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Abstracts of the 7th World Congress on Pediatric Critical Care

ABSTRACT 352

RANDOMIZED COMPARISON OF 20%-MANNITOL VS 3%-HYPERTONIC SALINE IN CHILDREN WITH RAISED INTRACRANIAL PRESSURE DUE TO ACUTE CENTRAL NERVOUS SYSTEM INFECTIONS

Ramesh Kumar, R.1; Singhi, S.1; Singhi, P.1; Bansal, A.1

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Pediatric Critical Care Medicine: May 2014 - Volume 15 - Issue 4_suppl - p 82
doi: 10.1097/01.pcc.0000449078.96534.26
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Background and aims: Role of various osmotherapy agents in treating children with raised intracranial pressure (ICP) due to acute central nervous system (CNS) infections is not well studied.

Aims: Compare the 20%-Mannitol versus 3%-Hypertonic saline (HTS) in children with raised ICP due to acute CNS infections.

Design: Prospective open label RCT in level-III PICU. Subjects: Children, aged 1–12 years with raised ICP and modified-GCS Score ≤8. Interventions: ICP was monitored using intraparenchymal microtransducer (Codman®). ICP above 20 mmHg was treated either with 20%-Mannitol, 0.5 gram/kg/dose over 20-min as and when required (Mannitol-Group, n=28) or 3%-HST, 10 ml/kg loading then 0.5–1 ml/kg/hr at sliding scale infusion (HTS-Group, n=29). Serum osmolarity of 330 mOsmol, sodium of 160 mEq/l were accepted. Outcomes: Primary: Efficacy of mannitol and HTS to bring ICP < 20 mmHg. Secondary: m-GCS score at 72-hrs and poor outcomes (death plus severe sequelae) at 3 months. Study registered with ctri.nic.in (CTRI/2011/09/001997).

Results: Significant reduction in mean ICP (14 vs. 22 mmHg, p=0.010) with a corresponding increase in CPP (67 vs. 53 mmHg; p=0.001) was noted during 72-hrs in HTS-group as compared to Mannitol-group. HTS successfully controlled raised ICP in 79% of patients, in contrast to 50% by mannitol (RR=0.63, 95% CI 0.42–0.95; p=0.020). Median (IQR) m-GCS score was higher in HTS-group as compared to Mannitol-group (10 (7–11) vs. 7 (3–9); p=0.003). HTS-group had a lower poor outcome than Mannitol-group (34.5% vs. 68%) (RR=0.49, 95% CI 0.27 - 0.89; p=0.012).

Conclusions: 3%-Saline was superior to 20%-Mannitol for controlling raised ICP in acute CNS infections.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies