Noninvasive Monitoring of Cerebral Blood Flow Autoregulation in Patients With Traumatic Brain Injury (TBI) (REG01)
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Purpose
BACKGROUND: The brain is very sensitive to both excessive and insufficient flow of blood. Cerebral blood flow (CBF) is normally auto-regulated by the blood vessels in the brain, but this protective mechanism is often disturbed after a traumatic brain injury (TBI). Impairment or loss of the CBF autoregulation makes the brain vulnerable to oscillations of either arterial blood pressure (ABP) or intracranial pressure (ICP). The ideal management of TBI patients, therefore, involves continuous measurement and management of the cerebral perfusion pressure (CPP = ABP - ICP) but the measurement of CPP is currently possible only with specialized equipment and expertise that is not available in all institutions. The investigators have converted a no-longer used system that continuously monitors CBF autoregulation using rheoencephalography (REG) technology into a modern, small, battery-powered, low-cost monitor (aka BM-1) that acquires the REG signals using only noninvasive electrodes placed on the skin/scalp. REG data can then be used to calculate the optimal CPP to maintain in each individual patient. BM-1 is also capable of monitoring electroencephalography (EEG) and impedance plethysmography (IPG), which can, respectively, be used to measure brain electrical activity and changes in peripheral blood flow caused by blood pressure changes.
OBJECTIVES: The primary objectives are to (Obj. 1) demonstrate that REG acquired noninvasively is equal to the well-established but invasive method using intracranial pressure (ICP) monitoring, (Obj. 2) retrospectively test the idea that TBI patients have a less favorable outcome if their CPP were found less optimal using the REG data, and (Obj. 3) determine if noninvasive IPG or the PPG finger sensor monitoring (used to measure heart rate in doctor's offices) can replace the invasive monitoring of arterial blood pressure (ABP).
METHODOLOGY: This is an observational study with retrospective data analysis. 20 adult patients (18-65 yrs) with acute TBI, who meet the inclusion/exclusion criteria, will be enrolled on a first-come-first-enroll basis. The enrolled patients will have the REG, EEG and IPG signals monitored for the duration of ICU stay or 15 days, whichever is shorter. Standard neurological assessment will be made at the patient's discharge from the ICU and at 3 months after injury. The study is expected to end June 2013.
| Condition |
|---|
|
Traumatic Brain Injury (TBI) |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Pilot (Feasibility) Study of New Portable Monitor for Continuous Assessment of Cerebral Blood Flow (CBF) Autoregulation in Patients With Moderate to Severe Traumatic Brain Injury (TBI) |
- Extended Glasgow Outcome Scale (GOSE) [ Time Frame: 3 months post-injury ] [ Designated as safety issue: No ]
- Neurobehavioral Symptom Inventory (NSI) [ Time Frame: 3 months post-injury ] [ Designated as safety issue: No ]
- Rappaport Disability Rating Scale (DSR) [ Time Frame: At discharge from intensive care unit; on average, 10 days post-injury ] [ Designated as safety issue: No ]Note regarding the time frame: based on the USC patient database for 2010 and 2011, patients may be discharged from the ICU anywhere between 4 days to 4 weeks; 50% of them will spend 10 +/- 3 days in the ICU.
- Katz Index of Independence in Activities of Daily Living (KI-ADL) [ Time Frame: 3 months post-injury ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 20 |
| Study Start Date: | August 2012 |
| Estimated Study Completion Date: | June 2013 |
| Estimated Primary Completion Date: | June 2013 (Final data collection date for primary outcome measure) |
Eligibility| Ages Eligible for Study: | 18 Years to 65 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
Adult patients (18 - 65 years) hospitalized in the surgical intensive care unit (ICU) because of moderate to severe traumatic brain injury
Inclusion Criteria:
- Clinical diagnosis of acute moderate or severe TBI
- Hospitalization within 12 hours from the injury
- Intraarterial catheterization and intracranial pressure (ICP) monitoring instantiated within 72 hours from the injury
Exclusion Criteria:
- Earlier head injuries, stroke, space-occupying intracranial lesions, meningitis, or cerebral vasculopathies
- Concomitant severe injuries of the chest, abdomen, pelvis, extremities or spine
- Concurrent terminal illness with a life expectancy of less than 6 months
- Unlikely to survive the next 48 hours after enrollment
- Implanted cardiac pacemaker, cardiac converter/defibrillator, or other electrical stimulator
- Pregnancy
- Patient is a prisoner or on a probation
Contacts and Locations| Contact: Kenji Inaba, MD | 323 - 409 - 8597 | kenji.inaba@med.usc.edu |
| United States, California | |
| LA County + USC Medical Center | Not yet recruiting |
| Los Angeles, California, United States, 90033 | |
| Contact: Kenji Inaba, MD 323-409-8050 kenji.inaba@med.usc.edu | |
| Principal Investigator: Kenji Inaba, MD | |
| Sub-Investigator: Lydia Lam, MD | |
| Principal Investigator: | Djordje Popovic, MD | Advanced Brain Monitoring, Inc. |
More Information
Publications:
| Responsible Party: | Advanced Brain Monitoring, Inc. |
| ClinicalTrials.gov Identifier: | NCT01605838 History of Changes |
| Other Study ID Numbers: | ABM-TBI-0001, W81XWH - 10 - C - 0061 |
| Study First Received: | May 22, 2012 |
| Last Updated: | May 23, 2012 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Advanced Brain Monitoring, Inc.:
|
TBI |
Additional relevant MeSH terms:
|
Brain Injuries Brain Diseases Central Nervous System Diseases Nervous System Diseases |
Craniocerebral Trauma Trauma, Nervous System Wounds and Injuries |
ClinicalTrials.gov processed this record on May 23, 2013