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Severe traumatic brain injury with increased intracranial pressure can lead to decreased cerebral blood flow. Low cerebral blood flow is responsible for secondary lesions, leading to bad prognosis. It is not yet established whether increasing cardiac output in these patients can lead to an increase in cerebral blood flow, although there are some arguments in favor of this hypothesis. The aim of this study is to demonstrate that increasing cardiac output will improve cerebral blood flow in patients with severe traumatic injury and high cerebral pressure.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Noradrenaline alone | Active Comparator | Treatment for 30 minutes with noradrenaline alone |
|
| Noradrenaline + dobutamine | Experimental | Treatment with noradrenaline and dobutamine for 30 minutes |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Norepinephrine | Drug |
| ||
| Dobutamine and norepinephrine |
| Measure | Description | Time Frame |
|---|---|---|
| Mean blood flow velocity | Mean blood flow velocity averaged on the two middle cerebral arteries (right and left) measured one after after the initiation of treatment. Each velocity is calculated as an average on the 10 last minutes form continuous transcranial doppler monitoring | After one hour of treatment |
| Measure | Description | Time Frame |
|---|---|---|
| Evolution of brain oxygenation under treatment | Comparison of the brain tissue oxygenation curves (PbrO2) under treatment with and without dobutamine | During one hour of treatment |
| Dobutamine doses |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Gilles Francony, MD | Contact | 0033476766688 |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Grenoble University Hospital | Recruiting | Grenoble | 38043 | France |
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| ID | Term |
|---|---|
| D009638 | Norepinephrine |
| D004280 | Dobutamine |
| ID | Term |
|---|---|
| D004983 | Ethanolamines |
| D000605 | Amino Alcohols |
| D000438 | Alcohols |
| D009930 | Organic Chemicals |
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|
Dobutamine doses required to reach the same cerebral perfusion pressure than noradrenaline alone
| After one hour of treatment |
| Resistivity index on renal doppler | Measure of resistivity index on renal doppler after one hour of treatment with and without dobutamine | After one hour of treatment |
| Pulsatility index on renal doppler | Measure of pulsatility index (PI) on renal doppler before and after one hour of treatment with and without dobutamine prediction of cerebral blood flow increase (patients with high initial renal PI) | After one hour of treatment |
| Cardiac output modifications | Comparison of cardiac blood flow modifications under treatment for one hour with and without dobutamine | During one hour of treatment |
| D000588 |
| Amines |
| D015306 | Biogenic Monoamines |
| D001679 | Biogenic Amines |
| D002395 | Catecholamines |
| D002396 | Catechols |
| D010636 | Phenols |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D010627 | Phenethylamines |
| D005021 | Ethylamines |