Role of hypertonic saline and mannitol in the management of raised intracranial pressure in children: A randomized comparative study

Objective: To compare the efficacy and side effects of 3% hypertonic saline and mannitol in the management of raised intracranial pressure in children. Design: Prospective randomized study. Setting: Pediatric intensive care unit (PICU) in a tertiary care hospital. Subject: 200 patients with raised intracranial pressure. Materials and Methods: Patients were randomized into two statistically comparable groups; Group A (n = 98) was treated with mannitol while Group B (n = 100) was treated with 3% hypertonic saline. Group C (n = 2) included those members of Group A in whom serum osmolality = 320 mosmol/kg and were then treated with 3% hypertonic saline. Both Drugs were given at a loading dose of 5 ml/kg stat followed by 2 ml/kg in every 6 h(both have same osmolarity) for two days in their respective groups. Besides monitoring, blood pressure (NIBP), mean arterial pressure (pre and post 30 min of drug), serum sodium, chloride and osmolality were measured. Intracranial pressure was assessed indirectly by measuring mean arterial ressure "MAP". Student paired 't' test was applied. Results: Decrease in MAP was highly significant (P< 0.001) at 0 h in males 0,6 h in females, and moderately significant at 12,36 h in females and significant(P< 0.05) at 6,24,42 h in males of Group B. Decrease in coma hours was a highly significant finding (P< 0.001) in Group B. In Group B, serum sodium and chloride increased significantly but remained within acceptable limits. There was no difference in osmolality and mortality (fisher Z). Conclusion: Mannitol has several side effects, 3% hypertonic saline is a safe and effective alternative in managing cerebral edema.