Intensive Monitoring of Brain Injured Patients
Condition: Traumatic Brain Injury
MeSH terms: Brain Injuries; Brain Injuries, Traumatic
Study type: Interventional

Summary: 
      Analysis of cerebral blood flow (CBF) and oxygenation using complementary focal and global
      monitoring techniques will permit the delivery of more informed individualised and 'targeted'
      therapy on the patient with severe head injury, reduce episodes of secondary brain injury and
      therefore improve outcomes.

      Aims

        -  To develop a deeper understanding of Cerebral Blood Flow and auto-regulation for TBI
           patients based on the results of data collected in patients post TBI.

        -  To establish the basis for further multi modality clinical trials in severely brain
           injured patients in the future.

        -  To improve understanding of the various secondary processes that continue to cause
           neuronal damage after the initial injury, and therefore affect patient outcome.

        -  To proceed to the second phase of the study, with the introduction of algorithms for
           treatment.
    

Detailed description: 
      The ultimate aim of this study is to improve the outcome of patients with severe head injury
      by reducing secondary brain injury. It is hoped that this will be achieved by improving
      clinical management through the adoption of Best Practice monitoring measures. The severe
      head injury population is a disparate clinical group with varying CBF derangements, and
      complex inter-relationships between the various physiological parameters which are being
      measured. Common protocol based therapy for all head-injured patients is simplistic and
      cannot fully accommodate the variations between patients or within an individual brain. We
      believe that to improve outcome, these individual derangements and patterns have to be
      identified and the correct therapeutic combinations fashioned on an individual basis. This is
      not the current practice in Australia. The first phase of this project was completed in March
      2004 following the recruitment of ten patients. These patients were intensively monitored and
      based on the data collected and current international literature we devised a new treatment
      protocol for patients with severe head injuries. We anticipate that implementation of this
      new protocol will improve outcome.

      We aim to:

        -  further clarify what the above mentioned relationships between monitoring parameters
           are, what are the most critical ones and the effect that optimisation of these
           parameters has on brain swelling, ICP control and on clinical outcome.

        -  introduce treatment algorithms/protocols to alter the haemodynamic parameters, CPP and
           ICP and to optimise PbrO2.

        -  study the patients having decompressive craniectomy using these techniques where
           possible

        -  compare patient outcomes to previous outcome studies at the Alfred Hospital.
    

Intervention name(s): Brain oxygenation and microdialysis catheters
Intervention type(s): Device
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment