Hyperosmolar therapy for traumatic brain injury in pediatric population: A Systematic Review and Meta-Analysis

Introduction: Pediatric traumatic brain injury is one of the main causes of death and morbidity among children aged 0 to 18 years. Hyperosmolar therapy is a cornerstone in this situation. However, the management of pediatric traumatic brain injury still poses a clinical challenge.

Methods: We systematically searched EMBASE, PubMed, and Cochrane Library in October 2023 for studies comparing hypertonic saline versus mannitol in children with traumatic brain injury or TBI and that evaluate efficacy of these therapies in terms of intracranial pressure and cerebral perfusion pressure. Statistical analyses were performed using R software version 5.4.1.

Results: Three studies were included, with 496 patients who underwent hyperosmolar therapy after a traumatic brain injury, 78 % were enrolled in hypertonic saline intervention. Analysing intracranial pressure (ICP), results favors the mannitol boluses group but without statistically significance (MD 0.57; 95% CI -0.98 to 2.13; p = 0.47) , cerebral perfusion pressure (CPP) results favors the 3% hypertonic saline group (MD -1.89; 95% CI -5.28 to 1.50; p = 0.27) but is not statistically significant.

Conclusion : In summary, results of this meta-analysis are not statistically significant to conclude that mannitol boluses is a good intervention to reduce intracranial pressure and 3 % hypertonic saline is efficient to increase cerebral perfusion pressure in children with traumatic brain injury.