The purpose of this innovative adaptive phase II trial design is to determine the optimal combination of hyperbaric oxygen treatment parameters that is most likely to demonstrate improvement in the outcome of severe TBI patients in a subsequent phase III trial.
Preclinical and clinical investigations strongly indicate that hyperbaric oxygen (HBO2) is physiologically active in improving the destructive processes in severe Traumatic Brain Injury (TBI). However, prior to a definitive efficacy study, important information is required regarding optimizing the HBO2 treatment paradigm instituted in terms of pressure and whether NBH enhances the clinical effectiveness of the HBO2 treatment. Preclinical investigators working with TBI models have used pressures varying from 1.5 to 3.0 atmospheres absolute (ATA). Clinical investigators have used pressure varying from 1.5 to 2.5 ATA. However, the lungs in severe TBI patients have frequently been compromised by direct lung injury and/or acquired ventilator pneumonia and are susceptible to oxygen (O2) toxicity. Working within these constraints, it is essential to determine the most effective HBO2 treatment parameters without producing O2 toxicity and clinical complications. This proposed clinical trial is designed to answer these questions and to provide important data to plan a definitive efficacy trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
200
HBO at 1.5 ATA for 60 minutes without NBH. Treatment will be twice a day for five days or until patient is following commands or brain dead
HBO at 2.0 ATA for 60 minutes without NBH. Treatment will be twice a day for five days or until patient is following commands or brain dead
HBO at 2.5 ATA for 60 minutes without NBH. Treatment will be twice a day for five days or until patient is following commands or brain dead
UCSD Medical Center - Hillcrest Hospital
San Diego, California, United States
RECRUITINGSt. Mary's Medical Center
West Palm Beach, Florida, United States
RECRUITINGGlasgow Outcome Scale Extended (GOS-E)
Time frame: Assessment at 6 months
Duration of ICP elevation
The duration of ICP elevation will be measured using the area under the curve methodology
Time frame: First 5 days
Therapeutic intensity level scores for controlling intracranial pressure (ICP)
This tracks the level of therapies used to control ICP during the first 5 days
Time frame: First 5 days
Brain tissue partial pressure of oxygen
This outcome will be measured only in patients with LICOX monitoring
Time frame: First 5 days
Serious adverse events
Events resulting in death, a life-threatening adverse event, or prolongation of existing hospitalization, a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions
Time frame: 180 days
Peak brain tissue oxygen (P02) during HBO treatments
To examine the association between peak brain tissue PO2 during hyperbaric treatment and favorable outcome at 6-months (measured by the GOS-E).
Time frame: First 5 days
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HBO at 1.5 ATA for 60 minutes followed by NBH for 3 hours. Treatment will be twice a day for five days or until patient is following commands or brain dead
HBO at 2.0 ATA for 60 minutes followed by NBH for 3 hours. Treatment will be twice a day for five days or until patient is following commands or brain dead
HBO at 2.5 ATA for 60 minutes followed by NBH for 3 hours. Treatment will be twice a day for five days or until patient is following commands or brain dead
100% fraction of inspired oxygen (FiO2) for 4.5 hours twice a day for five days or until patient following commands or brain dead
Will be treated with usual and customary care for severe traumatic brain injury
University of Iowa Hospitals and Clinics
Iowa City, Iowa, United States
RECRUITINGUniversity of Kentucky Hospital
Lexington, Kentucky, United States
RECRUITINGUniversity of Maryland
Baltimore, Maryland, United States
RECRUITINGDetroit Receiving Hospital
Detroit, Michigan, United States
RECRUITINGHennepin County Hospital
Minneapolis, Minnesota, United States
RECRUITINGUniversity of Nebraska Medical Center
Omaha, Nebraska, United States
COMPLETEDDuke University Hospital
Durham, North Carolina, United States
RECRUITINGThe Ohio State University Wexner Medical Center
Columbus, Ohio, United States
COMPLETED...and 1 more locations