Brain Oxygen Optimization in Severe Traumatic Brain Injury - Phase 3 (BOOST-3)

严重创伤性脑损伤中的脑氧优化 - 第 3 阶段 (BOOST-3)

基本信息

批准号：
10265997
负责人：
WILLIAM G BARSAN
金额：
$ 624.73万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-01 至 2025-11-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10265997
关键词：
Admission activity Adopted Adverse event American Area Behavior assessment Brain Brain Hypoxia Brain Injuries Caring Cause of Death Clinical Clinical Research Clinical Trials Clinical Trials Network Cognitive Coma Conscious Control Groups Data Devices Emergency Care Enrollment Family Glasgow Coma Scale Glasgow Outcome Scale Head Hospitalization Hospitals Hour Hypoxia Informed Consent Injury Intensive Care Units Intervention Intracranial Hypertension Intracranial Pressure Left Life Measures Medical Monitor Morbidity - disease rate Neurologic Neurological outcome Outcome Outcome Measure Oxygen Partial Pressure Participant Patient Monitoring Patients Phase Post-Head Injury Coma Procedures Protocols documentation Randomized Randomized Clinical Trials Randomized Controlled Trials Recovery Safety Severities Societies Supportive care Technology Time Traumatic Brain Injury Treatment Protocols United States United States Food and Drug Administration base behavioral outcome brain tissue clinical center clinical efficacy clinical research site clinically relevant cognitive testing cost estimate design disability effective intervention experience functional outcomes improved innovation mortality nerve injury prevent primary outcome psychosocial safety and feasibility secondary outcome severe injury trend

项目摘要

Traumatic brain injury (TBI) is a major cause of death and disability. Of the 3.5 million Americans who sustain a TBI every year, approximately 27,000 experience prolonged traumatic coma, the most severe form of TBI. Less than 20% of these patients make a good recovery, and most are left with life-long disabilities. ICU management of severe TBI focuses on monitoring intracranial pressure (ICP), but data from recently conducted randomized clinical trials indicate that this approach is overly simplistic. Another approach is to monitor the partial pressure of oxygen in brain tissue (PbtO2) and apply interventions to prevent brain tissue hypoxia and improve neurologic outcome. Clinical studies demonstrate that brain tissue hypoxia is common, that there is a strong relationship between low PbtO2 and poor outcome, and that timely interventions can reverse brain tissue hypoxia. The first randomized controlled trial of PbtO2 monitoring in severe TBI, titled “Brain Oxygen Optimization in Severe TBI (BOOST) Phase 2,” enrolled 122 subjects and demonstrated that the mean hypoxia burden was reduced by 74% by the treatment protocol informed by PbtO2 monitoring (p < 0.0001), and there were no significant safety issues. There was a trend towards improved functional outcome, supporting the pre-determined non-futility hypothesis. We are proposing the BOOST-3 trial to determine if there is evidence of clinical efficacy of a treatment protocol based on PbtO2 monitoring compared to treatment based on ICP monitoring alone. BOOST-3 will enroll patients with severe TBI requiring placement of ICP monitors within 6 hours of presentation to a participating hospital. Patients will be randomized to a treatment protocol based on ICP monitoring alone or the combination of ICP and PbtO2 monitoring. The Glasgow Outcome Scale-Extended (GOS-E) measured at 6 months post injury will be the primary outcome. Other secondary outcomes include functional, cognitive and behavioral assessments at 6 months, safety, survival to discharge, shortened time to follow commands, and reduction of total brain hypoxia exposure.

创伤性脑损伤（TBI）是维持350万美国人的死亡和残疾原因。每年TBI，大约27,000次经历了长时间的创伤性昏迷，这是最严重的TBI。不到20％的患者恢复了良好的恢复，并且剩下的是终身的ICU 严重TBI的管理重点是监测颅内压（ICP），但从最近开始的数据进行的随机临床试验表明，这种方法过于简单。监测脑组织（PBTO2）中氧气的部分压力，并采用干预措施以防止脑组织缺氧和改善神经学结局。低PBTO2与不良结果之间存在太阳关系，并且及时的干预措施可以反向脑组织缺氧。 “在严重的TBI（Boost）第2阶段中优化脑氧优化”，招募了122名受试者，并证明了通过PBTO2监控，通过治疗方案信息减轻了74％的低氧负担（P <<<< 0.0001），安多（Ando）没有重大的安全问题。支持确定的非实现假设。有证据表明，与信任相比仅根据ICP监测向参与医院介绍后6小时内监视。基于ICP监视的协议或ICP和PBTO2监视的组合受伤后6个月测得的结果量表扩展（GOS-E）将是主要结果。次要结果包括6个月的功能，认知和行为评估，生存到放电，缩短遵循命令的时间以及减少总脑缺氧暴露。