Traumatic Brain Injury | Patient
Conditions
Keywords
TBI, Normobaric hyperoxia, Outcome, GOS, GOSE
Brief summary
Aim of the study is to investigate the impact of two different fractions of inspired oxygen (FiO2) on outcome in patients with severe traumatic brain injury (TBI).
Detailed description
The high oxygen group is treated during mechanical ventilation with either a fraction of inspired oxygen of 0.7 (high oxygen group) or a fraction of inspired oxygen 0.4 (control group). The intervention continues until withdrawal of mechanical ventilation, ICU discharge or until 14 days from ICU randomisation. Primary outcome is worse than expected outcome in the corresponding treatment arms based on outcome meas-ured by the probability of bad outcome using the CRASH® risk calculator (prognostic model for predicting outcome after traumatic brain injury). Secondary outcome is occurence of lung injury during mechanical ventilation.
Interventions
OTHERNormobaric oxygen
Fraction of inspired oxygen
Sponsors
Tampere University Hospital
Turku University Hospital
Helsinki University Central Hospital
Kuopio University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients with isolated non-penetrating traumatic brain injury * Multiple trauma patient with brain injury and traumas outside abdomen, thorax or pelvis not affecting oxygenation * Glasgow coma scale eight or less (inclusive) * Expected need for intubation and for mechanical ventilation more than 24 hours. * Are recruited \<18 hours after admittance to ICU and * Time from TBI is less than 36 hours * Informed consent from patients representative
Exclusion criteria
* Age \<18 or \>65 years, * Anticipated brain death in 12 hours (donor treatment) or otherwise moribund patient expected to die in 24 hours * Expected need for mechanical ventilation less than 24 hours * Insufficient oxygenation assessed by a clinician or multiple trauma patients with brain injury and severe abdominal, thoracic or pelvic injury possibly affecting oxygenation. * No consent * Insufficient oxygenation with the treatment modality of the lower oxygenation group (Pa02 less than 13 kPa or SpO2 95% with Fi02 40%, PEEP 10 or less) or oxygenation failure probable during ICU care (severe aspiration, multiple trauma patients with brain injury and severe abdominal, thoracic or pelvic injury possibly affecting oxygenation) * Penetrating TBI * No consent * Suspected pregnancy (perform urinary or serological pregnancy test if suspected)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Glasgow outcome scale(GOS) and/or Extended glasgow outcome scale (GOSE) | 6 months | The study is powered to have 80% power at 5% significance level to detect a treatment effect that decreases the proportion of poor outcome from 55% to 45%. Each patient is given an individualized tailored prognosis based on patient's baseline prognosis in a large reference population. Outcome is measured by using functional outcome score, Glasgow outcome score (GOS) and/or GOS extended (GOSE). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 6 month outcome | 6 months | Combined proportion of unfavourable neurological outcomes at 6 months: severe disability (GOSE 2-4) or death (GOSE 1): Occurence of lung injury during mechanical ventilation: ALI-criteria or ARDS criteria used (paO2/FiO2 ratio less than 300 or 200 respectively): Mortality at 6 months: Proportion of surviving patients with unfavourable neurological outcome at 6 months (GOSE 2-4). Quality of life assessment (EQ-5D) at 6 months: Prolonged mechanical ventilation Re-intubation rates |
Countries
Finland
Outcome results
None listed