Safety and efficacy of normobaric oxygenation on rescuing acute intracerebral hemorrhage-mediated brain damage-a protocol of randomized controlled trial

Zhiying Chen, Jiayue Ding, Xiaoqin Wu, Bing Bao, Xianming Cao, Xiangbin Wu, Xiaoping Yin, Ran Meng, Zhiying Chen, Jiayue Ding, Xiaoqin Wu, Bing Bao, Xianming Cao, Xiangbin Wu, Xiaoping Yin, Ran Meng

Abstract

Background: All of the existing medication and surgical therapies currently cannot completely inhibit intracerebral hemorrhage (ICH)-mediated brain damage, resulting in disability in different degrees in the involved patients. Normobaric oxygenation (NBO) was reported attenuating ischemic brain injury. Herein, we aimed to explore the safety and efficacy of NBO on rescuing the damaged brain tissues secondary to acute ICH, especially those in the perihematoma area being threatened by ischemia and hypoxia.

Methods: A total of 150 patients confirmed as acute spontaneous ICH by computed tomography (CT) within 6 h after symptoms onset, will enroll in this study after signing the informed consent, and enter into the NBO group or control group randomly according to a random number. In the NBO group, patients will inhale high-flow oxygen (8 L/min, 1 h each time for 6 cycles daily) and intake low-flow oxygen (2 L/min) in intermittent periods by mask for a total of 7 days. While in the control group, patients will breathe in only low-flow oxygen (2 L/min) by mask for 7 consecutive days. Computed tomography and perfusion (CT/CTP) will be used to evaluate cerebral perfusion status and brain edema. CT and CTP maps in the two groups at baseline and day 7 and 14 after NBO or low-flow oxygen control will be compared. The primary endpoint is mRS at both Day14 post-ICH and the end of the 3rd month follow-up. The secondary endpoints include NIHSS and plasma biomarkers at baseline and Day-1, 7, and 14 after treatment, as well as the NIHSS at the end of the 3rd month post-ICH and the incidence of bleeding recurrence and the mortalities within 3 months post-ICH.

Discussion: This study will provide preliminary clinical evidence about the safety and efficacy of NBO on correcting acute ICH and explore some mechanisms accordingly, to offer reference for larger clinical trials in the future.

Trial registration: ClinicalTrials.gov NCT04144868 . Retrospectively registered on October 29, 2019.

Keywords: Cerebral perfusion; Intracerebral hemorrhage; Normobaric hyperoxia; Randomized controlled trial.

Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of this study. NBO, normobaric oxygenation
Fig. 2
Fig. 2
Maps of CT and CTP in an ICH patient example. a Cerebral blood flow (CBF). b Cerebral blood volume (CBV). b Mean transition time (MTT). d Time to peak (TTP). e CT brain scanning

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