Early mannitol administration improves clinical outcomes of pediatric patients with brain edema
Open Access
- 31 December 2018
- journal article
- research article
- Published by Faculty of Medicine, Universitas Indonesia in Medical Journal of Indonesia
- Vol. 27 (4), 244-9
- https://doi.org/10.13181/mji.v27i4.2377
Abstract
Background: Mannitol 20% is used to treat patients with decreased consciousness and as the first line of treatment to reduce intracranial pressure (ICP). However, its application in pediatric patients is still based on minimal evidence. This study was performed to determine the predictive factors of clinical outcomes in pediatric patients with brain edema in the pediatric intensive care unit (PICU). Methods: This prospective cohort study was conducted in the PICU, Sanglah Hospital Denpasar, Bali, Indonesia. The subjects were chosen by consecutive sampling from July 2016 to July 2017. The primary outcome variable was the patient’s clinical outcome. A chi-square test was used to evaluate the association between the timing of mannitol administration and the patient’s clinical outcome. Multivariate analysis was performed on all variables with p≤0.25. Results: Forty-one patients were included in the study, 65% of them were male, 65% had good nutritional status, 90% had non-traumatic brain injury, and 73% had confirmed intracranial infection. The risk of sequelae or death for patients in a coma was 1.8 times greater than that of non-comatose patients (p=0.018; CI 95% 1.119–3.047). Based on the timing of mannitol administration from the onset of decreased consciousness, the risk of sequelae or death in patients who received mannitol after 24 hours was 2.1 times higher than that in patients who received mannitol within 24 hours (p=0.006; CI 95% 1.167–3.779). Based on multivariate analysis, only two variables were associated with the patient’s clinical outcome: pediatric Glasgow coma scale (PGCS) ≤3 (p=0.03) and timing of mannitol administration >24 hours (p=0.01). Conclusion: Early administration (<24 hours) of mannitol and high PGCS are related to favorable outcomes in patients with brain edema in the PICU.Keywords
This publication has 11 references indexed in Scilit:
- Pathogenesis of Brain Edema and Investigation into Anti-Edema DrugsInternational Journal of Molecular Sciences, 2015
- New trends in hyperosmolar therapy?Current Opinion in Critical Care, 2013
- Mannitol: a review of its clinical usesContinuing Education in Anaesthesia Critical Care & Pain, 2012
- Brain Swelling and Mannitol Therapy in Adult Cerebral Malaria: A Randomized TrialClinical Infectious Diseases, 2011
- The role for osmotic agents in children with acute encephalopathies: a systematic reviewBMC Pediatrics, 2010
- Controversy in use of mannitol in head injuryIndian Journal of Neurotrauma, 2008
- Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trialJournal of Neurosurgery, 2004
- Cerebral Edema and its ManagementMedical Journal Armed Forces India, 2003
- Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injuryJournal of Neurosurgery, 2002
- Comparative effects of hypothermia, barbiturate, and osmotherapy for cerebral oxygen metabolism, intracranial pressure, and cerebral perfusion pressure in patients with severe head injury.Published by Springer Science and Business Media LLC ,1998