Hyperosmolar therapy in pediatric traumatic brain injury: a systematic review

Abstract

Background: Traumatic brain injury is a prominent reason of morbidity and mortality in children. The use of hyperosmolar therapy to manage increased intracranial pressure is portrayed in pediatric guidelines however, there still remains some debate regarding which option to select. The aim of this systematic review was to assess which hyperosmolar therapy - mannitol or hypertonic saline - is more effective in terms of lowering intracranial pressure and having better outcomes in treating children with traumatic brain injury. Methods: Literature search was conducted on September of 2021 using MEDLINE (through PubMed), Scopus and Web of Science. This review included 6 retrospective and prospective studies comparing the use of mannitol and hypertonic saline in pediatric patients with traumatic brain injury. Results: Hypertonic saline was the most frequently described hyperosmolar agent. Mannitol was less studied, but demonstrated a higher incidence of mortality than hypertonic saline. There were several studies that did not report monitoring outcomes associated with serum osmolarity, despite the use of hyperosmolar therapies. Discrepancies were noticed between the studies in the overall study design in addition to reported monitoring parameters and length of stay. Conclusions: Hypertonic saline seems to be safe and efficient in the treatment of severe traumatic brain injury in children. The reduced existing studies regarding the use of mannitol do not permit a strong decision to be made concerning its practice.