Neurogenic Myocardial and Lung Injury in SAH Patients
- Conditions
- Lung InjuryMyocardial InjurySubarachnoid Hemorrhage
- Interventions
- Diagnostic Test: hs-TnT (high-sensitive cardiac troponin T) plasma concentrationDiagnostic Test: CK-MB (creatine kinase myocardial band) plasma concentrationDiagnostic Test: CPK (creatine phosphokinase) plasma concentrationDiagnostic Test: NT-proBNP (N-terminal prohormone of brain natriuretic peptide) plasma concentrationDiagnostic Test: Metanephrine concentration in urine
- Registration Number
- NCT05408988
- Lead Sponsor
- Medical University of Silesia
- Brief Summary
Up to this day, little is known whether the extent of brain damage in patients with SAH correlates with the degree neurogenic myocardial injury and neurogenic lung injury.
This is a prospective observational study designed to asses relationship between catecholamine surge and development of myocardial and lung injury in subarachnoid haemorrhage patients.
- Detailed Description
Multiple forms of brain damage, primarily, subarachnoid haemorrhage (SAH) are frequently accompanied by neurogenic myocardial injury with changes in the electrocardiogram, accompanied by the release of markers of myocardial injury. This form of cardiac dysfunction is thought to be mediated by cellular toxicity associated with catecholamine release. Central nervous system damage in the course of intracranial haemorrhage may, in a similar pathogenic pathway, lead to neurogenic lung injury. Up to this day, little is known whether the extent of brain damage in patients with SAH correlates with the degree of neurogenic myocardial injury. Moreover, it remains unknown what is the full clinical picture and duration of this type of myocardial injury and how often it co-occurs with neurogenic lung injury. Such analysis is a fundamental and most important step in optimising the treatment of these patients.
Methods: In this prospective observational study the authors aim to recruit 30 patients with subarachnoid haemorrhage, requiring hospitalization in the Intensive Care Unit. The patients will be monitored for elevation in cardiac damage markers (hs-TnT, CPK, CK-MB, NT-proBNP) and worsening of respiratory conditions, defined by need for more invasive ventilation parameters, and subsequent changes in arterial blood gas. The above mentioned parameters will be assessed every 12 hours. Additionally, the patients will be screened for an elevation in catecholamine metabolite (metanephrine) concentration in 12-hour urine collection.
Hypothesis to be tested: Myocardial and lung injury in SAH patients is timely-associated with an increase in metanephrine concentration in urine.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 30
- patients with subarachnoid haemorrhage (both aneurysmal and non-aneurysmal) with acute consciousness disturbances (Glasgow Coma Scale < 8 pts) requiring intubation and mechanical ventilation, hospitalized in the ICU for over 24 hours
- severe prior pulmonary diseases
- severe prior cardiac diseases
- death in the first 72 hours of ICU stay
- need for any extracorporeal life-saving techniques
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Patients with subarachnoid haemorrhage CPK (creatine phosphokinase) plasma concentration Patients aged 18 or older hospitalized in the Intensive Care Unit with Subarachnoid Haemorrhage. Patients with subarachnoid haemorrhage hs-TnT (high-sensitive cardiac troponin T) plasma concentration Patients aged 18 or older hospitalized in the Intensive Care Unit with Subarachnoid Haemorrhage. Patients with subarachnoid haemorrhage CK-MB (creatine kinase myocardial band) plasma concentration Patients aged 18 or older hospitalized in the Intensive Care Unit with Subarachnoid Haemorrhage. Patients with subarachnoid haemorrhage Metanephrine concentration in urine Patients aged 18 or older hospitalized in the Intensive Care Unit with Subarachnoid Haemorrhage. Patients with subarachnoid haemorrhage NT-proBNP (N-terminal prohormone of brain natriuretic peptide) plasma concentration Patients aged 18 or older hospitalized in the Intensive Care Unit with Subarachnoid Haemorrhage.
- Primary Outcome Measures
Name Time Method Number of Patients with elevation in creatine kinase MB levels 7 days Creatine kinase MB treated as myocardial injury biomarker
In-hospital death (number of patients) 7 days Death of the patient during the first 7 days of hospitalization.
Number of Patients with elevation in NT-proBNP levels 7 days NT-proBNP treated as myocardial injury biomarker
Number of Patients with elevation in creatine kinase levels 7 days Creatine kinase treated as myocardial injury biomarker
Number of Patients with elevation in hs-TnT levels 7 days hs-TnT treated as myocardial injury biomarker
Number of Patients with a decrease in Horowitz index 7 days The decrease in Horowitz index treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
Number of Patients with need of increased PEEP values 7 days Need of increased PEEP values treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
Number of Patients with need for the use of neuro-muscular blocking agents 7 days Need for the use of neuro-muscular blocking agents treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
Number of Patients with need of increased FiO2 7 days Need of increased FiO2 treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
University Clinical Center prof. K. Gibiński of the Medical University of Silesia in Katowice
🇵🇱Katowice, Województwo Śląskie, Poland