Observational Study of Cerebral Tissue Oxygen Saturation During Blood Transfusion in Severe Traumatic Brain Injured Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 20
- 试验地点
- 1
- 主要终点
- Applicability of a 4 wavelength near-infrared spectroscopy (NIRS) to monitor the CHANGE in absolute cerebral oximetry over time
研究概览
简要总结
This proposal aims to provide some objective, non-invasively achieved, physiologically relevant data in order to provide some rational basis for decision-making for transfusion in sTBI. Specifically this proposal is an observational study of transfusion and brain tissue saturation in sTBI patients. The results will illustrate to what degree brain tissue oxygenation is critically dependent on the degree of anemia in sTBI and help in the decision of whether transfusion might be helpful.
详细描述
While there are studies that have invasively monitored cerebral saturation and brain tissue oxygen in severe traumatic brain injury (sTBI) patients, there are none using non-invasive cerebral saturation monitoring in TBI patients undergoing packed red blood cell (pRBC) transfusion. To date, all published studies have involved invasive monitoring with their concomitant potential side effects. Insertion of invasive probes and monitors has several risks and side effects including bleeding, local trauma and brain damage, and infection. Furthermore, they have limited utility as information is restricted to the region of the brain surrounding the probe, as opposed to a more global picture. We therefore propose an observational study using non-invasive near infrared spectroscopy to monitor brain tissue oxygen during the transfusion of packed red blood cells.
Primary Hypothesis:
• Improved oxygen delivery causes improved brain tissue oxygen saturation.
Testable Hypothesis:
• The transfusion of packed red blood cells resulting in a change in the hemoglobin in the 70- 100g/L range, will be associated with an increase in cerebral tissue oxygen saturation measured by near infrared spectroscopy in severe traumatic brain injured patients.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age > 18 years old
- •Patient with clinical diagnosis of severe TBI and GCS <9
- •Patient requiring PRBC transfusion with a qualifying Hb< 10/dL
排除标准
- •Inability to place the NIRS probes on the patients (facial fractures, facial laceration, etc.).
- •Deficient signal of SctO2 impeding its proper valuation
- •Active coronary ischemia as judged by dynamic ischemic ECG changes and/ or positive troponin levels not due to myocardial contusion.
- •Active hemorrhage: Example
- •Bleeding into the chest, abdomen or retro-peritoneum likely to require surgery +/- embolization
- •Pelvic fracture likely to require surgery +/- embolization
- •More than two long bone fractures requiring operative fixation
- •Clinical diagnosis of drug or alcohol intoxication as predominant cause of coma
- •Systolic BP <90mmHg
- •Heart rate > 120bpm
- •GCS=3 + un-reactive pupils
结局指标
主要结局
Applicability of a 4 wavelength near-infrared spectroscopy (NIRS) to monitor the CHANGE in absolute cerebral oximetry over time
时间窗: Compare the change from the start of the transfusion until 10 hours later.
After the physician in charge for the patient decides a PRBC transfusion is needed, the FORE-SIGHT probe will be placed on the patient's forehead. A single PRBC unit will be transfused over 30 - 60 minutes. Recording will be started 60 minutes before the transfusion and continued for up to 10 hours after the PRBC unit.
次要结局
- The impact of PRBC transfusion on absolute cerebral oximetry compared to peripheral values over time.(Level of hemoglobin and hematocrit on admission, before transfusion and hourly after the transfusion for up to 5 hours)