Diese Seite wurde automatisch übersetzt und die Genauigkeit der Übersetzung wird nicht garantiert. Bitte wende dich an die englische Version für einen Quelltext.

Gehirnsauerstoffoptimierung bei schwerem SHT, Phase 3 (BOOST3)

6. November 2026 aktualisiert von: William Barsan, University of Michigan

Gehirnsauerstoffoptimierung bei schwerem SHT (BOOST3): Eine vergleichende Wirksamkeitsstudie zum Testen der Wirksamkeit eines vorgeschriebenen Behandlungsprotokolls basierend auf der Überwachung des Sauerstoffpartialdrucks im Gehirngewebe.

BOOST3 is a randomized clinical trial to determine the comparative effectiveness of two strategies for monitoring and treating patients with traumatic brain injury (TBI) in the intensive care unit (ICU). The study will determine the safety and efficacy of a strategy guided by treatment goals based on both intracranial pressure (ICP) and brain tissue oxygen (PbtO2) as compared to a strategy guided by treatment goals based on ICP monitoring alone. Both of these alternative strategies are used in standard care. It is unknown if one is more effective than the other. In both strategies the monitoring and goals help doctors adjust treatments including the kinds and doses of medications and the amount of intravenous fluids given, ventilator (breathing machine) settings, need for blood transfusions, and other medical care. The results of this study will help doctors discover if one of these methods is more safe and effective.

Studienübersicht

Status

Aktiv, nicht rekrutierend

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

BOOST3 is a randomized clinical trial to determine the comparative effectiveness of two strategies for monitoring and treating patients with traumatic brain injury (TBI) in the intensive care unit (ICU).

When a person has a TBI, their injured brain can swell over a period of hours or days. If the brain swells too much, the pressure in the skull increases and becomes dangerous, causing further injury to the brain. To try to prevent this, doctors usually insert a device, an ICP monitor, into the brain through a hole in the skull of people with severe TBI. An ICP monitor measures the pressure inside the skull. Most doctors agree that it is important to measure and prevent high ICP. Patients with injured brains also suffer additional injury to the brain if the amount of oxygen in the brain gets too low. Some doctors also insert a second device, a PbtO2 monitor, in the brain through the same or a second hole in the skull to measure brain tissue oxygen. A PbtO2 monitor measures how much oxygen is in a small area of the brain near the tip of the monitor. Other doctors think this is unnecessary and unhelpful. Both monitoring devices are approved by the US Food and Drug Administration (FDA) and Health Canada for patients with TBI. Both are commonly used. The ICP and PbtO2 goals guided by these monitors are used to help doctors adjust their treatment choices. Treatments include kinds and doses of medications and the amount of intravenous fluids given, ventilator (breathing machine) settings, need for blood transfusions, and other medical care. Each of these treatment decisions is intended to improve outcomes. However, each treatment decision also involves potential risks. Different treatment decisions may result in different risks. This study will also help doctors better understand these risks. This study is funded by the National Institutes of Health because it answers questions important to the care of patients with TBI.

This study is a two-arm, single-blind, randomized, controlled, phase III, multi-center trial of ICU monitoring and treatment strategies for patients with severe TBI. It will compare the efficacy of ICU care guided by PbtO2 and ICP monitoring versus monitoring of ICP alone in the first 5 days after injury. Only subjects who have severe TBI and require invasive monitoring, according to Brain Trauma Foundation (BTF) and American College of Surgeons-Trauma Quality Improvement (ACS TQIP) guidelines, will be enrolled. All participants in this study will have both ICP monitors and PbtO2 monitors. Half of the participants will be randomized to an arm that includes treatment informed by PbtO2 and ICP, and half will be randomized to an arm that treats only ICP.

The PbtO2 values of those in the ICP only arm will be masked, so that the treating physicians will not be guided by PbtO2 information. Participants in the PbtO2 and ICP arm will have PbtO2 monitored and low measurements treated. Treatments to address physiological goals in both arms will follow a clinical standardization plan. Participants will be followed for 6 months and occurrence of serious adverse events or death will be recorded. Participants will have a follow-up interview to assess their level of recovery approximately 6 months post injury.

To reduce the likelihood of imbalance of important prognostic factors between groups, a covariate-adjusted randomization scheme will be used in this study. Adjustment variables are clinical site and probability of a poor outcome as defined by the IMPACT core model.

Studientyp

Interventionell

Einschreibung (Geschätzt)

1094

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienorte

      • Montreal, Kanada, H4J 1C5
        • CIUSSS-NIM Hopital du Sacre - Coeur de Montreal
    • Alberta
      • Calgary, Alberta, Kanada, T2N 2T9
        • University of Calgary - Foothills Medical Centre
    • Ontario
      • Toronto, Ontario, Kanada, M5B 1W8
        • St. Michaels Hospital
    • California
      • Los Angeles, California, Vereinigte Staaten, 90048
        • Cedars-Sinai Medical Center
      • Los Angeles, California, Vereinigte Staaten, 90095-7436
        • Ronald Reagan UCLA Medical Center
      • Palo Alto, California, Vereinigte Staaten, 94305
        • Stanford University Medical Center
      • Sacramento, California, Vereinigte Staaten, 95817
        • UC Davis Medical Center
      • San Francisco, California, Vereinigte Staaten, 94143
        • San Francisco General Hospital
    • Colorado
      • Aurora, Colorado, Vereinigte Staaten, 80045
        • University of Colorado Hospital
    • Connecticut
      • New Haven, Connecticut, Vereinigte Staaten, 06510
        • Yale New Haven Hospital
    • Florida
      • Gainesville, Florida, Vereinigte Staaten, 32608
        • UF Health Shands Hospital
    • Georgia
      • Atlanta, Georgia, Vereinigte Staaten, 30303
        • Grady Memorial Hospital
    • Hawaii
      • Honolulu, Hawaii, Vereinigte Staaten, 96813
        • The Queen's Medical Center
    • Illinois
      • Chicago, Illinois, Vereinigte Staaten, 60637
        • University of Chicago Medical Center
    • Indiana
      • Indianapolis, Indiana, Vereinigte Staaten, 46260
        • St. Vincent Hospital
    • Maine
      • Portland, Maine, Vereinigte Staaten, 04102
        • Maine Medical Center
    • Maryland
      • Baltimore, Maryland, Vereinigte Staaten, 21287
        • Johns Hopkins Hospital
      • Baltimore, Maryland, Vereinigte Staaten, 21201
        • University of Maryland Medical Center
    • Massachusetts
      • Boston, Massachusetts, Vereinigte Staaten, 02215
        • Beth Israel Deaconess Medical Center
      • Boston, Massachusetts, Vereinigte Staaten, 02115
        • Brigham and Women's Hospital
      • Boston, Massachusetts, Vereinigte Staaten, 02128
        • Massachusetts General Hospital
      • Worcester, Massachusetts, Vereinigte Staaten, 01655
        • UMASS Memorial Medical Center
    • Michigan
      • Ann Arbor, Michigan, Vereinigte Staaten, 48109
        • University of Michigan
      • Detroit, Michigan, Vereinigte Staaten, 48201
        • Detroit Receiving Hospital
      • Detroit, Michigan, Vereinigte Staaten, 48201
        • Henry Ford Hospital
    • Minnesota
      • Saint Paul, Minnesota, Vereinigte Staaten, 55101
        • Regions Hospital
    • New Jersey
      • Camden, New Jersey, Vereinigte Staaten, 08103
        • Cooper University Hospital
    • New Mexico
      • Albuquerque, New Mexico, Vereinigte Staaten, 87131
        • University of New Mexico Hospital
    • New York
      • Flushing, New York, Vereinigte Staaten, 11355
        • NewYork-Presbyterian Queens Hospital
      • Manhasset, New York, Vereinigte Staaten, 11030
        • North Shore University Hospital
      • New York, New York, Vereinigte Staaten, 10032
        • NYP Columbia University Medical Center
      • Rochester, New York, Vereinigte Staaten, 14642
        • Strong Memorial Hospital
      • Syracuse, New York, Vereinigte Staaten, 13210
        • SUNY Upstate Medical University
      • The Bronx, New York, Vereinigte Staaten, 10461
        • Jacobi Medical Center
    • North Carolina
      • Chapel Hill, North Carolina, Vereinigte Staaten, 27514
        • University of North Carolina Medical Center
      • Durham, North Carolina, Vereinigte Staaten, 27710
        • Duke University Hospital
    • Ohio
      • Cincinnati, Ohio, Vereinigte Staaten, 45219
        • University of Cincinnati Medical Center
      • Columbus, Ohio, Vereinigte Staaten, 43214
        • Riverside Methodist Hospital
      • Columbus, Ohio, Vereinigte Staaten, 43210
        • OSU Wexner Medical Center
    • Oregon
      • Portland, Oregon, Vereinigte Staaten, 97239
        • Oregon Health & Science University Hospital
    • Pennsylvania
      • Philadelphia, Pennsylvania, Vereinigte Staaten, 19107
        • Thomas Jefferson University Hospital
      • Philadelphia, Pennsylvania, Vereinigte Staaten, 19104
        • Penn Presbyterian Medical Center
      • Pittsburgh, Pennsylvania, Vereinigte Staaten, 15212
        • UPMC Presbyterian Hospital
    • Texas
      • Dallas, Texas, Vereinigte Staaten, 75235
        • Parkland Hospital
      • Houston, Texas, Vereinigte Staaten, 77030
        • Ben Taub General Hospital
      • San Antonio, Texas, Vereinigte Staaten, 78229
        • University of Texas Health Science Center San Antonio
    • Utah
      • Salt Lake City, Utah, Vereinigte Staaten, 84132
        • University of Utah Healthcare
    • Virginia
      • Richmond, Virginia, Vereinigte Staaten, 23298
        • VCU Medical Center
    • Washington
      • Seattle, Washington, Vereinigte Staaten, 98104
        • Harborview Medical Center
    • West Virginia
      • Morgantown, West Virginia, Vereinigte Staaten, 26506
        • WVU Healthcare Ruby Memorial Hospital
    • Wisconsin
      • Milwaukee, Wisconsin, Vereinigte Staaten, 53226
        • Froedtert Hospital

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

14 Jahre und älter (Kind, Erwachsene, Älterer Erwachsener)

Akzeptiert gesunde Freiwillige

Nein

Studienberechtigte Geschlechter

Alle

Beschreibung

Inclusion Criteria:

  • Non-penetrating traumatic brain injury
  • Glasgow Coma Scale (GCS) 3-8 measured off paralytics
  • Glasgow Coma Scale motor score < 6 if endotracheally intubated
  • Evidence of intracranial trauma on CT scan
  • Able to place intracranial probes and randomize within 6 hours of arrival at enrolling hospital
  • Able to place intracranial probes and randomize within 12 hours from injury
  • Age greater than or equal to 14 years

Exclusion Criteria:

  • Non-survivable injury
  • Bilaterally absent pupillary response in the absence of paralytic medication
  • Contraindication to the placement of intracranial probes
  • Treatment of brain tissue oxygen values prior to randomization
  • Planned use of devices which may unblind treating physicians to brain tissue hypoxia
  • Systemic sepsis at screening
  • Refractory hypotension
  • Refractory systemic hypoxia
  • PaO2/FiO2 ratio < 150
  • Known pre-existing neurologic disease with confounding residual neurological deficits
  • Known inability to perform activities of daily living (ADL) without assistance prior to injury
  • Known active drug or alcohol dependence that, in the opinion of site investigator, would interfere with physiological response to brain tissue oxygen treatments
  • Pregnancy
  • Prisoner
  • On EFIC Opt-Out list as indicated by a bracelet or medical alert

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Single

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Aktiver Komparator: ICP only

ICP guided management strategy: Care in the ICU of research participants randomized to this arm will be guided by a monitoring and treatment strategy in which doctors try to prevent high intracranial pressure (ICP) caused by a swollen brain. This strategy is one of two alternative strategies that is currently used in standard care of patients with traumatic brain injury.

In this management strategy, the physiological goal is to avoid ICP from exceeding 22 mm Hg. ICP and PbtO2 are monitored using devices inserted into the brain through a hole in the skull, but PbtO2 is not used to guide care. These devices are approved by the US Food and Drug Administration (FDA) and Health Canada, and are routinely used in patients with severe TBI. Doctors adjust their treatment choices to try to achieve this ICP goal. Treatments include kinds and doses of medications and the amount of intravenous fluids given, ventilator (breathing machine) settings, need for blood transfusions, and other medical care. This management strategy is used to guide care for 5 days in this research study.

Aktiver Komparator: ICP + PbtO2

ICP + PbtO2 guided management strategy: Care in the ICU of research participants randomized to this arm will be guided by a monitoring and treatment strategy in which doctors try to prevent high intracranial pressure (ICP), and also try to prevent low PbtO2 (brain tissue oxygen levels). This strategy is one of two alternative strategies that is currently used in standard care of patients with traumatic brain injury.

In this management strategy, the physiological goal is to avoid ICP from exceeding 22 mm Hg and to avoid PbtO2 dropping below 20 mm Hg. ICP and PbtO2 are monitored using devices inserted into the brain through a hole in the skull. These devices are approved by the US Food and Drug Administration (FDA) and Health Canada for patients with severe TBI. The devices are used in standard care at hospitals participating in this research study. Doctors adjust their treatment choices to try to achieve these ICP and PbtO2 goals. Treatments include kinds and doses of medications and the amount of intravenous fluids given, ventilator (breathing machine) settings, need for blood transfusions, and other medical care. This management strategy is used to guide care for 5 days in this research study.

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Glasgow Outcome Scale-Extended (GOS-E)
Zeitfenster: 6 months

The Glasgow Outcome Scale-Extended (GOS-E) is a global scale for functional outcome, in which higher scores indicate better outcomes. The GOS-E rates patient status into one of eight categories. A GOS-E score of 1 indicates death, 2 indicates a vegetative state, 3 or 4 indicates severe disability, 5 or 6 indicates moderate disability, and 7 or 8 indicates good recovery. The categories of severe disability, moderate disability and good recovery are subdivided into a lower and upper category. All injury related disabilities are assessed.

6 months

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Survival
Zeitfenster: At discharge from hospital, an average of 19 days

Survival at discharge from hospital

At discharge from hospital, an average of 19 days
Total Brain Hypoxia Exposure
Zeitfenster: Inclusive of up to 5 days of study intervention

The cumulative area on the time versus brain tissue oxygenation (PbtO2) curve in which PbtO2 is less than 20 mmHg.

Inclusive of up to 5 days of study intervention
Cognition: Rey Auditory Verbal Learning Test
Zeitfenster: 6 months

A measure of verbal learning and memory.

6 months
Cognition: Trail Making Test Part A+B
Zeitfenster: 6 months

A measure of attention, visual-motor tracking and executive functioning.

6 months
Emotional Health: Rivermead Post-Concussion Symptom Questionnaire
Zeitfenster: 6 months

A measure of the presence and severity of post-concussion somatic, cognitive, and emotional symptoms.

6 months
Emotional Health: Brief Symptom Inventory 18
Zeitfenster: 6 months

A measure of psychological distress and psychiatric disorders.

6 months
Emotional Health: Satisfaction with Life Scale
Zeitfenster: 6 months

A measure of global cognitive judgments of one's life satisfaction.

6 months
Functional Status Exam
Zeitfenster: 6 months

Change in the activities of every day life as a function of a sudden event or illness

6 months

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Mitarbeiter

Ermittler

  • Hauptermittler: Lori Shutter, MD, University of Pittsburgh, Pittsburgh, PA 15260
  • Hauptermittler: Ramon Diaz-Arrastia, MD, PhD, University of Pennsylvania, Philadelphia, PA 19104
  • Hauptermittler: William Barsan, MD, University of Michigan, Ann Arbor, MI 48109
  • Hauptermittler: Sharon Yeatts, PhD, Medical University of South Carolina, Charleston, SC 29425

Publikationen und hilfreiche Links

Die Bereitstellung dieser Publikationen erfolgt freiwillig durch die für die Eingabe von Informationen über die Studie verantwortliche Person. Diese können sich auf alles beziehen, was mit dem Studium zu tun hat.

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Tatsächlich)

28. August 2019

Primärer Abschluss (Geschätzt)

1. November 2027

Studienabschluss (Geschätzt)

1. November 2027

Studienanmeldedaten

Zuerst eingereicht

16. November 2018

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

22. November 2018

Zuerst gepostet (Tatsächlich)

27. November 2018

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

12. November 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

6. November 2026

Zuletzt verifiziert

1. November 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Andere Studien-ID-Nummern

  • BOOST3
  • U01NS099046 (US NIH Stipendium/Vertrag)

Plan für individuelle Teilnehmerdaten (IPD)

Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?

JA

IPD-Sharing-Zeitrahmen

1 year after publication on main outcome results paper

Art der unterstützenden IPD-Freigabeinformationen

  • STUDIENPROTOKOLL
  • SAFT
  • ICF

Arzneimittel- und Geräteinformationen, Studienunterlagen

Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt

Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

Produkt, das in den USA hergestellt und aus den USA exportiert wird

Nein

Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .