Hyperosmolar therapy in pediatric intracranial hypertension: a systematic review
DOI:
https://doi.org/10.32480/rscp.2026.e3116Keywords:
Traumatic brain injury, hypertonic saline solution, mannitol, pediatrics, intracranial hypertensionAbstract
Introduction: Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. Management of intracranial hypertension (ICH) using hyperosmolar therapy with hypertonic saline (HS) or mannitol is the clinical standard, though controversy persists regarding the superiority of one agent. Objective: To evaluate the efficacy and safety of HS versus mannitol in managing ICH secondary to pediatric TBI. Methodology: Systematic review following PRISMA guidelines. PubMed, Elsevier, SciELO, and LILACS were searched (2015-2025). Comparative studies in patients aged 0-18 with TBI were included; infectious etiologies were excluded. Quality was assessed using the Newcastle-Ottawa Scale. Results: Six studies were selected (n=1404). HS demonstrated greater efficacy in reducing intracranial pressure (ICP) during severe crises (>30 mmHg) and better hemodynamic stability. No statistically significant differences were found in overall mortality (p=0.34) or functional outcome at 3 months. Conclusions: Both agents are effective for ICH control. Selection should be individualized based on hemodynamic status, with HS being preferable in cases of instability or refractory ICH.
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