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Background <p>Elevated intracranial pressure (ICP) in pediatric patients is a critical condition that can lead to severe complications if not managed promptly. Hypertonic saline and mannitol are both commonly used to reduce ICP, yet their comparative effectiveness remains uncertain. Despite widespread use, existing studies show mixed results, with variations in treatment protocols and patient outcomes. This uncertainty underscores the need for a clearer understanding of the most effective treatment for pediatric ICP management.</p> Aim <p>To compare the effectiveness of hypertonic saline and mannitol in the management of elevated intracranial pressure in pediatric patients.</p> Methods <p>A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statements, was conducted (PROSPERO: CRD420251037689). A literature review was performed (sources: PubMed, Embase, and Cochrane Library databases; end-of-search date: April 15, 2025), and quality assessment was performed using the ROB2 and NewCastle Ottawa Scale. A random-effects model was used to pool the data for the meta-analyses.</p> Results <p>A total of 631 patients from five studies were included in the mortality analysis, with 367 in the HTS group and 264 in the mannitol group. The risk of mortality was not significantly different between groups (RR, 0.91; 95% CI, 0.54, 1.52; <i>p</i> = 0.71), with moderate heterogeneity observed (<i>I</i><sup>2</sup> = 41%). Two studies assessing ICP change at 72&#xa0;h found no significant difference (mean difference: −3.79&#xa0;mmHg, <i>p</i> = 0.46). Similarly, no significant difference was found for CPP change (mean difference: 4.55&#xa0;mmHg, <i>p</i> = 0.36). Secondary outcomes, including ICU and hospital length of stay and mechanical ventilation duration, showed no significant differences between groups.</p> Conclusions <p>This meta-analysis found no significant differences in mortality, ICP, or CPP changes between the HTS and mannitol groups. Secondary outcomes, including ICU and hospital length of stay and mechanical ventilation duration, also showed no notable differences. These findings suggest that both hypertonic saline and mannitol may be similarly effective for managing elevated ICP in pediatric patients.</p>

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Therapeutic comparison of hypertonic saline and mannitol in pediatric intracranial hypertension: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年12月20日

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  • Abdullah Afridi,
  • Zaryab Bacha,
  • Fatima Sajjad,
  • Iqra Shahid,
  • Iqra Khan,
  • Hira Habib,
  • Yasir Saleem,
  • Makzooma Batool,
  • Madiha Gul,
  • Fazia Khattak,
  • Farwa Nisa,
  • Muhammad Abdullah Ali,
  • Rida Khan Hoti,
  • Muhammad Hamza Khan,
  • Hafsa Khan,
  • Kamil Ahmad Kamil

摘要

Background

Elevated intracranial pressure (ICP) in pediatric patients is a critical condition that can lead to severe complications if not managed promptly. Hypertonic saline and mannitol are both commonly used to reduce ICP, yet their comparative effectiveness remains uncertain. Despite widespread use, existing studies show mixed results, with variations in treatment protocols and patient outcomes. This uncertainty underscores the need for a clearer understanding of the most effective treatment for pediatric ICP management.

Aim

To compare the effectiveness of hypertonic saline and mannitol in the management of elevated intracranial pressure in pediatric patients.

Methods

A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statements, was conducted (PROSPERO: CRD420251037689). A literature review was performed (sources: PubMed, Embase, and Cochrane Library databases; end-of-search date: April 15, 2025), and quality assessment was performed using the ROB2 and NewCastle Ottawa Scale. A random-effects model was used to pool the data for the meta-analyses.

Results

A total of 631 patients from five studies were included in the mortality analysis, with 367 in the HTS group and 264 in the mannitol group. The risk of mortality was not significantly different between groups (RR, 0.91; 95% CI, 0.54, 1.52; p = 0.71), with moderate heterogeneity observed (I2 = 41%). Two studies assessing ICP change at 72 h found no significant difference (mean difference: −3.79 mmHg, p = 0.46). Similarly, no significant difference was found for CPP change (mean difference: 4.55 mmHg, p = 0.36). Secondary outcomes, including ICU and hospital length of stay and mechanical ventilation duration, showed no significant differences between groups.

Conclusions

This meta-analysis found no significant differences in mortality, ICP, or CPP changes between the HTS and mannitol groups. Secondary outcomes, including ICU and hospital length of stay and mechanical ventilation duration, also showed no notable differences. These findings suggest that both hypertonic saline and mannitol may be similarly effective for managing elevated ICP in pediatric patients.