Cerebral Hemodynamic Effects of Hypertonic Solutions in Severely Head-Injured Patients

NCT ID: NCT00125229

Last Updated: 2012-06-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Total Enrollment

10 participants

Study Classification

OBSERVATIONAL

Study Start Date

2005-08-31

Study Completion Date

2006-06-30

Brief Summary

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This is a clinical study comparing the physiologic effects of two hypertonic solutions (mannitol, hypertonic saline) with a particular emphasis on changes in cerebral blood flow in patients with intracranial hypertension following serious traumatic brain injury (TBI).

Detailed Description

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This is a study comparing effects of two hypertonic solutions (mannitol, 6.4% hypertonic saline) on intracranial hypertension, cerebral blood flow, serum/urine osmolarity in patients with increased intracranial pressure caused by traumatic brain injury. The study is conducted during first 72 hours after the injury without any interference with standard medical treatment as performed at the institution. When the hypertonic solution is indicated by caregiver, the study team is informed and performs a set of physiologic bedside measurements including evaluation of cerebral blood flow and changes in plasma and urine osmolarity. The study is noninvasive and the study protocol does not hamper, in any way, standard care of treatment for these patients.

Conditions

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Traumatic Brain Injury Intracranial Hypertension

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Interventions

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Mannitol

Intervention Type DRUG

Hypertonic Saline

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients with severe TBI (motor Glasgow Coma Scale \[GCS\] score \< 5)
* Age \> 18 years
* Health care provider indicated a treatment of intracranial hypertension using hyperosmotic agent

Exclusion Criteria

* Brain dead (GCS 3, fixed dilated pupils)
* Life-threatening systemic injuries (AIS \> 4 in an organ system other than brain); AIS = Abbreviated Injury Score
* Hypotension not responsive to fluid resuscitation and low doses of dopamine
* Clinical or imaging sign/suspicion for internal carotid artery injury
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The University of Texas Health Science Center at San Antonio

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Roman Hlatky, M.D.

Role: PRINCIPAL_INVESTIGATOR

Center for Neurosurgical Sciences - UTHSC San Antonio

Locations

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Center for Neurosurgery Sciences - UTHSCSA - Surgical Intensive Care Unit (SICU)

San Antonio, Texas, United States

Site Status

Countries

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United States

References

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Miller JD, Becker DP, Ward JD, Sullivan HG, Adams WE, Rosner MJ. Significance of intracranial hypertension in severe head injury. J Neurosurg. 1977 Oct;47(4):503-16. doi: 10.3171/jns.1977.47.4.0503.

Reference Type BACKGROUND
PMID: 903804 (View on PubMed)

Doyle JA, Davis DP, Hoyt DB. The use of hypertonic saline in the treatment of traumatic brain injury. J Trauma. 2001 Feb;50(2):367-83. doi: 10.1097/00005373-200102000-00030. No abstract available.

Reference Type BACKGROUND
PMID: 11242309 (View on PubMed)

Wade CE, Kramer GC, Grady JJ, Fabian TC, Younes RN. Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies. Surgery. 1997 Sep;122(3):609-16. doi: 10.1016/s0039-6060(97)90135-5.

Reference Type BACKGROUND
PMID: 9308620 (View on PubMed)

Valadka AB, Robertson CS. Should we be using hypertonic saline to treat intracranial hypertension? Crit Care Med. 2000 Apr;28(4):1245-6. doi: 10.1097/00003246-200004000-00069. No abstract available.

Reference Type BACKGROUND
PMID: 10809326 (View on PubMed)

Berger S, Schurer L, Hartl R, Deisbock T, Dautermann C, Murr R, Messmer K, Baethmann A. 7.2% NaCl/10% dextran 60 versus 20% mannitol for treatment of intracranial hypertension. Acta Neurochir Suppl (Wien). 1994;60:494-8. doi: 10.1007/978-3-7091-9334-1_135.

Reference Type BACKGROUND
PMID: 7526628 (View on PubMed)

Worthley LI, Cooper DJ, Jones N. Treatment of resistant intracranial hypertension with hypertonic saline. Report of two cases. J Neurosurg. 1988 Mar;68(3):478-81. doi: 10.3171/jns.1988.68.3.0478.

Reference Type BACKGROUND
PMID: 3343621 (View on PubMed)

Qureshi AI, Suarez JI, Bhardwaj A, Mirski M, Schnitzer MS, Hanley DF, Ulatowski JA. Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain. Crit Care Med. 1998 Mar;26(3):440-6. doi: 10.1097/00003246-199803000-00011.

Reference Type BACKGROUND
PMID: 9504569 (View on PubMed)

Qureshi AI, Wilson DA, Traystman RJ. Treatment of elevated intracranial pressure in experimental intracerebral hemorrhage: comparison between mannitol and hypertonic saline. Neurosurgery. 1999 May;44(5):1055-63; discussion 1063-4. doi: 10.1097/00006123-199905000-00064.

Reference Type BACKGROUND
PMID: 10232539 (View on PubMed)

Vialet R, Albanese J, Thomachot L, Antonini F, Bourgouin A, Alliez B, Martin C. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med. 2003 Jun;31(6):1683-7. doi: 10.1097/01.CCM.0000063268.91710.DF.

Reference Type BACKGROUND
PMID: 12794404 (View on PubMed)

Battison C, Andrews PJ, Graham C, Petty T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med. 2005 Jan;33(1):196-202; discussion 257-8. doi: 10.1097/01.ccm.0000150269.65485.a6.

Reference Type BACKGROUND
PMID: 15644669 (View on PubMed)

Cruz J, Minoja G, Okuchi K, Facco E. Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial. J Neurosurg. 2004 Mar;100(3):376-83. doi: 10.3171/jns.2004.100.3.0376.

Reference Type BACKGROUND
PMID: 15035271 (View on PubMed)

Tseng MY, Al-Rawi PG, Pickard JD, Rasulo FA, Kirkpatrick PJ. Effect of hypertonic saline on cerebral blood flow in poor-grade patients with subarachnoid hemorrhage. Stroke. 2003 Jun;34(6):1389-96. doi: 10.1161/01.STR.0000071526.45277.44. Epub 2003 May 1.

Reference Type BACKGROUND
PMID: 12730557 (View on PubMed)

Other Identifiers

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045-1503-266

Identifier Type: -

Identifier Source: org_study_id

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