OBJECTIVE: The general objective of this meta-analysis was to determine the efficacy of HSS versus mannitol in decreasing cerebral edema. The specific objectives were to compare the magnitude of decrease in intracranial pressure (ICP), the changes in cerebral perfusion pressure (CPP), mean arterial pressure (MAP), serum sodium and serum osmolality, between administrations of mannitol versus HSS.

METHOD: Systematic online search was conducted through MEDLlNE, PubMed and Cochrane Database. Search terms used were (mannitol) AND (hypertonic saline solution OR HSS OR hypertonic) AND (intracranial pressure OR ICP OR cerebral edema) AND (stroke OR cerebrovascular OR brain injury). A free text search was also done via Yahoo and Google search engine. Only randomized clinical controlled trials of adults with cerebral edema, due to traumatic brain injury, ischemic or hemorrhagic stroke were included. Interventions encompassed either mannitol or HSS. The outcomes measured include ICP, CPP, MAP, serum sodium and serum osmolality. Primary outcome measured was the magnitude of decline in ICP after giving the osmotic agents. Secondary outcomes were the effects of treatment to the CPP, MAP, serum sodium and serum osmolality. Analysis was done through mean change from baseline, and reported as Weighted Mean Difference (WMD) and 95% Confidence Interval (CI).

RESULTS: Four randomized clinical trials compared mannitol versus HSS in decreasing cerebral edema. A total of 70 patients and 196 episodes of increased ICP were treated with the either hypertonic saline solution or mannitol. The pooled analysis for the mean change from baseline was statistically significant and favored HSS treatment (p