A systematic Review of treatment outcomes following hyperosmolar solutions for the treatment of brain edema in patients with intracerebral hemorrhage
Keywords:
Intracerebral hemorrhages, Critical care, Brain edema, Mannitol, Hypertonic salineAbstract
Background: The treatment of intracerebral hemorrhage (ICH) is a medical emergency. Surgery has been found to be an effective form of medical treatment. Appropriate medical treatments including hyperosmolar solutions are essential for satisfactory outcomes. Objective: This systematic review was conducted to review state-of-the-art hyperosmolar solutions for the treatment of brain edema in patients with ICH. Methods: A systematic review was performed in accordance with established standards for systematic reviews following meta-analyses guidelines. Trials were identified by electronic searches using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Pubmed and Science direct. The primary outcomes measured focused on mortality rate, clinical outcomes and quality of life. Secondary outcomes included intracranial pressure (ICP), Glasgow coma scale (GCS), length of stay in an intensive care unit and adverse effects. Results: Five studies comprising 225 patients were included in the review. Hyperosmolar solutions found in the included studies were hypertonic saline and mannitol. Their protocols were various, especially the formulation and dose of the solutions. No statistically significant differences were identified in terms of mortality rate, quality of life, ICP, GCS, length of stay in an intensive care unit or adverse effects between mannitol groups and hypertonic saline solution group. No study reported clinical outcomes. Conclusions: Current evidence indicates that the effects of hyperosmolar solutions including mannitol and hypertonic saline on mortality rate, quality of life, ICP, GCS and length of stay in an intensive care unit remain undefined.
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