Multimodal Neuromonitoring at the ICU

NCT ID: NCT07285733

Last Updated: 2025-12-16

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 50 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2010-02-28
• Study Completion Date: 2014-04-30

Brief Summary

Neurocritical care has become a distinct discipline within the field of intensive care medicine with a major focus on the treatment of patients with acute damage to the most complex organ of the human body, the brain. The main indications for acute neurocritical care concern aneurysmal Subarachnoid Hemorrhage (SAH) and severe Traumatic Brain Injury (TBI). These disease entities form a major health and socioeconomic problem as they afflict young patients and the rate of death and disability is high. The pathology and treatment of these patients is heterogeneous and complex. Despite advances in basic neuroscience which have increased our understanding of processes in the injured brain, approaches to management are largely unfocused and adhere to the concept of a 'one pill for everybody' approach. Novel monitoring technology and new neuroimaging techniques now offer opportunities for advancing the care for these patients to a more individualized targeted management.

In the period of 2010-2014, a prospective trial was conducted in the Antwerp University Hospital, including 50 patients with either SAH or TBI, who underwent extensive monitoring, known as "Individualized targeted management in neurocritical care".

In NEMO-RETRO, the investigators want to answer proposed and new research questions in retrospective analyses, using current insights and methodologies.

Objectives:

1. Cerebral blood flow monitoring

1. Investigate the effect of changes in therapy (nature/intensity) on Cerebral Blood Flow (CBF) measured by thermal diffusion flowmetry and Transcranial Doppler (TCD)

2. Determine the added value of continuous CBF monitoring for the early detection of vasospasm and ischaemia

2. Brain tissue oxygen tension

1. Investigate the effect of changes in therapy (nature/intensity) on cerebral oxygenation as measured by Brain Tissue Oxygen Tension (PTiO2)

2. Investigate the relation between PTiO2 and hemodynamic parameters such as CBF, CPP, and ICP

3. Systemic effects of brain specific therapy

1. Investigate the effects of brain-targeted therapy on cardiac output and lung function

2. Determine the relation of CBF to cardiac output, in particular following triple H therapy

4. Neuroimaging

1. Accurately document structural brain damage following TBI and SAH

2. Document vasospasm and quantify flow and perfusion

3. Quantify the degree of secondary ischaemic damage to the brain

4. Differentiate swelling from edema

5. Train and validate models to interpret neuroimaging

5. Outcome

1. Assess global functional outcome at 6 months post-injury

2. Assess health-related quality of life at 6 months after injury

6. Integrated approach analysis

1. Describe the effects of brain-targeted therapy on cerebral and systemic parameters

2. Define the added value of extended multimodality monitoring and advanced neuroimaging to detect vasospasm and secondary ischaemic damage, defined by markers of neuronal injury and cell death

3. Develop recommendations for individualized targeted management

Conditions

Subarachnoid Aneurysm Hemorrhage; Traumatic Brain Injury

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Study Groups

Acute brain injury

Patients with acute brain injury (TBI or aSAH)

Multimodal neuromonitoring

Intervention Type: DEVICE

Imaging: CT, MRI, XA Neuromonitoring: Brain Tissue Monitoring Probe, Hemedex, External ventricular drain, Cortical microdialysis catheter Other monitoring: Arterial catheter, Jugular bulb catheter, routine vital parameters

Interventions

Multimodal neuromonitoring

Imaging: CT, MRI, XA Neuromonitoring: Brain Tissue Monitoring Probe, Hemedex, External ventricular drain, Cortical microdialysis catheter Other monitoring: Arterial catheter, Jugular bulb catheter, routine vital parameters

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• male or female patients aged 18 to 70 years, inclusive
• sustained head injury within the previous 24 hours
• TBI diagnosed by history, clinical examination with a GCS of 12 or less
• evidence of TBI confirmed by abnormalities on CT scan
• clinical indication to monitor ICP
• informed consent is obtained from the patient or from a legally acceptable representative

• male or female patients aged 18 to 70 years, inclusive
• ruptured aneurysm, demonstrated by CT angiography or DSA
• onset of SAH clinical symptoms within the preceding 72 hours
• World Federation of Neurosurgery (WFNS) grade III-IV and grade V patients, who improve within 24 hours after ventriculostomy
• indication for ICP monitoring or CSF drainage
• informed consent is obtained from the patient or a legally acceptable representative

Exclusion Criteria

• life expectancy of less than 24 hours as determined by the investigator
• any spinal cord injury
• coma suspected to be primarily due to causes other than head injury, such as drug or alcohol overdose
• clinically significant or active gastro-intestinal, renal, hepatic, endocrine or CNS disease or chronic condition (e.g.psychiatric disorder) that can be ascertained at the time of admission and could affect functional outcome
• respiratory/hemodynamic instability, refractory to treatment and precluding transport for neuroimaging studies
• pregnancy
• informed consent is obtained from a legally acceptable representative, prior to any study related activity

For aneurysmal subarachnoid hemorrhage:

• non-aneurysmal subarachnoid hemorrhage
• admission in a clinical state with extremely poor prognosis (e.g. wide, non-reactive pupils for more than 1 hour)
• significant coagulation disturbances (thrombocytes < 80 per mL, partial thromboplastin time > 45 sec, INR > 1.5)
• cytostatic therapy in patients with malignant disease
• pregnancy
• respiratory and/or hemodynamic instability precluding

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

CENTER TBI

UNKNOWN

Sponsor Role: collaborator

Research Foundation - Flanders (Fonds Wetenschappelijk Onderzoek)

OTHER

Sponsor Role: collaborator

University Hospital, Antwerp

OTHER

Sponsor Role: lead

Responsible Party

Philppe Jorens

MD, PhD

Responsibility Role: PRINCIPAL_INVESTIGATOR

Other Identifiers

EDGE 4584

Identifier Type: -

Identifier Source: org_study_id