Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury
Author(s)
Yanan Zhu
Quan Wang
Paula Caporal
Juan D. Roa
Freddy Israel Pantoja Chamorro
Thelma Elvira Terán Miranda
Hongxing Dang
Chin Seng Gan
Qalab Abbas
Ivan J. Ardila
Mohannad Antar
Jesús Domínguez-Rojas
María Miñambres Rodríguez
Natalia Zita Watzlawik
Natalia Elizabeth Gómez Arriola
Adriana Yock‐Corrales
Rubén Eduardo Lasso Palomino
Ming Mei Xiu
Jacqueline Soo May Ong
Hiroshi Kurosawa
Gabriela Aparicio
Chun‐Feng Liu
Rujipat Samransamruajkit
Juan Camilo Jaramillo-Bustamante
Nattachai Anantasit
Yek Kee Chor
Deborah M. Turina
Pei Chuen Lee
Marisol Fonseca Flores
J. Pilar Orive
Jing Wen
Sebastián González‐Dambrauskas
Jan Hau Lee
Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pediátrica de Latinoamérica (LARed)
Yasser Kazzaz
Jian Ji
Suyun Qian
Lijia Fan
Olive Pei Ee Lee
Soo Lin Chuah
Kai You
Tao Zhang
Deiby Lasso Noguera
Esteban Cerón
Andrea Leal Barceló
Susana Reyes
Cesia J Ortega Ocas
Date Issued
11 de marzo de 2025
Type
Article
Volume
8
Issue
3
Start Page
e250438
End Page
e250438
Abstract
Importance: The use of hypertonic saline (HTS) vs mannitol in the control of elevated intracranial pressure (ICP) secondary to neurotrauma is debated. Objective: To compare mortality and functional outcomes of treatment with 3% HTS vs 20% mannitol among children with moderate to severe traumatic brain injury (TBI) at risk of elevated ICP. Design, Setting, and Participants: This prospective, multicenter cohort study was conducted between June 1, 2018, and December 31, 2022, at 28 participating pediatric intensive care units in the Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pediátrica de Latinoamérica (LARed) in Asia, Latin America, and Europe. The study included children (aged <18 years) with moderate to severe TBI (Glasgow Coma Scale [GCS] score ≤13). Exposure: Treatment with 3% HTS compared with 20% mannitol. Main Outcomes and Measures: Multiple log-binomial regression analysis was performed for mortality, and multiple linear regression analysis was performed for discharge Pediatric Cerebral Performance Category (PCPC) scores and 3-month Glasgow Outcome Scale-Extended Pediatric Version (GOS-E-Peds) scores. Inverse probability of treatment weighting was also performed using the propensity score method to control for baseline imbalance between groups. Results: This study included 445 children with a median age of 5.0 (IQR, 2.0-11.0) years. More than half of the patients (279 [62.7%]) were boys, and 344 (77.3%) had severe TBI. Overall, 184 children (41.3%) received 3% HTS, 82 (18.4%) received 20% mannitol, 69 (15.5%) received both agents, and 110 (24.7%) received neither agent. The mortality rate was 7.1% (13 of 184 patients) in the HTS group and 11.0% (9 of 82 patients) in the mannitol group (P = .34). After adjusting for age, sex, presence of child abuse, time between injury and hospital arrival, lowest GCS score in the first 24 hours, and presence of extradural hemorrhage, no between-group differences in mortality, hospital discharge PCPC scores, or 3-month GOS-E-Peds scores were observed. Conclusions and Relevance: In this cohort study of children with moderate to severe TBI, the use of HTS was not associated with increased survival or improved functional outcomes compared with mannitol. Future large multicenter randomized clinical trials are required to validate these findings.
Subjects