ReviewCritical care (London, England)2012
Hypertonic saline, not mannitol, should be considered gold-standard medical therapy for intracranial hypertension.
Review in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury.The Cochrane database of systematic reviews · 2020Pooled it
- Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury.The Cochrane database of systematic reviews · 2019Pooled it
- Comparison of the effects of 7.2% hypertonic saline and 20% mannitol on whole blood coagulation and platelet function in dogs with suspected intracranial hypertension - a pilot study.BMC veterinary research · 2017Trial
- Efficacy and Renal Safety of Protocol-based 11.7% Hypertonic Saline Infusion Compared with 20% Mannitol in Patients with Elevated Intracranial Pressure: A Study Protocol for a Randomized Clinical Trial.Electrolyte & blood pressure : E & BP · 2024Review
- Clinical treatment of cryptococcal meningitis: an evidence-based review on the emerging clinical data.Journal of neurology · 2024Review
- Association between serum creatinine and 30 days all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: analysis of the MIMIC-IV database.Frontiers in neurology · 2024Article
- Elevated Intracranial Pressure in Cryptococcal Meningoencephalitis: Examining Old, New, and Promising Drug Therapies.Pathogens (Basel, Switzerland) · 2022Review
- Optimal Dose and Concentration of Hypertonic Saline in Traumatic Brain Injury: A Systematic Review.Medeniyet medical journal · 2022Article
- Comparison of the effects of 7.2% hypertonic saline and 20% mannitol on electrolyte and acid-base variables in dogs with suspected intracranial hypertension.Journal of veterinary internal medicine · 2021Article
- An overview of management of intracranial hypertension in the intensive care unit.Journal of anesthesia · 2020Review
- Hyperosmolar Treatment for Patients at Risk for Increased Intracranial Pressure: A Single-Center Cohort Study.International journal of environmental research and public health · 2020Article
- Mannitol and the Combination of Mannitol and Gelatin Impair Whole Blood Coagulation and the Platelet FunctionTurkish journal of anaesthesiology and reanimation · 2019Article
- Current trends in the management of canine traumatic brain injury: An Internet-based survey.The Canadian veterinary journal = La revue veterinaire canadienne · 2019Article
- Comparison of electrical impedance tomography and intracranial pressure during dehydration treatment of cerebral edema.NeuroImage. Clinical · 2019Article
- Osmotherapy: science and evidence-based practice.BJA education · 2018Review
- Microdialysate concentration changes do not provide sufficient information to evaluate metabolic effects of lactate supplementation in brain-injured patients.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2016Article
- In vitro effects of 3% hypertonic saline and 20% mannitol on canine whole blood coagulation and platelet function.BMC veterinary research · 2015Article
- [Comparison clinical efficacy of 3% hypertonic saline solution with 20% mannitol in treatment of intracranial hypertension in patients with aneurysmal subarachnoid hemorrhage].Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences · 2015Article
- Efficacy and Safety of Continuous Micro-Pump Infusion of 3% Hypertonic Saline combined with Furosemide to Control Elevated Intracranial Pressure.Medical science monitor : international medical journal of experimental and clinical research · 2015Article
- Use of electrical impedance tomography to monitor regional cerebral edema during clinical dehydration treatment.PloS one · 2014Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Hyperosmolar therapy is the principal medical management strategy for elevated intracranial pressure. Mannitol has been the primary hyperosmolar agent for nearly a century and remains the de facto gold standard for medical management of intracranial hypertension. Over the past 25 years, however, hypertonic saline (HTS) has become a progressively more common alternative to mannitol, and several recent studies have suggested its relative superiority. These findings have prompted calls for large-scale comparator trials of mannitol and HTS, but such trials would only be necessary if the designation of mannitol as the gold standard is appropriate and if current evidence suggests its therapeutic equipoise with HTS. Mounting evidence supporting HTS suggests that neither of these conditions is necessarily true and, instead, mandates reassessment of the actual gold-standard agent for hyperosmolar therapy. In the present article I make the case that current evidence supports HTS, not mannitol, as the better choice for gold-standard therapy for medical management of intracranial hypertension. This is accomplished first by examining the evidence on which the apparent designation of mannitol as the presumed gold-standard is based, then by reviewing the recent comparative efficacy data for HTS versus mannitol, and finally by discussing additional clinical considerations for appropriate designation of a gold-standard agent for hyperosmolar therapy. This assessment has important implications both for patient care and for clinical trial design.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.