First Author and Publication date Design of included studies Number of included studies (n) Patients (n) Efficiency of ICP reduction between Mannitol and HTS Main conclusions Rating by AMSTAR 2
Jiajie Gu, 2018 RCT n=12 n=438 (1) The pooled MD of maximal ICP reduction, comparing HTS to mannitol was −0.16 (95% CI: −0.59 to 0.27, p = 0.473). (2) The pooled relative risk of successful ICP control was 1.06 (95% CI: 1.00 to 1.13, p = 0.044). There is no specific recommendation to select HTS or mannitol as a first-line agent for TBI. Low
Elyse Berger-Pelleiter, 2016 RCT n=11 n=1820 HTS did not improve ICP control (WMD −1.25 mm Hg, 95% CI −4.18 to 1.68, I2 = 78%) as compared to any other solutions. There is no difference between HTS and other solutions in ICP reduction. Moderate
Sarah Burgess, 2016 RCT n=7 n=191 Risk of ICP treatment failure favored HTS (risk ratio = 0.39; 95% CI = 0.18-0.81). There is no significant difference between HTS and mannitol for mean ICP reduction. HTS appears to lead to fewer ICP treatment failures. Low
Min Li, 2015 RCT; 2-arm prospective studies n=7 n=169 A pooled MD = -1.69 (95% CI: 2.95 to 0.44, P = 0.008) indicated that HTS reduced ICP more effectively than mannitol when compared from the baseline value to the last measurement after treatment. HTS is more effective than mannitol for reducing ICP in TBI. Low
A C Rickard, 2013 RCT n=6 n=171 (599 episodes of raised ICP) The WMD in ICP reduction, using HTS solutions compared with mannitol, was 1.39 mm Hg (95% CI −0.74 to 3.53). There is no significant difference between HTS and mannitol for ICP reduction. Critical Low
Martin M. Mortazavi, 2012 RCT; nonrandomized prospective observational trials; retrospective trials n=36 n=823 A higher rate of treatment failure or insufficiency with mannitol versus HTS (OR=0.36, 95% CI: 0.19 to 0.68). HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. Critical Low
Hooman Kamel, 2011 RCT n=5 n=112 The relative risk of ICP control was 1.16 (95% CI, 1.00–1.33), and the difference in mean ICP reduction was 2.0 mmHg (95% CI: 1.6 to 5.7), with both favoring HTS over mannitol. HTS is more effective than mannitol for treatment of elevated ICP. Critical Low