Efficacy of reducing intracranial hypertension with 3% hypertonic saline vs. mannitol: a Meta-analysis

Objective To systemically compare the effect of 3% hypertonic hypertonic saline (HS) and mannitol in reducing the intracranial hypertension. Methods Cochrane Library, PubMed, Embase, China Biological Medicine Database, CNKI, Wanfang Database, and VIP were retrieved. The related literature about randomized controlled trials of comparing intracranial hypertension with 3% hypertonic saline (HS) and mannitol from the establishment of the databases to January 2016 was collected. RevMan 5.3 software was used to conduct Meta-analyze for each indicator. Results Finally, 15 articles met the inclusion criteria were enrolled. A total of 680 patients were included, in which 341 used 3%HS (HS group) and 339 used mannitol (mannitol group). There were no significant differences in the value of intracranial pressure (ICP), ICP decline range, cerebral perfusion pressure (CPP) after intervention, plasma osmotic pressure after intervention, and onset time of drugs between the 2 groups (all P>0.05). There were significant differences in the aspects of reducing the maintenance time of ICP effect(95%CI: 1.01~1.56, Z=9.12, P<0.001), central venous pressure (CVP)(95%CI: 0.48~5.87, Z=2.31, P=0.02), and mean arterial pressure (MAP)(95%CI: 1.48~8.15, Z=2.83, P=0.005) between the HS group and the mannitol group. Conclusion Both 3%HS and mannitol may effectively decrease intracranial pressure, however, the effect of 3%HS in reducing intracranial pressure is more durable and may effectively improve CVP and MAP. Key words: Intracranial hypertension; Intracranial pressure; Saline solution, hypertonic; Mannitol; Meta-analysis