Effectiveness of hypertonic saline infusion in management of traumatic brain injury: an updated systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Objective

This study aimed to find out the efficacy of using Hypertonic saline solution (HSS) over mannitol in the management of TBI by comparing their performance in improving different outcomes.

Methods

Electronic databases were searched for randomized controlled trials (RCTs) assessing the impact of HSS vs. mannitol on ICP in patients who suffered TBI. Outcomes of interest were mortality, neurologic functional outcomes, risk ratio (RR) of successful ICP treatment, reduction in ICP after 30–60 and 90–120 min, improvement in cerebral perfusion pressure (CPP) at 30–60 and 90–120 min, and also treatment failure. Evaluations were reported as RR or mean difference (MD) with 95% confidence intervals (CIs) using weighted random-effects models.

Results

The analysis included 624 patients from 15 RCTs. HSS infusion had a significant impact on the improvement of CPP at 30–60 min [MD = 5.54, 95% CI (3.04, 8.03),p < 0.001] compared to mannitol. However, results yielded no significant difference between HSS and mannitol in terms of mortality, neurologic functional outcomes, successful ICP treatment, reduction in ICP after 30–60 min and 90–120 min, improvement in CPP at 90–120 min, and treatment failure.

Conclusion

HSS and mannitol are both effective treatments for elevated ICP due to TBI. However, further research is required to derive a better comparison.

KEYWORDS:

• Traumatic brain injury, hypertonic saline solution
• intracranial pressure
• mannitol
• healthcare
• health management

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

The authors’ responsibilities were as follows: W.H. conceived the study. L.C. and W.H. carried out the literature search. L.C. and W.H. carried out data extraction and independent reviewing. L.C. conducted data analysis and interpretation. L.C. wrote the manuscript. W.H. conducted critical revision. All authors approved the final manuscript.

Data availability statement

Data described in the manuscript will be made available upon reasonable request pending application and approval by contacting the Corresponding author.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2024.2363340

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.