Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury

作者：Shu‐Ling Chong, Yanan Zhu, Quan Wang, Paula Caporal, Juan D. Roa, Freddy Israel Pantoja Chamorro, Thelma Elvira Terán Miranda, Hongxing Dang, Chin Seng Gan, Qalab Abbas, Ivan J. Ardila, Mohannad Antar, Jesús Domínguez-Rojas, María Miñambres Rodríguez, Natalia Zita Watzlawik, Natalia Elizabeth Gómez Arriola, Adriana Yock‐Corrales, Rubén Eduardo Lasso Palomino, Ming Mei Xiu, Jacqueline Soo May Ong, Hiroshi Kurosawa, Gabriela Aparicio, Chun‐Feng Liu, Rujipat Samransamruajkit, Juan Camilo Jaramillo-Bustamante, Nattachai Anantasit, Yek Kee Chor, Deborah M. Turina, Pei Chuen Lee, Marisol Fonseca Flores, J. Pilar Orive, Jing Wen, Sebastián González‐Dambrauskas, Jan Hau Lee, Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pediátrica de Latinoamérica (LARed), Yasser Kazzaz, Jian Ji, Suyun Qian, Lijia Fan, Olive Pei Ee Lee, Soo Lin Chuah, Kai You, Tao Zhang, Deiby Lasso Noguera, Esteban Cerón, Andrea Leal Barceló, Susana Reyes, Cesia J Ortega Ocas · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.0438 · 被引用次数：12 · 研究领域：Traumatic Brain Injury and Neurovascular Disturbances、Trauma, Hemostasis, Coagulopathy, Resuscitation、Cardiac Arrest and Resuscitation

Importance: The use of hypertonic saline (HTS) vs mannitol in the control of elevated intracranial pressure (ICP) secondary to neurotrauma is debated. Objective: To compare mortality and functional outcomes of treatment with 3% HTS vs 20% mannitol among children with moderate to severe traumatic brain injury (TBI) at risk of elevated ICP. Design, Setting, and Participants: This prospective, multicenter cohort study was conducted between June 1, 2018, and December 31, 2022, at 28 participating pediatric intensive care units in the Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pediátrica de Latinoamérica (LARed) in Asia, Latin America, and Europe. The study included children (aged <18 years) with moderate to severe TBI (Glasgow Coma Scale [GCS] score ≤13). Exposure: Treatment with 3% HTS compared with 20% mannitol. Main Outcomes and Measures: Multiple log-binomial regression analysis was performed for mortality, and multiple linear regression analysis was performed for discharge Pediatric Cerebral Performance Category (PCPC) scores and 3-month Glasgow Outcome Scale-Extended Pediatric Version (GOS-E-Peds) scores. Inverse probability of treatment weighting was also performed using the propensity score method to control for baseline imbalance between groups. Results: This study included 445 children with a median age of 5.0 (IQR, 2.0-11.0) years. More than half of the patients (279 [62.7%]) were boys, and 344 (77.3%) had severe TBI. ...