Terapi Hiperosmolar dalam Tata Laksana Cedera Otak Traumatis

Authors

  • Martin Susanto Universitas Sumatera Utara, Medan, Indonesia; Puskesmas Petang II, Bali, Indonesia

DOI:

https://doi.org/10.55175/cdk.v49i8.288

Keywords:

Cedera otak traumatis, manitol, saline hipertonis, tekanan intrakranial, TIK

Abstract

Latar Belakang: Cedera otak traumatis merupakan salah satu penyebab kematian dan kecacatan tertinggi di dunia. Angka mortalitas pasien cedera kepala dengan tekanan intrakranial di bawah 20 mmHg adalah 18,4%, sedangkan angka mortalitas setinggi 55,6% dilaporkan pada pasien dengan tekanan intrakranial melebihi 40 mmHg. Terapi hiperosmolar dengan manitol atau saline hipertonis merupakan tata laksana medis utama untuk menangani peningkatan intrakranial akibat cedera otak traumatis. Tinjauan sistematis ini bertujuan membandingkan efektivitas kedua terapi hiperosmolar tersebut dalam tata laksana cedera otak traumatis. Metode: Penelitian ekstensif dilakukan pada database PubMed, DOAJ, dan Cochrane dengan kriteria inklusi publikasi dalam dua puluh tahun terakhir. Artikel penelitian dalam bentuk meta-analisis, uji klinis, dan uji acak terkontrol lebih diutamakan. Kriteria eksklusi adalah pernyataan tidak jelas, korelasi yang tidak relevan dengan topik utama, atau fokus pada penyakit lain. Hasil: Sebelas penelitian menyimpulkan bahwa efektivitas saline hipertonis sebanding dengan manitol, enam penelitian menunjukkan bahwa saline hipertonis lebih unggul. Simpulan: Saline hipertonis layak dipertimbangkan sebagai alternatif untuk manitol, direkomendasikan untuk pasien dengan hipovolemia, hiponatremia, atau gagal ginjal. Penelitian lebih lanjut diperlukan untuk mendapatkan dosis terapi dan konsentrasi saline hipertonis yang optimal.   Background: Traumatic brain injury is one of the leading causes of death and disability worldwide. Mortality rate of head injuries with intracranial pressure below 20 mmHg was reported 18.4%, whereas those with intracranial pressure more than 40 mmHg had a 55.6% mortality rate. Hyperosmolar therapy with mannitol or hypertonic saline is the mainstay of medical management for treating elevated intracranial pressure in traumatic brain injury. This systematic review aimed to compare the effectiveness of these two hyperosmolar therapies in the management of traumatic brain injury. Methods: The PubMed, DOAJ, and Cochrane databases were used to perform extensive study, with the inclusion criteria of publications in the last twenty years. Meta-analyses, clinical trials, and randomized controlled trials were included. Unclear statements, irrelevant correlation with the main topic, or focusing more on other diseases were the exclusion criteria. Results: Eleven researches stated that the effectiveness of mannitol and hypertonic saline are comparable, six researches showed that hypertonic saline was better. Conclusion: Hypertonic saline should be considered as a preferable alternative to mannitol, recommended for patients with hypovolemia, hyponatremia, or renal failure. Further studies are required to find the optimal therapeutic dose and concentration of hypertonic saline.

 

Downloads

Download data is not yet available.

References

Han C, Yang F, Guo S, Zhang J. Hypertonic saline compared to mannitol for the management of elevated intracranial pressure in traumatic brain injury: A meta- analysis. Front Surg. 2022;8:765784.

Chen H, Song Z, Dennis JA. Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury. Cochrane Database Syst Rev. 2020;1(1):CD010904.

Huang X, Yang L, Ye L, He S, Wang B. Equimolar doses of hypertonic agents (saline or mannitol) in the treatment of intracranial hypertension after severe traumatic brain injury. Medicine (Baltimore) 2020;99(38):e22004.

Boone MD, Oren-Grinberg A, Robinson TM, Chen CC, Kasper EM. Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned? Surg Neurol Int. 2015;6:177.

Marko NF. Hypertonic saline, not mannitol, should be considered gold-standard medical therapy for intracranial hypertension. Crit Care 2012;16(1):113.

Patil H, Gupta R. A comparative study of bolus dose of hypertonic saline, mannitol, and mannitol plus glycerol combination in patients with severe traumatic brain injury. World Neurosurg. 2019;125:221-8.

Shi J, Tan L, Ye J, Hu L. Hypertonic saline and mannitol in patients with traumatic brain injury: A systematic and meta-analysis. Medicine (Baltimore) 2020;99(35):e21655.

Vialet R, Albanèse J, Thomachot L, Antonini F, Bourgouin A, Alliez B, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med. 2003;31(6):1683-7.

Kochanek PM, Adelson PD, Rosario BL, Hutchison J, Ferguson NM, Ferrazzano P, et al. Comparison of intracranial pressure measurements before and after hypertonic saline or mannitol treatment in children with severe traumatic brain injury. JAMA Netw Open 2022;5(3):e220891.

Kamel H, Navi BB, Nakagawa K, Hemphill 3rd JC, Ko NU. Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: A meta-analysis of randomized clinical trials. Crit Care Med. 2011;39(3):554-9.

Schwimmbeck F, Voellger B, Chappell D, Eberhart L. Hypertonic saline versus mannitol for traumatic brain injury: A systematic review and meta-analysis with trial sequential analysis. J Neurosurg Anesthesiol. 2021;33(1):10-20.

Tatro HA, McMillen JC, Hamilton LA, Rowe AS. 23.4% Sodium chloride versus mannitol for the reduction of intracranial pressure in patients with traumatic brain injury: A single-center retrospective cohort study. 2021;55(8):988-94.

Francony G, Fauvage B, Falcon D, Canet C, Dilou H, Lavagne P, et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Crit Care Med. 2008;36(3):795-800.

Huang X, Yang L. Comparison of 20% mannitol and 15% hypertonic saline in doses of similar osmotic burden for treatment of severe traumatic brain injury with intracranial hypertension. Nan Fang Yi Ke Da Xue Xue Bao. Journal of Southern Medical University 2014;(12):723-6.

Jagannatha AT, Sriganesh K, Devi BI, Rao GSU. An equiosmolar study on early intracranial physiology and long-term outcome in severe traumatic brain injury comparing mannitol and hypertonic saline. J Clin Neurosci. 2016;27:68-73.

Kumar SA, Devi BI, Reddy M, Shukla D. Comparison of equiosmolar dose of hyperosmolar agents in reducing intracranial pressure-a randomized control study in pediatric traumatic brain injury. Childs Nerv Syst. 2019;35(6):999-1005.

Miyoshi Y, Kondo Y, Suzuki H, Fukuda T, Yasuda H, Yokobori S. Effects of hypertonic saline versus mannitol in patients with traumatic brain injury in prehospital, emergency department, and intensive care unit settings: A systematic review and meta-analysis. J Intensive Care 2020;8:61.

Gu J, Huang H, Huang Y, Sun H, Xu H. Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: A meta-analysis of randomized controlled trials. Neurosurg Rev. 2019;42(2):499-509.

Rickard AC, Smith JE, Newell P, Bailey A, Kehoe A, Mann C. Salt or sugar for your injured brain? A meta-analysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury. Emerg Med J. 2014;31(8):679-83.

Diringer MN. New trends in hyperosmolar therapy?. Curr Opin Crit Care 2013;19(2):77-82.

Rangel-Castilla L, Gopinath S, Robertson CS. Management of intracranial hypertension. Neurol Clin. 2008;26(2):521-41, x.

Singla A, Mathew PJ, Jangra K, Gupta SK, Soni SL. A comparison of hypertonic saline and mannitol on intraoperative brain relaxation in patients with raised intracranial pressure during supratentorial tumors resection: A randomized control trial. Neurol India. 2020;68(1):141-5.

Downloads

Published

01-08-2022

How to Cite

Susanto, M. (2022). Terapi Hiperosmolar dalam Tata Laksana Cedera Otak Traumatis. Cermin Dunia Kedokteran, 49(8), 451–457. https://doi.org/10.55175/cdk.v49i8.288