Acute Brain Injury
Conditions
Keywords
Brain injury, Intensive care, Neurointensive care, Anaesthesiology, Multimodal neuromonitoring
Brief summary
Acute brain injury due to aneurysmal subarachnoid haemorrhage (SAH) or traumatic brain injury (TBI) is a condition with a high mortality, and surviving patients often have permanent disabilities. Multimodal neuromonitoring of intracranial pressure, brain tissue oxygen tension (PbtO2), and brain energy metabolism (measured with microdialysis (MD)) may help individualise the treatment of this patient group to protect the brain and potentially improve outcomes. However, there is still a significant lack of knowledge regarding the advantages and disadvantages of this type of monitoring. The present study consists of four substudies with the overall aim of examining which factors are most influential for regulating commonly measured intracerebral parameters such as oxygenation, glucose, and lactate. Additionally, the influence of these of parameters on functional outcome and mortality will be explored. The individual studies are detailed below:
Detailed description
Substudy 1: This study investigates the relationship between glucose in blood and microdialysate (MD-glucose) in patients with severe traumatic brain injury (TBI) or aneurysmal subarachnoid haemorrhage (SAH). Substudy 2: The aim of this substudy is to examine the contribution of arterial oxygen tension (PaO2) to PbtO2 in patients with acute brain injury. We hypothesize that there is an association between the two parameters, that this relationship is altered in patients with concurrent intracranial hypoertension, and that a higher burden of cerebral hypoxia is associated with poor functional outcome and mortality. Substudy 3: The study aims to estimate the contribution of systemic lactate to microdialysate lactate, hypothesizing that: 1. PbtO2 and cerebral perfusion pressure are independent predictors of microdialysate lactate in patients with cerebral hypoxia (PbtO2\<20). 2. Systemic lactate is an independent predictor of microdialysis lactate in patients without cerebral hypoxia. Substudy 4: The study aims to establish whether there is a predictive threshold value of MD-glutamate for unfavourable functional outcome 6 months after ictus of brain injury. Additionally, we aim to explore whether there is a pattern of MD-glutamate that can predict episodes of neuroworsening.
Interventions
None listed
Sponsors
Rigshospitalet, Denmark
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients admitted to the Neurointensive care unit at Rigshospitalet, Copenhagen * Diagnosis of traumatic brain injury or subarachnoid haemorrhage * Multimodal neuromonitoring consisting intracranial pressure, brain tissue oxygen tension, and/or cerebral microdialysis
Exclusion criteria
* Age below 18 years * Acute brain injury due to causes other than the above mentioned
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The predictive value of glutamate measured by intracerebral microdialysis for 6-month functional outcome | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) | Modified Rankin Scale |
| Correlation between systemic glucose and microdialysis glucose | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) | Median goodness of fit (Pearsons R2) |
| Median goodness of fit (Pearsons R2) of the relationship between PaO2 (kPa) and PbtO2 (mmHg). | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) | Median goodness of fit (Pearsons R2) |
| Correlation between systemic lactate and microdialysis lactate when corrected for PbtO2 and cerebral perfusion pressure. | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) | Median goodness of fit (Pearsons R2) |
| The predictive value of glutamate measured by intracerebral microdialysis for episodes of neuroworsening | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) | Area under the curve |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of hospital stay | From admission until discharge (1-300 days) | Time in days |
| Mixed effects linear regression of the relationship betwen PaO2 (kPa) and PbtO2 (mmHg). | Six months after admission to the neuro-ICU | mmHg/kPa |
| Functional outcome at six months | Six months after admission to the neuro-ICU | Modified Rankin Scale |
| Mortality at six months | Six months after admission to the neuro-ICU | Percent |
| Length of stay in the ICU | From admission until discharge from the ICU (1-300 days) | Time in days |
Countries
Denmark
Outcome results
None listed