Hyperosmolar therapy may reduce intracranial hypertension (IH) and act as a lifesaving method in critically ill patients with IH. There is no established superiority of either HS or MAN, the most frequently used agents, in pediatric patients.

PubMed, Embase, and Cochrane databases were searched for studies and abstracts published up to October 1st, 2022. Studies were excluded if boluses of HS or MAN were held in patients undergoing elective procedures. The outcomes of interest were mortality; changes in intracranial pressure (ICP); and changes in cerebral perfusion pressure (CPP).

Six studies with 819 patients were included. The mean patient age ranged from 9 months to 13.5 years. Mortality was not significantly different between the HS (15.6%) and the MAN (21.6%) groups (risk ratio [RR] 0.66; 95% confidence interval [CI] 0.44,0.99; p=0.05). There were also no significant changes in ICP (standardized mean difference -0.25; 95% CI -0.90,0.40; p=0.45) or CPP (standardized mean difference 0.20; 95% CI -0.29,0.68; p=0.42) between patients treated with HS or MAN. 

In this meta-analysis including 819 children with elevated intracranial pressure, there was no difference in mortality, ICP, or CPP between patients treated with HS or MAN.