Effectiveness of 3% saline versus mannitol in children with cerebral oedema of non traumatic etiology

Yıl 2012, Cilt: 4 Sayı: 3, 1 - 6, 17.08.2012

Kumaraguru D Poovazhagi Varadarajan , Shanthi Sangareddi Ramachandran Padmanabhan Jeyachandran P

Öz

Objective: A randomized controlled trial was undertaken at the pediatric intensive care department of a tertiary care Pediatric hospital at Chennai, to evaluate the effectiveness of 3% saline as an anti-edema measure in comparison to mannitol in children with non-traumatic coma. Subjects: The study comprised of 40 children with cerebral edema in each group. Outcome measures: The outcome was analyzed in terms of survival/death, duration of coma and complications. Results: Study parameters like age, gender, Glasgow coma scale, etiology of coma, signs of cerebral edema and duration of coma were comparable among the two groups and did not reveal statistically significant difference. Among the complications shock(p- 0.03) and dehydration (p-0.045) were more common in children who received mannitol and hypernatremia(p-0.026) was common in children who received 3% saline. The mortality rates among the two groups did not reveal statistically significant difference(p-0.07). Conclusions: In the treatment of cerebral edema of non traumatic origin in children, 3% saline can be considered as effective and safe as mannitol.

Anahtar Kelimeler

Mannitol, 3% saline, cerebral edema

Kaynakça

• Stack C. Trauma. In: Stack C, Dobbs P eds.Essentials of Pediatric Intensive Care, 1st edn. London: Greenwich Medical Media Limited, 2004: 155-161.
• Hayden W, David C and Bala V. The Use of Hypertonic Saline for Treating Intracranial Hypertension After Traumatic Brain Injury, Anesthesia and analgesia 2006; 102(6): 1836-1846.
• Rautaray S S, Sarkar PD, Agrawal BK. Study of the effect of mannitol on serum electrolytes before and after three days in stroke patients. Biomedical Research 2008; 19 (3): 177-180.
• Zornow MH. Hypertonic saline as a safe and efficacious treatment of intracranial hypertension. J Neurosurg Anesthesiol 1996;8:175-177.
• Qureshi AI, Suarez JI, Bhardwaj A, Mirski M, Schnitzer MS, Hanley DF,et al. Use of hypertonic saline/ acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain. Crit Care Med 1998;26: 440-446.
• Suarez JI, Qureshi AI, Bhardwaj A, Williams MA, Schnitzer MS, Mirski M, et al. Treatment of refractory intracranial hypertension with 23.4% saline. Crit Care Med 1998;26:1118-22.
• Himmelsher S. Hypertonic saline solutions for treatment of intracranial hypertension. Current Opinion in Anaesthesiology 2007; 20(5): 414-426 ,
• Wakai A, Roberts I, Schierhout G. Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev 2007; 1:CD001049.
• Bhardwaj A, Ulatowski JA. Hypertonic saline in brain injury. Curr Opin Crit Care 2004; 10:126–131.
• Suarez JL. Hypertonic saline for cerebral edema and elevated intracranial pressure. Cleveland Clin J Med 2004; 71 (suppl 1):S9–S13.
• Gemma M, Cozzi S, Tommasino C, Mungo M, Calvi MR, Capriani A, et al. 7.5% hypertonic saline versus 20% mannitol during elective neurosurgical supratentorial procedures. J Neurosurg Anesth 1997; 9:329–334.