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Intervention Review

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Mannitol for acute traumatic brain injury

  1. Abel Wakai1,*,
  2. Ian G Roberts2,
  3. Gillian Schierhout3

Editorial Group: Cochrane Injuries Group

Published Online: 24 JAN 2007

Assessed as up-to-date: 28 FEB 2006

DOI: 10.1002/14651858.CD001049.pub4

How to Cite

Wakai A, Roberts IG, Schierhout G. Mannitol for acute traumatic brain injury. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001049. DOI: 10.1002/14651858.CD001049.pub4.

Author Information

  1. 1

    Sunnybrook Health Sciences Centre, Division of Emergency Medicine, Toronto, Ontario, Canada

  2. 2

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

  3. 3

    London School of Hygiene & Tropical Medicine, c/o Cochrane Injuries Group, London, UK

*Abel Wakai, Division of Emergency Medicine, Sunnybrook Health Sciences Centre, Suite C7-16, Toronto, Ontario, M4N 3M5, Canada. abelwakai@gmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Mannitol is sometimes effective in reversing acute brain swelling, but its effectiveness in the ongoing management of severe head injury remains unclear. There is evidence that, in prolonged dosage, mannitol may pass from the blood into the brain, where it might cause increased intracranial pressure.

Objectives

To assess the effects of different mannitol therapy regimens, of mannitol compared to other intracranial pressure (ICP) lowering agents, and to quantify the effectiveness of mannitol administration given at other stages following acute traumatic brain injury.

Search methods

The review drew on the search strategy for the Injuries Group as a whole. We checked reference lists of trials and review articles, and contacted authors of trials. The searches were last updated in March 2006.

Selection criteria

Randomised controlled trials of mannitol, in patients with acute traumatic brain injury of any severity. The comparison group could be placebo-controlled, no drug, different dose, or different drug. We excluded cross-over trials, and trials where the intervention was started more than eight weeks after injury.

Data collection and analysis

We independently rated quality of allocation concealment and extracted the data. Relative risks (RR) and 95% confidence intervals (CI) were calculated for each trial on an intention to treat basis.

Main results

We identified four eligible randomised controlled trials. One trial compared ICP-directed therapy to 'standard care' (RR for death = 0.83; 95% CI 0.47 to 1.46). One trial compared mannitol to pentobarbital (RR for death = 0.85; 95% CI 0.52 to 1.38). One trial compared mannitol to hypertonic saline (RR for death = 1.25; 95% CI 0.47 to 3.33). One trial tested the effectiveness of pre-hospital administration of mannitol against placebo (RR for death = 1.75; 95% CI 0.48 to 6.38).

Authors' conclusions

Mannitol therapy for raised ICP may have a beneficial effect on mortality when compared to pentobarbital treatment, but may have a detrimental effect on mortality when compared to hypertonic saline. ICP-directed treatment shows a small beneficial effect compared to treatment directed by neurological signs and physiological indicators. There are insufficient data on the effectiveness of pre-hospital administration of mannitol.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Mannitol for acute traumatic brain injury

Mannitol is a sugar alcohol solution which is sometimes effective in reducing brain swelling after head injury. However, its effectiveness in the ongoing treatment of severe head injury remains unclear. There is evidence that excessive administration of mannitol may be harmful, by mannitol passing from the bloodstream into the brain, where it increases pressure within the skull and worsens brain swelling. The review authors searched the medical literature and identified four randomized controlled trials comparing mannitol to other treatment strategies for reducing brain swelling after head injury. One trial compared treatment with mannitol directed by measurement of the pressure within the skull (intracranial pressure) with ‘standard treatment’ (treatment without measurement of intracranial pressure). One trial compared treatment with mannitol to treatment with pentobarbital (a barbiturate drug). One trial compared treatment with mannitol to treatment with hypertonic saline (highly concentrated salt solution). One trial compared treatment with mannitol to treatment with placebo (an inactive ‘dummy’ solution) before arrival in the hospital (pre-hospital). The review found that treatment with mannitol for increased intracranial pressure reduced the likelihood of death when compared to treatment with pentobarbital. In contrast, it found that treatment with mannitol may increase the likelihood of death when compared to treatment with hypertonic saline. The review also found a small benefit when mannitol treatment is directed by measurement of intracranial pressure compared to ‘standard treatment.’ The review found insufficient data on the effectiveness of pre-hospital administration of mannitol.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Mannitol治療急性腦創傷

Mannitol對扭轉急性腦水腫有些效果,但對於嚴重的腦創傷之療效仍未明。有證據指出當延長使用時,mannitol可能有血液進入腦部,致使顱內壓增加。

目標

評估各種mannitol療程的效果,與其他降顱內壓(intracranial pressure, ICP))藥物相較,並於急性腦創傷個階段量化mannitol投與療效。

搜尋策略

搜尋策略由外傷群組整體規劃,我們檢視參考文獻清單、審閱這些文章及聯絡臨床試驗的作者,整個搜尋資料最後於2006年3月更新。

選擇標準

針對各種急性腦創傷患者的Mannitol隨機控制試驗,對照組可以是安慰劑、未含藥物、不同的劑量或是不同的藥物。排除交叉試驗、受傷後過了8週以上才進行的試驗。

資料收集與分析

我們各自就隱匿分配和擷取數據的品質分級,每個試驗以所意圖治療數目來計算相對風險(RR) and 95%信賴區間(CI)。

主要結論

我們評選了四篇合適的隨機控制試驗。試驗1比較了ICP治療與「標準照護」治療(RR for death = 0.83; 95% CI 0.47 to 1.46);試驗2以mannitol相較pentobarbital (RR for death = 0.85; 95% CI 0.52 to 1.38);試驗3用mannitol相較hypertonic saline (RR for death = 1.25; 95% CI 0.47 to 3.33)。試驗4將mannitol和安慰劑相較,測試住院前投與效果(RR for death = 1.75; 95% CI 0.48 to 6.38)。

作者結論

Mannitol治療對於升高ICP在相較於用pentobarbital治療對於死亡率有正面效益,但是相較於hypertonic saline又反而是不利的。ICP直接治療相較於針對神經學症狀和生理指標治療的效益是小的。住院前投與mannitol的數據尚不足以呈現有效性。

翻譯人

本摘要由高雄榮民總醫院毛志民翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

待補。