Early mannitol administration improves clinical outcomes of pediatric patients with brain edema

Abstract

Background: Mannitol 20% is used to treat patients with decreased consciousness and as the first line of treatment to reduce intracranial pressure (ICP). However, its application in pediatric patients is still based on minimal evidence. This study was performed to determine the predictive factors of clinical outcomes in pediatric patients with brain edema in the pediatric intensive care unit (PICU).Methods: This prospective cohort study was conducted in the PICU, Sanglah Hospital Denpasar, Bali, Indonesia. The subjects were chosen by consecutive sampling from July 2016 to July 2017. The primary outcome variable was the patient’s clinical outcome. A chi-square test was used to evaluate the association between the timing of mannitol administration and the patient’s clinical outcome. Multivariate analysis was performed on all variables with p≤0.25.Results: Forty-one patients were included in the study, 65% of them were male, 65% had good nutritional status, 90% had non-traumatic brain injury, and 73% had confirmed intracranial infection. The risk of sequelae or death for patients in a coma was 1.8 times greater than that of non-comatose patients (p=0.018; CI 95% 1.119–3.047). Based on the timing of mannitol administration from the onset of decreased consciousness, the risk of sequelae or death in patients who received mannitol after 24 hours was 2.1 times higher than that in patients who received mannitol within 24 hours (p=0.006; CI 95% 1.167–3.779). Based on multivariate analysis, only two variables were associated with the patient’s clinical outcome: pediatric Glasgow coma scale (PGCS) ≤3 (p=0.03) and timing of mannitol administration >24 hours (p=0.01).Conclusion: Early administration (<24 hours) of mannitol and high PGCS are related to favorable outcomes in patients with brain edema in the PICU.

Karakteristik Penderita Ensefalopati Pada Anak Di Ruang Gawat Darurat Dan Picu Rsup Sanglah Denpasar Pada Tahun 2018

“…Hasil ini sesuai dengan penelitian yang dilakukan oleh Sekarningrum dkk RSUP Sanglah, Bali pada tahun 2018 yang juga menemukan bahwa sebagian besar anak yang mengalami penurunan kesadaran adalah berjenis kelamin laki-laki. 16 Perbedaan distribusi jenis kelamin yang cukup signifikan ini belum diketahui apakah memang jenis kelamin memiliki peran atau merupakan faktor risiko terhadap kejadian ensefalopati pada anak. Hal ini mungkin perlu dilakukan penelitian lebih mendalam untuk doi:10.24843.MU.2021.V10.i3.P18 membuktikan apakah jenis kelamin pria memiliki kecenderungan yang lebih tinggi untuk mengalami ensefalopati dibandingkan dengan wanita.…”

Effective and safe pharmacotherapy for pediatric population: a call for academia to conduct clinical research

“…Academia is the key for the conduct of a scientifically sound and significant pediatric trials by providing a good study design. 3 Two clinical research that involved pediatric populations are discussed in the present volume: a cohort study for early use of mannitol in pediatric intensive care unit, 7 and a clinical trial of new regimen of albendazole in soiltransmitted helminths (STH) infection. 8 The two studies provide data to support the effectiveness and safety of the respective drugs in diseases that greatly affects children.…”