Severe Traumatic Brain Injury With High Cerebral Pressure
Conditions
Brief summary
Severe traumatic brain injury with increased intracranial pressure can lead to decreased cerebral blood flow. Low cerebral blood flow is responsible for secondary lesions, leading to bad prognosis. It is not yet established whether increasing cardiac output in these patients can lead to an increase in cerebral blood flow, although there are some arguments in favor of this hypothesis. The aim of this study is to demonstrate that increasing cardiac output will improve cerebral blood flow in patients with severe traumatic injury and high cerebral pressure.
Interventions
DRUGNorepinephrine
DRUGDobutamine and norepinephrine
Sponsors
University Hospital, Grenoble
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Traumatic brain injury (TBI) with pattern of oligemia (diastolic velocity \< 30cm/second and/or mean velocity \< 45cm/second measured with transcranial doppler or oxygen tissue pressure \< 15mmHg) * Closed traumatic brain injury * Isolated TBI or polytraumatism * Age between 18 and 65 years old * Affiliated to a social security system
Exclusion criteria
* Instable episodes of high cerebral pressure * Craniectomy * High cerebral pressure without TBI * No autoregulation * Current hemorrhagic shock * Chronic cardiac failure * Chronic renal failure * Hyperemia measured with transcranial doppler * Short life expectancy * Refused consent from the family * Protected patients by the law * Hypersensibility to one of the treatment or sulfites
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean blood flow velocity | After one hour of treatment | Mean blood flow velocity averaged on the two middle cerebral arteries (right and left) measured one after after the initiation of treatment. Each velocity is calculated as an average on the 10 last minutes form continuous transcranial doppler monitoring |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evolution of brain oxygenation under treatment | During one hour of treatment | Comparison of the brain tissue oxygenation curves (PbrO2) under treatment with and without dobutamine |
| Dobutamine doses | After one hour of treatment | Dobutamine doses required to reach the same cerebral perfusion pressure than noradrenaline alone |
| Resistivity index on renal doppler | After one hour of treatment | Measure of resistivity index on renal doppler after one hour of treatment with and without dobutamine |
| Pulsatility index on renal doppler | After one hour of treatment | Measure of pulsatility index (PI) on renal doppler before and after one hour of treatment with and without dobutamine prediction of cerebral blood flow increase (patients with high initial renal PI) |
| Cardiac output modifications | During one hour of treatment | Comparison of cardiac blood flow modifications under treatment for one hour with and without dobutamine |
Countries
France
Contacts
Primary ContactGilles Francony, MD
Outcome results
None listed