Sugar or Salt (“SOS”): a protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension

Veenith, Tonny; Scomparin, Charlotte; Wilson, Mark; Hutchinson, Peter J.; Kolias, Angelos G.; Lall, Ranjit; Regan, Scott; Mason, James; Andrews, Peter; Horner, Daniel; Naisbitt, Jay; Devrell, Anne; Malins, A F; Dark, Paul; Perkins, Gavin D

doi:10.1101/19008276

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…Further high-quality studies, like The Sugar or Salt Trial [25] that is planned to be finished in December 2023 funded by National Institute for Health Research in the United Kingdom, will probably bring more answers for individualized care of patients with intracranial hypertension.…”

Section: Discussionmentioning

confidence: 99%

Salted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension

Lamperti¹,

Lobo²,

Tufegdzic³

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review article is to present current recommendations regarding the use of hypertonic saline and mannitol for the treatment of intracranial hypertension. Recent findingsIn recent years, a significant number of studies have been published comparing hypertonic saline with mannitol in patients with acute increased intracranial pressure, mostly caused by traumatic brain injury. Albeit several randomized controlled trials, systematic reviews and meta-analysis support hypertonic saline as more effective than mannitol in reducing intracranial pressure, no clear benefit in regards to the longterm neurologic outcome of these patients has been reported.

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Section: Discussionmentioning

confidence: 99%

Salted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension

Lamperti¹,

Lobo²,

Tufegdzic³

2022

Current Opinion in Anaesthesiology

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show abstract

“…This will make interpretation of current results more easy until the time more data comes available from a new RCT. This new RCT ("Sugar or Salt") is on its way [30]. The primary aim of this RCT is to assess if HTS versus mannitol improves 6-month functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary aims encompass the degree of ICP control, progression to higher intensity treatments, the requirement for organ support during ICU stay, the length of stay on the ICU and in the hospital, and the quality of life. These aims create the possibility for a detailed health economics analysis plan [30].…”

Section: Discussionmentioning

confidence: 99%

Mannitol or Hypertonic Saline in Traumatic Brain Injury patients: a CENTER-TBI study

Veen

Nieboer

Kompanje

et al. 2022

Preprint

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Introduction: Increased intracranial pressure (ICP) is one of the most important modifiable and immediate threats to critically ill patients suffering from traumatic brain injury (TBI). Two hyperosmolar agents (HOA), mannitol and hypertonic saline (HTS) are routinely used in clinical practice to treat increased ICP. We aimed to assess whether a preference for mannitol, HTS or their combined use translated into differences in (functional) outcome.Methods: The CENTER-TBI Study is a prospective multicenter cohort study. For this study, patients with TBI, admitted to the ICU, treated with mannitol and/or HTS, aged ≥16, were included. Patients and centers were differentiated based on treatment preference with mannitol and/or HTS based on structured, data-driven criteria such as first administered HOA at the ICU. We assessed influence of center and patient characteristics in the choice of agent using adjusted multivariate models. Furthermore, we assessed the influence of HOA preference on (functional) outcome using adjusted ordinal and logistic regression models, and instrumental variable analyses.Results: In total, 2056 patients were assessed. Of these, 502 (24%) patients received mannitol and/or HTS on the ICU. The first bolus of a HOA was HTS for 287 (57%) patients, mannitol for 149 (30%) patients, and both for 66 (13%) patients. Two unreactive pupils were more common for patients receiving both (13, 21%), compared to patients receiving HTS (40, 14%), or mannitol (22, 16%). Center, rather than patient characteristics, was independently associated with the preferred choice of HOA (p-value < 0.05). ICU mortality and 6-month functional outcome were similar between patients preferably treated with mannitol compared to HTS (OR = 0.8, CI = 0.4 – 1.7; OR = 1.1, CI = 0.7 – 1.8 respectively). Patients who received both also had a similar ICU mortality and 6-month functional outcome compared to patients receiving HTS (OR = 1.9, CI = 0.7 - 4.9; OR = 0.7, CI = 0.3 – 1.6 respectively).Conclusion: We found between center variability regarding HOA preference. Moreover, we found that center is a more important driver of the choice of HOA than patient characteristics. However, our study indicates that this variability is an acceptable practice given absence of differences in outcomes associated with a specific HOA.

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Management of moderate to severe traumatic brain injury: an update for the intensivist

et al. 2022

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Sugar or Salt (“SOS”): a protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension

Cited by 4 publications

References 27 publications

Salted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension

Salted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension

Mannitol or Hypertonic Saline in Traumatic Brain Injury patients: a CENTER-TBI study

Management of moderate to severe traumatic brain injury: an update for the intensivist

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