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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT00886054
Other study ID # 200901010R
Secondary ID 97WFA0102463
Status Active, not recruiting
Phase N/A
First received April 20, 2009
Last updated December 20, 2009
Start date December 2009
Est. completion date December 2010

Study information

Verified date December 2009
Source National Taiwan University Hospital
Contact n/a
Is FDA regulated No
Health authority Taiwan: Department of Health
Study type Observational

Clinical Trial Summary

The purpose of this study is to use transcranial Doppler (TCD) to predict intracranial pressure (ICP) and clinical outcome of neurocritical patients.


Description:

Transcranial Doppler (TCD) and Transcranial color-coded duplex sonography (TCCS) play an important part in neurocritical monitoring systems. Currently there are studies using flow velocities and pulsatility index (PI) to predict intracranial pressure (ICP) and clinical outcome. But the use of B-mode in such prediction is not yet investigated. The purposes of this study are to establish the correlation among clinical data, CT findings and information collected by TCCS, and to predict ICP and neurological outcome using such information. The focus would be on 3rd ventricle size, midline shift and anteroposterior-transverse ration of midbrain (midbrain index) obtained by B-mode of TCCS. This study is a prospective clinical study targeting on 30 neurocritical patients admitted to intensive care units in one year. The timing of performance of TCCS will be (1) within 6 hours after admission, (2) within 6 hours after each CT examination, and (3) when ICP is higher than 20 mmHg for more than 5 minutes. Glasgow coma scale (GCS), heart rate, blood pressure (systolic, diastolic, and mean), body temperature, central venous pressure (CVP), brain temperature, ICP, cerebral perfusion pressure (CPP), mean velocity (MV) of bilateral middle cerebral arteries (MCAs), PI, midline shift, 3rd ventricular dimension, anteroposterior to transverse ratio of midbrain (midbrain index, MI) are recorded. The latter three parameters are also obtained from CT scans, and compared with those obtained from TCCS. Outcome is evaluated with extended Glasgow outcome scale (GOSE), and analyzed with previous records. This study is going to prove that TCCS is a safe, convenient, real-time and cheap tool in clinical care for neurocritical patients. It also provides prediction of ICP and clinical outcome.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 30
Est. completion date December 2010
Est. primary completion date December 2010
Accepts healthy volunteers No
Gender Both
Age group 16 Years to 80 Years
Eligibility Inclusion Criteria:

- Aged 16 to 80 years

- Neurocritical patient (head injury, hemorrhagic or ischemic stroke, subarachnoid hemorrhage, etc.) who was admitted to intensive care unit and had undergone intracranial pressure monitoring

Exclusion Criteria:

- associated with multiple organ impairment or failure

- single organ failure prior to neurocritical condition, such as cardiac, hepatic, or renal failure

- associated with severe infection or sepsis

Study Design

Observational Model: Cohort, Time Perspective: Prospective


Locations

Country Name City State
Taiwan Department of Traumatology, National Taiwain University Hospital Taipei

Sponsors (2)

Lead Sponsor Collaborator
National Taiwan University Hospital National Science Council, Taiwan

Country where clinical trial is conducted

Taiwan, 

References & Publications (22)

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Baumgartner RW. Transcranial color-coded duplex sonography. J Neurol. 1999 Aug;246(8):637-47. Review. — View Citation

Baussart B, Cheisson G, Compain M, Leblanc PE, Tadie M, Benhamou D, Duranteau J. Multimodal cerebral monitoring and decompressive surgery for the treatment of severe bacterial meningitis with increased intracranial pressure. Acta Anaesthesiol Scand. 2006 Jul;50(6):762-5. — View Citation

Berland LL, Bryan CR, Sekar BC, Moss CN. Sonographic examination of the adult brain. J Clin Ultrasound. 1988 Jun;16(5):337-45. — View Citation

Bogdahn U, Becker G, Winkler J, Greiner K, Perez J, Meurers B. Transcranial color-coded real-time sonography in adults. Stroke. 1990 Dec;21(12):1680-8. — View Citation

Bor-Seng-Shu E, Hirsch R, Teixeira MJ, De Andrade AF, Marino R Jr. Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression. J Neurosurg. 2006 Jan;104(1):93-100. — View Citation

Bouma GJ, Muizelaar JP. Cerebral blood flow in severe clinical head injury. New Horiz. 1995 Aug;3(3):384-94. Review. — View Citation

Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968 Jan;28(1):14-20. — View Citation

Klingelhöfer J, Dander D, Holzgraefe M, Bischoff C, Conrad B. Cerebral vasospasm evaluated by transcranial Doppler ultrasonography at different intracranial pressures. J Neurosurg. 1991 Nov;75(5):752-8. — View Citation

Lindegaard K-F. Indices of pulsatility. In: Newell DW, Aaslid RA, eds. Transcranial Doppler. New York: Raven Press, 1992:67-82.

Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien). 1989;100(1-2):12-24. — View Citation

Manno EM. Transcranial Doppler ultrasonography in the neurocritical care unit. Crit Care Clin. 1997 Jan;13(1):79-104. Review. — View Citation

Martí-Fàbregas J, Belvís R, Guardia E, Cocho D, Muñoz J, Marruecos L, Martí-Vilalta JL. Prognostic value of Pulsatility Index in acute intracerebral hemorrhage. Neurology. 2003 Oct 28;61(8):1051-6. — View Citation

McCartney JP, Thomas-Lukes KM, Gomez CR. Introduction to Transcranial Doppler. In: Handbook of transcranial Doppler. New York: Springer-Verlag, 1997;1-13.

McQuire JC, Sutcliffe JC, Coats TJ. Early changes in middle cerebral artery blood flow velocity after head injury. J Neurosurg. 1998 Oct;89(4):526-32. — View Citation

Mitchell P, Gregson BA, Vindlacheruvu RR, Mendelow AD. Surgical options in ICH including decompressive craniectomy. J Neurol Sci. 2007 Oct 15;261(1-2):89-98. Epub 2007 Jun 4. Review. — View Citation

Newell DW, Aaslid R, Stooss R, Seiler RW, Reulen HJ. Evaluation of hemodynamic responses in head injury patients with transcranial Doppler monitoring. Acta Neurochir (Wien). 1997;139(9):804-17. — View Citation

Schmidt B, Klingelhöfer J, Schwarze JJ, Sander D, Wittich I. Noninvasive prediction of intracranial pressure curves using transcranial Doppler ultrasonography and blood pressure curves. Stroke. 1997 Dec;28(12):2465-72. — View Citation

Shiogai T, Sato E, Tokitsu M, Hara M, Takeuchi K. Transcranial Doppler monitoring in severe brain damage: relationships between intracranial haemodynamics, brain dysfunction and outcome. Neurol Res. 1990 Dec;12(4):205-13. — View Citation

Tang SC, Huang SJ, Jeng JS, Yip PK. Third ventricle midline shift due to spontaneous supratentorial intracerebral hemorrhage evaluated by transcranial color-coded sonography. J Ultrasound Med. 2006 Feb;25(2):203-9. — View Citation

Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, Boutron C, Couvreur G, Rouanet F, Touzé E, Guillon B, Carpentier A, Yelnik A, George B, Payen D, Bousser MG; DECIMAL Investigators. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007 Sep;38(9):2506-17. Epub 2007 Aug 9. — View Citation

Wozniak MA, Sloan MA, Rothman MI, Burch CM, Rigamonti D, Permutt T, Numaguchi Y. Detection of vasospasm by transcranial Doppler sonography. The challenges of the anterior and posterior cerebral arteries. J Neuroimaging. 1996 Apr;6(2):87-93. — View Citation

* Note: There are 22 references in allClick here to view all references

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