Mannitol for acute traumatic brain injury
ABSTRACT Mannitol is sometimes effective in reversing acute brain swelling, but its effectiveness in the ongoing management of severe head injury remains unclear. There is evidence that, in prolonged dosage, mannitol may pass from the blood into the brain, where it might cause increased intracranial pressure.
To assess the effects of different mannitol therapy regimens, of mannitol compared to other intracranial pressure (ICP) lowering agents, and to quantify the effectiveness of mannitol administration given at other stages following acute traumatic brain injury.
We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), ISI Web of Science (SCI-EXPANDED & CPCI-S) and PubMed. We checked reference lists of trials and review articles, and contacted authors of trials. The search was updated on the 20th April 2009.
Randomised controlled trials of mannitol, in patients with acute traumatic brain injury of any severity. The comparison group could be placebo-controlled, no drug, different dose, or different drug. We excluded cross-over trials, and trials where the intervention was started more than eight weeks after injury.
We independently rated quality of allocation concealment and extracted the data. Relative risks (RR) and 95% confidence intervals (CI) were calculated for each trial on an intention to treat basis.
We identified four eligible randomised controlled trials. One trial compared ICP-directed therapy to 'standard care' (RR for death = 0.83; 95% CI 0.47 to 1.46). One trial compared mannitol to pentobarbital (RR for death = 0.85; 95% CI 0.52 to 1.38). One trial compared mannitol to hypertonic saline (RR for death = 1.25; 95% CI 0.47 to 3.33). One trial tested the effectiveness of pre-hospital administration of mannitol against placebo (RR for death = 1.75; 95% CI 0.48 to 6.38).
Mannitol therapy for raised ICP may have a beneficial effect on mortality when compared to pentobarbital treatment, but may have a detrimental effect on mortality when compared to hypertonic saline. ICP-directed treatment shows a small beneficial effect compared to treatment directed by neurological signs and physiological indicators. There are insufficient data on the effectiveness of pre-hospital administration of mannitol.
SourceAvailable from: Haytham M A Kaafarani[Show abstract] [Hide abstract]
ABSTRACT: Traumatic brain injuries are common and costly to hospital systems. Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines. This is a review of the current literature discussing the evolving practice of traumatic brain injury.
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ABSTRACT: Diffuse Axonal Injury (DAI) is the most common type of head injury among head trauma types. Mannitol 20% has an important role in the treatment of decreasing intracranial pressure (ICP) as hyperosmolar agent. The aim of the present study was to evaluate three doses of 20% mannitol on brain edema reduction level and consciousness increase in patients with brain edema and diffuse axonal lesions associated with cerebral edema and shift of more than 5 mm. Thirty DAI patients admitted with GCS≤8 and cerebral edema and midline shift >5mm were randomly studied in three groups (10 patients in each group): groups I, II, and III received mannitol with doses of 0.5g/kg, 1g/kg and 1.5g/kg, respectively. GCS and the shift midline change were compared and analyzed during hospitalization and 48 hours after admission. GCS was increased at 48h after admission in all three groups, but the difference was not significant (P=0.08). Cerebral edema and brain shift between first and second group and first and third groups was significant (P<0.001). However, this difference was not significant between groups II and III (P=0.99). Our study demonstrated that in DAI increasing dose of mannitol from 0.5g/kg to 1.5g/kg did not significantly increase consciousness during 48h after hospitalization. By increasing dose of mannitol from 0.5g/kg to 1g/kg and 1.5g/kg, the level of edema decreased significantly.Life Science Journal 07/2013; 1010:1228-12311097. · 0.17 Impact Factor
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ABSTRACT: Intravenous fluid is a fundamental component of trauma care and fluid management influences patient outcomes. This narrative review appraises recent clinical studies of fluid therapy in patients with traumatic brain injury (TBI), with respect to its use in volume resuscitation and prevention of secondary injury.Current Opinion in Critical Care 06/2014; DOI:10.1097/MCC.0000000000000114 · 3.18 Impact Factor