Does the administration of mannitol prevent renal failure in open abdominal aortic aneurysm surgery?

A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether mannitol might prevent renal failure in patients undergoing open repair of an abdominal aortic aneurysm. Altogether more than 25 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. In total, 319 patients were included in these eight studies. Five of the included studies date from 1961-1965, and the remaining three from 1986, 1996 and 2002. The age of study is reflected in the level of evidence presented. The three recent studies provide evidence at a level of 1b, the remaining five giving evidence only at level 3b or 4. Of note also is that the earlier studies used urine output as their main indicator of renal failure in reaching their conclusions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that no clinical trials to date have demonstrated any clinical reduction in the incidence of renal failure in patients undergoing repair of an abdominal aortic aneurysm who have been given mannitol.