1 mL/kg/hr infusion. An intraparenchymal catheter was used to monitor the intracranial pressure. The primary outcome was the proportion of patients achieved target average intracranial pressure less than 20mm Hg during 72 hours. Secondary outcomes were interventions, morbidity, and mortality.

--The proportion of patients with target average intracranial pressure (less than 20mm Hg) was higher in hypertonic saline-group as compared to mannitol-group (79.3% vs 53.6%).
--Mean (± se) reduction of intracranial pressure and elevation of cerebral perfusion pressure from baseline were significant in hypertonic saline-group.
--Mean (± se) intracranial pressure over 72 hours was lower (14±2 vs 22±2mm Hg), and cerebral perfusion pressure was higher (65±2.2 vs 58±2.2) in hypertonic saline-group.
--Hypertonic saline-group had higher modified-Glasgow Coma Scale score at 72 hours (median, interquartile range 10), lower mortality (20.7% vs 35.7%), shorter duration of mechanical ventilation (5 vs 15 d), and PICU stay (11 vs 19 d) and less severe neurodisability at discharge (31% vs 61%).

Conclusively, In pediatric acute CNS infections, 3%-hypertonic saline was associated with a greater reduction of intracranial pressure as compared to 20% mannitol.

Source: https://journals.lww.com/pccmjournal/Abstract/2020/12000/Randomized_Clinical_Trial_of_20__Mannitol_Versus.7.aspx