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Evidence summaries

Mannitol for Acute Traumatic Brain Injury

Mannitol therapy for raised intracranial pressure (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. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 4 trials with a total of 197 subjects. Mannitol therapy for raised intracranial pressure (ICP) may have a beneficial effect on mortality when compared to pentobarbital treatment (RR for death = 0.85; 95% CI 0.52 to 1.38; 1 trial, n=59) but may have a detrimental effect on mortality when compared to hypertonic saline (RR for death = 1.25; 95% CI 0.47 to 3.33; 1 trial, n=20). ICP-directed treatment shows a small beneficial effect compared to treatment directed by neurological signs and physiological indicators (RR for death = 0.83; 95% CI 0.47 to 1.46; 1 trial, n=80). There are insufficient data on the effectiveness of pre-hospital administration of mannitol (RR for death = 1.75; 95% CI 0.48 to 6.38; 1 trial, n=44).

Comment: The quality of evidence was downgraded by imprecise results (few studies and few patients in each comparison).

    References

    • Wakai A, McCabe A, Roberts I et al. Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev 2013;8():CD001049. [PubMed]

Primary/Secondary Keywords