OBJECTIVE:
To compare the
efficacy and side effects of hypertronic saline and
mannitol use in
cerebral edema.
DESIGN:
Retrospective study.
SETTING:
Pediatric intensive care unit.
SUBJECTS:
67
patients with
cerebral edema.
METHODS:
Patients with
cerebral edema treated with either
mannitol or hypertronic saline (HS) (Group II n = 25), and both
mannitol and HS (Group III n = 20) were evaluated retrospectively.
Cerebral edema and increased
intracranial pressure were based on the clinical and/or radiological (CT, MR) findings. When treating with both
mannitol and HS (Group IIIA), if
patients serum osmality was greater than 325 mosmol/L,
mannitol was stopped and
patients were treated with only HS (Group IIIB). All
patients were closely monitored for
fever,
pulse,
blood pressure,
central venous pressure (CVP),
oxygen saturation, volume of fluid intake and
urine output.
Mannitol was given at a
dose of 0.25-0.5 g/kg while the hypertonic saline was given as 3% saline to maintain the
serum-Na within the range of 155-165 mEq/L.
RESULTS:
There was no statistically significant difference in terms of
Glasgow coma scale, age,
gender, and etiologic distribution between the groups. And also distribution of the other
treatments given for
cerebral edema is not significiant.
Mannitol was given for a total
dose of 9.3 +/-5.0 (2-16) doses in Group I, and 6.5 +/-2.8 (2-10) doses in Group III. Hypertonic saline was infused for 4-25 times in Group II. Although there was no statistically significant difference in the highest
serum Na and
osmolarity levels of the groups, duration of
comatose state and mortality rate were significantly lower in Group II and Group III A B.
Patients who received only HS were subdivided according to their
serum Na concentrations into 2 groups as those between 150-160 mEqL and those between 160-170 mEqL. The duration of
comatose state and
mortality was not different in
patients with
serum-Na of 150-160 mEqL and in
patients with 160-170 mEqL in the hypertonic saline receiving
patients. Four
patients in the group II developed hyperchloremic
metabolic acidosis and 2
patients in the group I had
hypotension. As two
patients in group II had
diabetes insipidus and one
patient had
renal failure in group I, the
treatment was terminated. The
causes of death were
septic shock,
ventilator associated
pneumonia with
acute respiratory distress syndrome, progressive
cerebral edema and
cerebral edema with
pulmonary edema.
Multivariate analysis showed that age,
gender, cause of
cerebral edema,
electrolyte imbalance,
hyperglycemia and hyper-
ventilation had no significant impact on outcome.
CONCLUSION:
Hypertonic saline seems to be more effective than
mannitol in the
cerebral edema.