ArticleNeurosurgery2020
Hypertonic Saline is Superior to Mannitol for the Combined Effect on Intracranial Pressure and Cerebral Perfusion Pressure Burdens in Patients With Severe Traumatic Brain Injury.
Article in Neurosurgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 3 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
25 citing papers in PubMed, 3 syntheses or guidelines pooled it, 77 citations in OpenAlex.
- Hypertonic Saline Versus Other Intracranial-Pressure-Lowering Agents for Patients with Acute Traumatic Brain Injury: A Systematic Review and Meta-analysis.Neurocritical care · 2024Pooled it
- Hypertonic Saline Compared to Mannitol for the Management of Elevated Intracranial Pressure in Traumatic Brain Injury: A Meta-Analysis.Frontiers in surgery · 2021Pooled it
- Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients.Neurocritical care · 2020Guideline
- Lidocaine coinfusion alleviates vascular pain induced by hypertonic saline infusion: a randomized, placebo-controlled trial.BMC anesthesiology · 2021Trial
- Trial
- Continuous 3% Saline Infusion Combined with 7.5% Hypertonic Saline Bolus is Associated with Lower Mortality in Patients with Severe Brain Injury: A Single-Center Retrospective Cohort Study.Neurocritical care · 2026Article
- Peripheral administration of 11.7% hypertonic saline and phlebitis risk in acute ischemic stroke requiring hyperosmolar therapy in South Korea.Acute and critical care · 2026Article
- Radiomics-based machine learning model for predicting secondary decompressive craniectomy in TBI patients after emergent craniotomy with bone flap replacement.Chinese neurosurgical journal · 2026Article
- Superior Outcomes With Ommaya Reservoir in Sustained Intracranial Hypertension Control.Revista de neurologia · 2025Article
- Advancements in Non-Invasive Intracranial Pressure Monitoring via Optic Nerve Sheath Diameter Measurement.Medical science monitor : international medical journal of experimental and clinical research · 2025Review
- 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
- Article
- The establishment and validation of a prediction model for traumatic intracranial injury patients: a reliable nomogram.Frontiers in neurology · 2023Article
- The Level of Serum Osmolarity at Admission in Prognosis of Nosocomial Mortality in Patients with Severe Brain Trauma.Advanced biomedical research · 2023Article
- Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention.Acute and critical care · 2022Article
- Hypertonic lactate for the treatment of intracranial hypertension in patients with acute brain injury.Scientific reports · 2022Article
- Initial neurocritical care of severe traumatic brain injury: New paradigms and old challenges.Surgical neurology international · 2022Review
- Construction and Evaluation of Prognosis Prediction Model for Patients with Brain Contusion and Laceration Based on Machine Learning.Computational and mathematical methods in medicine · 2022Article
- Response to Drs. Quintard, et al.Neurocritical care · 2020Article
- Hyperosmolar Treatment for Patients at Risk for Increased Intracranial Pressure: A Single-Center Cohort Study.International journal of environmental research and public health · 2020Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundHypertonic saline (HTS) and mannitol are effective in reducing intracranial pressure (ICP) after severe traumatic brain injury (TBI). However, their simultaneous effect on the cerebral perfusion pressure (CPP) and ICP has not been studied rigorously.
objectiveTo determine the difference in effects of HTS and mannitol on the combined burden of high ICP and low CPP in patients with severe TBI.
methodsWe performed a case-control study using prospectively collected data from the New York State TBI-trac® database (Brain Trauma Foundation, New York, New York). Patients who received only 1 hyperosmotic agent, either mannitol or HTS for raised ICP, were included. Patients in the 2 groups were matched (1:1 and 1:2) for factors associated with 2-wk mortality: age, Glasgow Coma Scale score, pupillary reactivity, hypotension, abnormal computed tomography scans, and craniotomy. Primary endpoint was the combined burden of ICPhigh (> 25 mm Hg) and CPPlow (< 60 mm Hg).
resultsThere were 25 matched pairs for 1:1 comparison and 24 HTS patients matched to 48 mannitol patients in 1:2 comparisons. Cumulative median osmolar doses in the 2 groups were similar. In patients treated with HTS compared to mannitol, total number of days (0.6 ± 0.8 vs 2.4 ± 2.3 d, P < .01), percentage of days with (8.8 ± 10.6 vs 28.1 ± 26.9%, P < .01), and the total duration of ICPhigh + CPPlow (11.12 ± 14.11 vs 30.56 ± 31.89 h, P = .01) were significantly lower. These results were replicated in the 1:2 match comparisons.
conclusionHTS bolus therapy appears to be superior to mannitol in reduction of the combined burden of intracranial hypertension and associated hypoperfusion in severe TBI patients.
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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.