Table 1.
State of the literature concerning mannitol and hypertonic saline for intracranial hypertension.
| Year | Study design | HTS or M concentration | HTS or M dose | Effects |
|---|---|---|---|---|
| Jagannatha et al. (33) | Randomized controlled trial | HTS 3% M 20% |
2.5 mL/kg 2.5 mL/kg |
At equimolar doses, HTS and M are equally effective in reducing HICP, but HTS acts faster |
| Mangat et al. (34) | Retrospective | HTS 3–23.4% and M 20% | NR | HTS reduces HICP more than M, and is less expensive for prolonged ICU stays |
| Major et al. (35) | Prospective observational | HTS 30% | 10 mL | Highly concentrated HTS does not affect laboratory values |
| Colton et al. (36) | Retrospective | HTS 3% | 250–500 mL | When HTS reduces ICP for more than 2 h, it is associated with decreased mortality and long-term disability |
| Dias et al. (37) | Prospective observational | HTS 20% | 0.5 mL/kg | HTS reduces ICP, improves CBF and CPP, and does not affect cerebral oxygenation |
| Ichai et al. (38) | Randomized controlled trial | Sodium Lactate Isotonic Saline |
0.5 mL/kg/h 0.5 mL/kg/h |
Hyperosmolar lactate is effective in reducing HICP without modifying plasma osmolarity |
| Roquilly et al. (39) | Randomized controlled trial | Balanced isotonic Isotonic saline |
30 mL/kg/day 30 mL/kg/day |
No effects on HICP |
| Eskandari et al. (40) | Prospective observational | HTS 14.6% | 40 mL | HTS administrated as repeated boluses reduces ICP, even in refractory HICP |
| Diringer et al. (41) | Prospective observational | HTS 20% | 1 mg/kg | Mannitol reduces HICP, but does not reduce CBV |
| Wells et al. (42) | Retrospective | HTS 3 or 7% | 150 mL bolus, continuous infusion | Patients with low serum Na+ require more HTS than those with normal serum Na+ |
| Scalfani et al. (43) | Prospective observational | HTS 23.4% M 20% |
0.686 mL/kg 1 g/kg |
HTS and M reduce HICP, increase CPP, and increase CBF |
| Paredes-Andrade et al. (44) | Retrospective | HTS 23.4% | 30 mL | Boluses of HTS can reduce HICP without modifying serum or CSF osmolarity |
| Sakellaridis et al. (45) | Randomized controlled trial | HTS 15% M 20% |
0.42 mL/kg 2 mL/kg |
HTS and M are equally effective in reducing HICP |
| Roquilly et al. (39) | Retrospective | HTS 20% | Continuous infusion | HTS continuous infusion does not cause HICP rebound when stopped |
| Bourdeaux et al. (46) | Randomized controlled trial | HTS 5% Na+HCO3− 8.4% |
100 mL 85 mL |
HTS and Na+HCO3− are equally effective in reducing HICP |
| Rhind et al. (47) | Randomized controlled trial | HTS 7.5% IS 0.9% |
250 mL 250 mL |
HTS reduces neuroinflammation and hypercoagulation |
| Oddo et al. (48) | Prospective observational | HTS 7.5% M 25% |
250 mL 0.75 g/kg |
HTS is an effective treatment for refractory HICP to M, also improving CPP |
| Kerwin et al. (49) | Retrospective | HTS 23.4%M | 30 mL | HTS and M are equally effective in reducing HICP |
| Ichai et al. (50) | Randomized controlled trial | Sodium Lactate M 20% |
1.5 mL/kg 1.5 mL/kg |
Hyperosmolar lactate is effective in reducing HICP and the effect is maintained longer than M |
| Froelich et al. (51) | Retrospective analysis of prospective data | HTS 3% | 1.5 mL/kg bolus, continuous infusion | HTS can cause hypernatremia and induce renal dysfunction (especially when serum Na+ >155 mEq/L) |
| Rockswold et al. (52) | Retrospective | HTS 23.4% | 30 mL | HTS reduces HICP and increases CPP |
| Francony et al. (53) | Randomized controlled trial | HTS 7.45% M 20% |
100 mL 231 mL |
M and HTS are equally effective in reducing HICP. HTS is preferred in hypovolemic and hyponatremic patients; M is preferred in hypoperfused patients |
| Sorani et al. (54) | Retrospective | M 20% | 50–100 g | Each 0.1 g/kg increase in M decreases ICP by 1 mmHg, only in case of HICP |
| Sakowitz et al. (55) | Prospective observational | M 20% | 0.5 g/kg | M reduces HICP by tissue dehydration |
| Soustiel et al. (56) | Prospective observational | M 20% | 0.5 g/kg | M reduces HICP and increases CPP as hyperventilation does. CBF improves with M in respect to hyperventilation |
| Ware et al. (57) | Retrospective | HTS 23.4% M 75 g or 0.86 g/kg |
continuous infusion bolus | HTS and M are equally effective in reducing HICP. HTS acts longer than M |
| Gasco et al. (58) | Prospective observational | M 20% | 100 mL | M reduces HICP and improves cerebral oxygenation |
| Munar et al. (59) | Prospective observational | HTS 7.2% | 1.5 mL/kg | HTS reduces HICP without affecting hemodynamics for at least 2 h |
| Horn et al. (60) | Prospective observational | HTS 7.5% | 2 mL/kg | HTS can reduce HICP even in cases refractory to mannitol |
| Suarez et al. (61) | Retrospective | HTS 23.4% | 30 mL | HTS reduces HICP and increases CPP |
| Hartl et al. (62) | Prospective observational | M 20% | 125 mL | M reduces HICP, increases CPP, and does not alter cerebral oxygenation |
| Hartl et al. (63) | Prospective observational | HTS 7.5% | Continuous infusion | HTS reduces HICP, increases CPP, and does not affect hemodynamics |
| Unterberg et al. (64) | Prospective observational | M 20% | 125 mL | M reduces HICP. If CPP>60 mmHg, M does not improve brain tissue oxygenation |
| Fortune et al. (65) | Prospective observational | M | 25 g | M reduces HICP, but increases CBV |
M, mannitol; HTS, hypertonic saline; ICP, intracranial pressure; HICP, intracranial hypertension; CPP, cerebral perfusion pressure; CBF, cerebral blood flow; CBV, cerebral blood volume.