Precedex Versus Propofol-Awakening for Reducing Brain Injury Expansion

A Phase IV Single Center Cross Over Clinical Study Comparing Two Different Sedations Strategies for Mechanically Ventilated Patients With Neurological Critical Illness

The purpose of this study is to evaluate brain injury when two different drugs (propofol and precedex) are used to sedate patients who need a neurologic exam.

The hypothesis is that a neurologic exam performed when the subject has continuous infusion of precedex will result in less brain injury (where the lactate/pyruvate ratio indicates injury) then when a neurologic exam is performed on subjects receiving propofol, because that exam requires that the propofol infusion be stopped.

Inclusion Criteria:

• primary diagnosis of Traumatic Brain Injury (TBI), Subarachnoid Hemorrhage (SAH),Intracranial Hemorrhage (ICH), stroke
• Must require (be on) mechanical ventilation
• must require (have in place) intracranial pressure (ICP) monitoring
• must require (be receiving) continuous IV sedation

Exclusion Criteria:

• Bleeding diathesis
• Glasgow Coma Scale (GCS) < 5 with fixed pupils
• Pregnant
• elevated ICP that requires deep sedation
• pulmonary instability
• Hx of Ethanol(ETOH) abuse that requires current benzodiazepine treatment for delirium - allergy to propofol or precedex
• status epilepticus
• current neuromuscular blockade