• A C Rickard, J E Smith, P Newell, A Bailey, A Kehoe, and C Mann.
• Emergency Department, Derriford Hospital, Plymouth, UK.
• Emerg Med J. 2014 Aug 1;31(8):679-83.

BackgroundRising intracranial pressure (ICP) is a poor prognostic indicator in traumatic brain injury (TBI). Both mannitol and hypertonic sodium solutions are used to treat raised ICP in patients with TBI.ObjectiveThis meta-analysis compares the use of mannitol versus hypertonic sodium solutions for ICP control in patients with TBI.Data Sources And Study EligibilityRandomised clinical trials in adults with TBI and evidence of raised ICP, which compare the effect on ICP of hypertonic sodium solutions and mannitol.MethodsThe primary outcome measure is the pooled mean reduction in ICP. Studies were combined using a Forest plot.ResultsSix studies were included, comprising 171 patients (599 episodes of raised ICP). The weighted mean difference in ICP reduction, using hypertonic sodium solutions compared with mannitol, was 1.39 mm Hg (95% CI -0.74 to 3.53).LimitationsMethodological differences between studies limit the conclusions of this meta-analysis.ConclusionsThe evidence shows that both agents effectively lower ICP. There is a trend favouring the use of hypertonic sodium solutions in patients with TBI.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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