Table 1.
The characteristics and results of the included studies
| Study | Design | Setting | Participants | Age | Male ratio | Intervention | Mortality | Neurologic outcome | ICP |
|---|---|---|---|---|---|---|---|---|---|
| Ware M. 2005 | Retrospective study | San Francisco General Hospital, United States | 13 | 42 ± 15 | 76.9% | 22 treatments with 23.4% HTS and 19 treatments Mannitol | – | – |
ICP peak: Mannitol: 38 mm Hg HTS: 36 mm Hg average reduction in ICP: Mannitol: 20 mm Hg HTS: 15 mm Hg |
| Francony G. 2008 | RCT | Michallon’s Hospital, Grenoble, France | 20 (Mannitol: 10 and HTS: 10) |
Mannitol: 43 ± 11 HTS: 37 ± 16 |
Mannitol: 70% HTS: 90% |
100 mL of 7.45% HSS and 231 mL of 20% mannitol | – | – |
Mannitol: 45% reduction ICP HSS: 32% reduction ICP |
| Vialet R. 2003 | RCT | University hospital trauma center, France | 20 (Mannitol: 10 and HTS: 10) |
Mannitol: 30.8 ± 19 HTS: 35.0 ± 18 |
Mannitol: 40% HTS: 50% |
20% mannitol (1160 mOsm/kg/H2O) or HTS: (2400 mOsm /kg/H2O) |
Mannitol: 50% HTS: 40% |
Severe GOS: Mannitol: 50% HTS: 60% |
Number of episodes per day ICP < 25 mm Hg: Mannitol: 13.3 ± 14.2 HTS: 6.8 ± 5.5 Total duration of episodes ICP < 25 mm Hg: 95 ± 92 Mannitol: HTS: 62 ± 81 |
| Cheng F. 2018 | Retrospective study | First People’s Hospital of Kunshan, China | 60 (Mannitol: 30 and HTS: 30) |
Mannitol: 41.53 ± 15.27 HTS: 42.27 ± 17.03 |
Mannitol: 83.3%HTS: 80% | 3% HTS or 20% mannitol | 2 HTS vs. 1 mannitol; P = 0.554 | – |
Mean daily ICP burden: Mannitol: 12.37 ± 2.95 HTS: 11.57 ± 3.65 |
| Cottenceau V. 2011 | RCT | two university hospitals from France and Israel | 47 (Mannitol: 25 and HTS: 22) |
Mannitol: 36.1 ± 16.8 HTS: 42.7 ± 19.9 |
– | 7.5% saline or 20%manitol | No significant difference in Glasgow Outcome Scales | – |
ICP after 30 min: Mannitol: 10.5 ± 6.8 HTS: 12.2 ± 6.1 ICP after 120 min: Mannitol: 13.6 ± 7.5 HTS: 13.9 ± 7.8 |
| Jagannatha AT. 2017 | RCT | United Kingdom | 38 (Mannitol: 20 and HTS: 18) | Mannitol: 31 ± 13 HTS: 27 ± 8 | Mannitol: 90% HTS: 88% | 20% mannitol or 3% saline, in an equimolar dose | Favorable GOS score at 6 months: Mannitol: 0 HTS: 2 | In-hospital mortality: Mannitol: 10 HTS: 3 6 months mortality: Mannitol: 10 HTS: 6 | Fall in ICP (mmHg): Mannitol: 8.9 ± 8.4 HTS: 10.1 ± 8.7 Duration of ICP fall, minutes: Mannitol:57 ± 31 HTS: 55 ± 32 |
| Carter C. 2017 | Case–control study | United States | 44 (11 5%NaCl, and 33 23.4%NaCl) | 5% NaCl: 55 ± 1623.4% NaCl: 43 ± 17 | – | 5% NaCl or 23.4% NaCl | – | – |
reductions in ICP at 30 min: 5% NaCl: 34 23.4% NaCl: 26 reductions in ICP at 60 min: 5% NaCl: 48 23.4% NaCl: 40 reductions in ICP at and 120 min: 5% NaCl: 46 23.4% NaCl: 30 |
| Schatzmann C. 1998 | Clinical trial | Germany | 6 | – | – | 100 ml 10% NaCl | – | – | Relative ICP decrease was 43% [28%-58%] Pressure drop: 18 mm Hg [15–27 mm Hg] |
HTS Hypertonic saline, RCT randomized control trial