Chapter 11. Use of hyperosmolar therapy in the management of severe pediatric traumatic brain injury

One must thus weigh the value of long-standing clinical acceptance and safety of a therapy (mannitol) that has limited evidentiary support (two class III studies) of its efficacy against a newer therapy (hypertonic saline) with a limited clinical experience but reasonably good performance in contemporary clinical trials (three class II studies for intracranial pressure and one class III study).