Impact of Cardiac Blood Flow on Cerebral Blood Flow in Patients With Severe Traumatic Brain Injury

Phase 2UnknownNCT02019810

University Hospital, Grenoble20 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Severe Traumatic Brain Injury With High Cerebral Pressure

Interventions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

Mean blood flow velocity

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

Time frame: After one hour of treatment

Secondary Outcomes

Evolution of brain oxygenation under treatment

Comparison of the brain tissue oxygenation curves (PbrO2) under treatment with and without dobutamine

Time frame: During one hour of treatment

Dobutamine doses

Dobutamine doses required to reach the same cerebral perfusion pressure than noradrenaline alone

Time frame: After one hour of treatment

Resistivity index on renal doppler

Measure of resistivity index on renal doppler after one hour of treatment with and without dobutamine

Time frame: After one hour of treatment

Pulsatility index on renal doppler

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)

Time frame: After one hour of treatment

Cardiac output modifications

Comparison of cardiac blood flow modifications under treatment for one hour with and without dobutamine

Time frame: During one hour of treatment

Impact of Cardiac Blood Flow on Cerebral Blood Flow in Patients With Severe Traumatic Brain Injury

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts