Comparison of strategies for monitoring and treating patients at the early phase of severe traumatic brain injury: the multicentre randomised controlled OXY-TC trial study protocol

Jean-Francois Payen, Marion Richard, Gilles Francony, Gérard Audibert, Emmanuel L Barbier, Nicolas Bruder, Claire Dahyot-Fizelier, Thomas Geeraerts, Laurent Gergele, Louis Puybasset, Bernard Vigue, Kristina Skaare, Jean Luc Bosson, Pierre Bouzat, Jean-Francois Payen, Marion Richard, Gilles Francony, Gérard Audibert, Emmanuel L Barbier, Nicolas Bruder, Claire Dahyot-Fizelier, Thomas Geeraerts, Laurent Gergele, Louis Puybasset, Bernard Vigue, Kristina Skaare, Jean Luc Bosson, Pierre Bouzat

Abstract

Introduction: Intracranial hypertension is considered as an independent risk factor of mortality and neurological disabilities after severe traumatic brain injury (TBI). However, clinical studies have demonstrated that episodes of brain ischaemia/hypoxia are common despite normalisation of intracranial pressure (ICP). This study assesses the impact on neurological outcome of guiding therapeutic strategies based on the monitoring of both brain tissue oxygenation pressure (PbtO2) and ICP during the first 5 days following severe TBI.

Methods and analysis: Multicentre, open-labelled, randomised controlled superiority trial with two parallel groups in 300 patients with severe TBI. Intracerebral monitoring must be in place within the first 16 hours post-trauma. Patients are randomly assigned to the ICP group or to the ICP + PbtO2 group. The ICP group is managed according to the international guidelines to maintain ICP≤20 mm Hg. The ICP + PbtO2 group is managed to maintain PbtO2 ≥20 mm Hg in addition to the conventional optimisation of ICP. The primary outcome measure is the neurological status at 6 months as assessed using the extended Glasgow Outcome Scale. Secondary outcome measures include quality-of-life assessment, mortality rate, therapeutic intensity and incidence of critical events during the first 5 days. Analysis will be performed according to the intention-to-treat principle and full statistical analysis plan developed prior to database freeze.

Ethics and dissemination: This study has been approved by the Institutional Review Board of Sud-Est V (14-CHUG-48) and from the National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament et des produits de santé) (141 435B-31). Results will be presented at scientific meetings and published in peer-reviewed publications.The study was registered with ClinTrials NCT02754063 on 28 April 2016 (pre-results).

Keywords: Neurosurgery; adult intensive & critical care; trauma management.

Conflict of interest statement

Competing interests: No.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study design and flow of the Oxy-TC trial. ICP, intracranial pressure; ICU, intensive care unit; PbtO2, brain tissue oxygen pressure.
Figure 2
Figure 2
Algorithms for the therapeutic strategies for the ICP group. CPP, cerebral perfusion pressure; ICP, intracranial pressure.
Figure 3
Figure 3
Algorithms for the therapeutic strategies for the ICP + PbtO2 group. CI, cardiac index; CPP, cerebral perfusion pressure; Hb, haemoglobin; ICP, intracranial pressure; PbtO2, brain tissue oxygen pressure.

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