Comparision between 3% Hypertonic Saline and 20% Mannitol in the Management of Raised Intracranial Pressure in Children

Background

Osmotic agents like mannitol and hypertonic saline are the mainstay of management of raised intracranial pressure (ICP) along with non-pharmacological measures like head elevation, hyperventilation, and hypothermia and CSF drainage. Several recent studies have shown hypertonic saline relatively superior to mannitol however, both are being used commonly. So, this study was done to compare the efficacy of mannitol and hypertonic saline in management of raised ICP in children.

Methods

This was a prospective randomized comparative study done among 40 children aged 1-5 years admitted in department of Pediatrics and Adolescent Medicine, BPKIHS, Dharan with clinical signs and symptoms of raised ICP They were divided into two groups based on consecutive sampling with group 1 receiving 20% mannitol and group 2 receiving 3% hypertonic saline.

Results

Both the groups were comparable for age distribution, gender and baseline characteristics. Pretreatment mean MAP was higher in group 2 as compared to group 1 while decrease in MAP was present in both groups at 24, 36-, 48-, 56- and 60-hours post-treatment; however, this was not statistically significant. 78.9% cases improved with mannitol while 90.5% improved with 3% hypertonic saline but this was not statistically significant.

Conclusion

Hypertonic saline can be an equally effective agent for management of raised ICP in children but larger and multi-centric study may help in determining which one is better.