Mannitol Versus 3% NaCL for Management of Severe Pediatric Traumatic Brain Injury

• Intracranial pressure management is a crucial part of care rendered by nurses, nurse practitioners, intensivists, and neurosurgeons.
• Although mannitol is commonly used as a first-line therapy, recent studies suggest that the use of hypertonic saline is more effective in lowering elevated intracranial pressure.
• In our study, it appears that there may be a benefit from administering a combined therapy of mannitol and hypertonic saline.
• To date, all pediatric data published lacks the evidence of recommending certain protocols over the other and most results are based on small randomized studies of adult patients.
• This lack of evidence presents a valuable opportunity to conduct large controlled randomized trials in both adults and pediatric clients in order to identify the best treatment modalities used separately or perhaps in combination that will enhance and improve patients’ outcomes.

The study purpose was to investigate the relationship between the type of hyperosmolar therapy used in treating elevated intracranial pressure and the outcome of children with severe traumatic brain injury. Two outcomes were investigated: length of stay in the intensive care unit and disposition status at discharge from hospital. Children who received mannitol had the shortest length of stay and the highest mortality rate of 80%, whereas the group who received sodium chloride 3% had the longest length of stay in the intensive care unit. The group who received combined therapy of mannitol and sodium chloride 3% had the lowest mortality rate, which may suggest better modalities to manage increased intracranial pressures.