Pharmacological Interventions for Reducing Intracranial Pressure After Traumatic Brain Injury: An Overview of Systematic Reviews with Randomized Controlled Trials

AbstractObjectivesHypertonic saline solutions are increasingly used to treat increased intracranial pressure following severe traumatic brain injury. However, whether hypertonic saline provides superior management of intracranial pressure and improves outcome is unclear. We thus conducted a systematic review to evaluate the effect of hypertonic saline in patients with severe traumatic brain injury.MethodsTwo researchers independently selected randomized controlled trials studying hypertonic saline in severe traumatic brain injury and collected data using a standardized abstraction form. No language restriction was applied. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and BIOSIS databases. We searched grey literature via OpenGrey and National Technical Information Service databases. We searched the references of included studies and relevant reviews for additional studies.ResultsEleven studies (1,820 patients) were included. Hypertonic saline did not decrease mortality (risk ratio 0.96, 95% confidence interval [CI] 0.83 to 1.11, I2=0%) or improve intracranial pressure control (weighted mean difference −1.25 mm Hg, 95% CI −4.18 to 1.68, I2=78%) as compared to any other solutions. Only one study reported monitoring for adverse events with hypertonic saline, finding no significant differences between comparison groups.ConclusionsWe observed no mortality benefit or effect on the control of intracranial pressure with the use of hypertonic saline when compared to other solutions. Based on the current level of evidence pertaining to mortality or control of intracranial pressure, hypertonic saline could thus not be recommended as a first-line agent for managing patients with severe traumatic brain injury.

Download Full-text

Faculty Opinions recommendation of Between-centre differences and treatment effects in randomized controlled trials: a case study in traumatic brain injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13360103.14730254 ◽

2011 ◽

Author(s):

Nicole Gabler

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Controlled Trials ◽

Treatment Effects ◽

Controlled Trials ◽

Randomized Controlled

Download Full-text

Efficacy of Progesterone for Acute Traumatic Brain Injury: a Meta-analysis of Randomized Controlled Trials

Molecular Neurobiology ◽

10.1007/s12035-015-9614-3 ◽

2015 ◽

Vol 53 (10) ◽

pp. 7070-7077 ◽

Cited By ~ 3

Author(s):

Zhen Wang ◽

LiGen Shi ◽

Wu Ding ◽

FangJie Shao ◽

Jun Yu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Acute Traumatic Brain Injury

Download Full-text

Role of Decompressive Craniectomy in Traumatic Brain Injury – A Meta-analysis of Randomized Controlled Trials

Neurology India ◽

10.4103/0028-3886.271260 ◽

2019 ◽

Vol 67 (5) ◽

pp. 1225 ◽

Cited By ~ 4

Author(s):

Kanwaljeet Garg ◽

PreetM Singh ◽

Raghav Singla ◽

Ankita Aggarwal ◽

Anuradha Borle ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Controlled Trials ◽

Decompressive Craniectomy ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled

Download Full-text

An Overview of Systematic Reviews of Randomized Controlled Trials on Acupuncture Treating Migraine

Pain Research and Management ◽

10.1155/2019/5930627 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Xia-tian Zhang ◽

Xin-yi Li ◽

Chen Zhao ◽

Ye-yin Hu ◽

Yi-yi Lin ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Systematic Reviews ◽

Preventive Treatment ◽

Sham Acupuncture ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Overview Of Systematic Reviews ◽

Meta Analyses ◽

Pain Improvement

Objectives. To review the evidence of acupuncture for acute and preventive treatment of migraine for further awareness of the effect of acupuncture for migraine. Design. An overview of systematic reviews and meta-analyses (SR/MAs) for randomized controlled trials. Material and Methods. We searched PubMed, Embase, the Cochrane Library, China Knowledge Resource Integrated Database, VIP Chinese Journal Full Text Database, WANFANG Data, and China Biology Medicine disc from their establishment to May 27, 2018. SR/MAs of randomized controlled trials comparing the effect of the acupuncture intervention with another treatment control in migraine patients were included. Results. 428 SRs were identified, and 15 of them were included. Only 4 SR/MAs were assessed by GRADE, which showed certainty of most evidence being low or very low. Assessed by AMSTAR-2, fourteen was critically low rating overall confidence in the results, and 1 was low rating overall confidence in the results. Evidence suggested that acupuncture has a significant advantage of pain improvement, efficacy, and safety relative to blank control, sham acupuncture, or drug treatment, but some of these results are contradictory. Conclusions. We found that acupuncture on treating migraine has the advantage for pain improvement and safety, but the quality of SR/MAs of acupuncture for migraine remains to be improved.

Download Full-text