The grades of evidence (I-III) and levels of recommendations (I-III) are defined at the end of the "Major Recommendations" field.
Level I
There are insufficient data to support a Level I recommendation for this topic.
Level II
Mannitol is effective for control of raised intracranial pressure (ICP) at doses of 0.25 g/kg to 1 g/kg body weight. Arterial hypotension (systolic blood pressure <90 mm Hg) should be avoided.
Level III
Restrict mannitol use prior to ICP monitoring to patients with signs of transtentorial herniation or progressive neurological deterioration not attributable to extracranial causes.
Summary
Mannitol is effective in reducing ICP in the management of traumatic intracranial hypertension. Current evidence is not strong enough to make recommendations on the use, concentration, and method of administration of hypertonic saline for the treatment of traumatic intracranial hypertension.
Definitions:
Grades of Evidence
Class I - Good quality randomized controlled trial (RCT)
Class II - Moderate quality RCT, good quality cohort, or good quality case-control
Class III - Poor quality RCT; moderate or poor quality cohort; moderate or poor case-control; case series, databases or registries
Levels of Recommendation
Levels of recommendation are Level I, II, and III, derived from Class I, II, and III evidence, respectively.
Level I - Recommendations are based on the strongest evidence for effectiveness, and represent principles of patient management that reflect a high degree of clinical certainty.
Level II - Recommendations reflect a moderate degree of clinical certainty.
Level III - Recommendations for which the degree of clinical certainty is not established.