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Optimering av hjärnsyre vid svår TBI, fas 3 (BOOST3)

6 november 2026 uppdaterad av: William Barsan, University of Michigan

Brain Oxygen Optimization in Severe TBI (BOOST3): En jämförande effektivitetsstudie för att testa effektiviteten av ett föreskrivet behandlingsprotokoll baserat på övervakning av partialtrycket av hjärnvävnadssyre.

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.

Studieöversikt

Status

Aktiv, inte rekryterande

Betingelser

Intervention / Behandling

Detaljerad beskrivning

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.

Studietyp

Interventionell

Inskrivning (Beräknad)

1094

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

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

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

14 år och äldre (Barn, Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

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

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Enda

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Aktiv 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.

Aktiv 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.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Glasgow Outcome Scale-Extended (GOS-E)
Tidsram: 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

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Survival
Tidsram: 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
Tidsram: 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
Tidsram: 6 months

A measure of verbal learning and memory.

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

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

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

A measure of psychological distress and psychiatric disorders.

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

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

6 months
Functional Status Exam
Tidsram: 6 months

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

6 months

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

Samarbetspartners

Utredare

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

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

28 augusti 2019

Primärt slutförande (Beräknad)

1 november 2027

Avslutad studie (Beräknad)

1 november 2027

Studieregistreringsdatum

Först inskickad

16 november 2018

Först inskickad som uppfyllde QC-kriterierna

22 november 2018

Första postat (Faktisk)

27 november 2018

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

12 november 2026

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

6 november 2026

Senast verifierad

1 november 2026

Mer information

Termer relaterade till denna studie

Andra studie-ID-nummer

  • BOOST3
  • U01NS099046 (U.S.S. NIH-anslag/kontrakt)

Plan för individuella deltagardata (IPD)

Planerar du att dela individuella deltagardata (IPD)?

JA

Tidsram för IPD-delning

1 year after publication on main outcome results paper

IPD-delning som stöder informationstyp

  • STUDY_PROTOCOL
  • SAV
  • ICF

Läkemedels- och apparatinformation, studiedokument

Studerar en amerikansk FDA-reglerad läkemedelsprodukt

Nej

Studerar en amerikansk FDA-reglerad produktprodukt

Nej

produkt tillverkad i och exporterad från U.S.A.

Nej

Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .