search
Back to results

Ketamine and Glutamate After Brain Injury : a Microdialysis Study (KETABRAIN)

Primary Purpose

Head Trauma

Status
Unknown status
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Ketamine
Sufentanil
Sponsored by
Pierre-Julien CUNGI
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Head Trauma focused on measuring traumatic brain injury, ketamine, microdialysis, PtiO2, glutamate

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • > 18 years old
  • Glasgow Coma Scale (GCS) < 9
  • > 3 days of sedation expected at the arrival

Exclusion Criteria:

  • pregnancy
  • < 18 years old
  • estimated survival < 48 hours post-trauma
  • expected sedation < 3 days
  • coagulation impairment (platelets<100.000/mm3 and prothrombin time (TP) <60%)
  • Cardiac arrest before ICU admission
  • Admission > 12 hours after trauma
  • Multimodal monitoring implanted > 24 hours post trauma
  • Participation to the study refused by the next of kind
  • No next of kind

Sites / Locations

  • Sainte Anne Military Teaching Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

ketamine

sufentanil

Arm Description

ketamine 5 mg/kg/h, continuous infusion for 48 hours

sufentanil 0,5 mcg/kg/h, continuous infusion for 48 hours

Outcomes

Primary Outcome Measures

brain glutamate concentrations
To compare the kinetic of brain glutamate concentration decrease during 4 periods of 12 hours between ketamine infusion group (KET) and sufentanil standard infusion group (STD)

Secondary Outcome Measures

metabolic profile
To compare the brain metabolic profile (normal, ischemic, hyperglycolytic and metabolic crisis) of the patients related to their group of treatment : ketamine (KET) and sufentanil (STD) by measuring brain glucose, brain lactate, brain glycerol concentrations and brain lactate/pyruvate ratio.
Episodes of intracranial hypertension (ICHT) and brain ischemia
To compare the number of ICHT episodes (ICP>20 mm Hg more than 15 minutes) and to compare the number of ischemic episodes (PtiO2<20 mm Hg more than 15 minutes) between the 2 groups
Therapeutic Intensity Level (TIL)
To compare the TIL value between the 2 groups. TIL is a score developed to measure the intensity of cares for head trauma patients. Lower scores are meaning less intense cares. It is calculated for 24 hours periods.
Glasgow Outcome Scale (GOS) et extended Glasgow Outcome Scale (eGOS)
To describe the prognosis of the patients of the KETAMINE group versus SUFENTANIL group. GOS is the international validated score for evaluation of the prognosis after head trauma.

Full Information

First Posted
September 2, 2014
Last Updated
September 2, 2014
Sponsor
Pierre-Julien CUNGI
search

1. Study Identification

Unique Protocol Identification Number
NCT02232347
Brief Title
Ketamine and Glutamate After Brain Injury : a Microdialysis Study
Acronym
KETABRAIN
Official Title
Effect of Ketamine Versus Sufentanil on Cerebral Glutamate After Traumatic Brain Injury : a Randomized, Double-blinded, Microdialysis Study
Study Type
Interventional

2. Study Status

Record Verification Date
September 2014
Overall Recruitment Status
Unknown status
Study Start Date
October 2014 (undefined)
Primary Completion Date
October 2016 (Anticipated)
Study Completion Date
May 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Pierre-Julien CUNGI

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of the study is to compare the effects of 48 hours ketamine infusion versus sufentanil infusion on brain glutamate concentrations measured with microdialysis after traumatic brain injury. We hypothesize that ketamine infusion will decrease high glutamate values faster than sufentanil.
Detailed Description
Inclusion of 20 consecutive head trauma patients. Randomization and double-blind to compare the effects of ketamine versus sufentanil on brain glutamate concentrations measured with microdialysis. Ketamine is an anti-N-methyl-D-aspartate (NMDA) medication. It is supposed to limit excitotoxicity of amino-acids, especially glutamate. Glutamate is known to be elevated in more than 60% of the severe head trauma patients. It induces cortical spreading depression which can aggravate prognosis. It's a daily used medication in anesthesia and intensive care units for sedation and induction of anesthesia. It's the recommended medication for induction of unstable wounded soldiers on the field because of its neutrality on haemodynamic state. Sufentanil is the reference opioid for sedation in ICU in Europe. It can induce hypotension which is deleterious for cerebral perfusion pressure after brain trauma. In our unit, patients with severe head injury are monitored by a triple lumen access device including ICP (IntraCerebral Pressure), PtiO2 (oxygen pressure in the brain) and microdialysis. This last monitoring allows measurement of brain parenchymal concentrations of small molecules : glucose, lactate, pyruvate, glutamate, glycerol,.... It's a tool to evaluate the metabolic state of the brain divided into 4 categories : normal, hyperglycolysis, ischemia and metabolic crisis. Then, we will detail the effects of ketamine on metabolic state of the brain, especially glutamate concentration. Normal values are below 10 micromol/ml. After head trauma it can dramatically increase to values up to 50 or even 100 micromol/ml, with normalization after 24 hours. Ketamine is expected to decrease these high values faster than described in observational studies.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Head Trauma
Keywords
traumatic brain injury, ketamine, microdialysis, PtiO2, glutamate

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
ketamine
Arm Type
Experimental
Arm Description
ketamine 5 mg/kg/h, continuous infusion for 48 hours
Arm Title
sufentanil
Arm Type
Active Comparator
Arm Description
sufentanil 0,5 mcg/kg/h, continuous infusion for 48 hours
Intervention Type
Drug
Intervention Name(s)
Ketamine
Intervention Type
Drug
Intervention Name(s)
Sufentanil
Primary Outcome Measure Information:
Title
brain glutamate concentrations
Description
To compare the kinetic of brain glutamate concentration decrease during 4 periods of 12 hours between ketamine infusion group (KET) and sufentanil standard infusion group (STD)
Time Frame
H0-H12, H12-H24, H24-H36 and H36-H48
Secondary Outcome Measure Information:
Title
metabolic profile
Description
To compare the brain metabolic profile (normal, ischemic, hyperglycolytic and metabolic crisis) of the patients related to their group of treatment : ketamine (KET) and sufentanil (STD) by measuring brain glucose, brain lactate, brain glycerol concentrations and brain lactate/pyruvate ratio.
Time Frame
H0-H12, H12-H24, H24-H36 and H36-H48
Title
Episodes of intracranial hypertension (ICHT) and brain ischemia
Description
To compare the number of ICHT episodes (ICP>20 mm Hg more than 15 minutes) and to compare the number of ischemic episodes (PtiO2<20 mm Hg more than 15 minutes) between the 2 groups
Time Frame
H0-H12, H12-H24, H24-H36 and H36-H48
Title
Therapeutic Intensity Level (TIL)
Description
To compare the TIL value between the 2 groups. TIL is a score developed to measure the intensity of cares for head trauma patients. Lower scores are meaning less intense cares. It is calculated for 24 hours periods.
Time Frame
Days 1 and 2
Title
Glasgow Outcome Scale (GOS) et extended Glasgow Outcome Scale (eGOS)
Description
To describe the prognosis of the patients of the KETAMINE group versus SUFENTANIL group. GOS is the international validated score for evaluation of the prognosis after head trauma.
Time Frame
6 months and 1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: > 18 years old Glasgow Coma Scale (GCS) < 9 > 3 days of sedation expected at the arrival Exclusion Criteria: pregnancy < 18 years old estimated survival < 48 hours post-trauma expected sedation < 3 days coagulation impairment (platelets<100.000/mm3 and prothrombin time (TP) <60%) Cardiac arrest before ICU admission Admission > 12 hours after trauma Multimodal monitoring implanted > 24 hours post trauma Participation to the study refused by the next of kind No next of kind
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ambroise MONTCRIOL, MD
Phone
0483162358
Ext
0033
Email
ambroise.montcriol@free.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ambroise MONTCRIOL, MD
Organizational Affiliation
Direction Centrale du Service de Santé des Armées
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sainte Anne Military Teaching Hospital
City
Toulon
ZIP/Postal Code
83130
Country
France
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pierre Julien CUNGI, MD
First Name & Middle Initial & Last Name & Degree
Eric MEAUDRE, MD
First Name & Middle Initial & Last Name & Degree
Henry BORET, MD

12. IPD Sharing Statement

Citations:
PubMed Identifier
17511549
Citation
Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS; Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW. Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma. 2007;24 Suppl 1:S7-13. doi: 10.1089/neu.2007.9995. No abstract available. Erratum In: J Neurotrauma. 2008 Mar;25(3):276-8. multiple author names added.
Results Reference
background
PubMed Identifier
22101599
Citation
Hughes S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: is ketamine a viable induction agent for the trauma patient with potential brain injury. Emerg Med J. 2011 Dec;28(12):1076-7. doi: 10.1136/emermed-2011-200891.
Results Reference
background
PubMed Identifier
20219164
Citation
Filanovsky Y, Miller P, Kao J. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. CJEM. 2010 Mar;12(2):154-7. doi: 10.1017/s1481803500012197. No abstract available.
Results Reference
background
PubMed Identifier
19640746
Citation
Hudetz JA, Pagel PS. Neuroprotection by ketamine: a review of the experimental and clinical evidence. J Cardiothorac Vasc Anesth. 2010 Feb;24(1):131-42. doi: 10.1053/j.jvca.2009.05.008. Epub 2009 Jul 29. No abstract available.
Results Reference
background
PubMed Identifier
21817985
Citation
Ward JL, Harting MT, Cox CS Jr, Mercer DW. Effects of ketamine on endotoxin and traumatic brain injury induced cytokine production in the rat. J Trauma. 2011 Jun;70(6):1471-9. doi: 10.1097/TA.0b013e31821c38bd.
Results Reference
background
PubMed Identifier
21926656
Citation
Bhutta AT, Schmitz ML, Swearingen C, James LP, Wardbegnoche WL, Lindquist DM, Glasier CM, Tuzcu V, Prodhan P, Dyamenahalli U, Imamura M, Jaquiss RD, Anand KJ. Ketamine as a neuroprotective and anti-inflammatory agent in children undergoing surgery on cardiopulmonary bypass: a pilot randomized, double-blind, placebo-controlled trial. Pediatr Crit Care Med. 2012 May;13(3):328-37. doi: 10.1097/PCC.0b013e31822f18f9.
Results Reference
background
PubMed Identifier
19520992
Citation
Sakowitz OW, Kiening KL, Krajewski KL, Sarrafzadeh AS, Fabricius M, Strong AJ, Unterberg AW, Dreier JP. Preliminary evidence that ketamine inhibits spreading depolarizations in acute human brain injury. Stroke. 2009 Aug;40(8):e519-22. doi: 10.1161/STROKEAHA.109.549303. Epub 2009 Jun 11.
Results Reference
background
PubMed Identifier
22056157
Citation
Hartings JA, Bullock MR, Okonkwo DO, Murray LS, Murray GD, Fabricius M, Maas AI, Woitzik J, Sakowitz O, Mathern B, Roozenbeek B, Lingsma H, Dreier JP, Puccio AM, Shutter LA, Pahl C, Strong AJ; Co-Operative Study on Brain Injury Depolarisations. Spreading depolarisations and outcome after traumatic brain injury: a prospective observational study. Lancet Neurol. 2011 Dec;10(12):1058-64. doi: 10.1016/S1474-4422(11)70243-5. Epub 2011 Nov 3.
Results Reference
background
PubMed Identifier
22720148
Citation
Raboel PH, Bartek J Jr, Andresen M, Bellander BM, Romner B. Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods-A Review. Crit Care Res Pract. 2012;2012:950393. doi: 10.1155/2012/950393. Epub 2012 Jun 8.
Results Reference
background
PubMed Identifier
20107926
Citation
Stuart RM, Schmidt M, Kurtz P, Waziri A, Helbok R, Mayer SA, Lee K, Badjatia N, Hirsch LJ, Connolly ES, Claassen J. Intracranial multimodal monitoring for acute brain injury: a single institution review of current practices. Neurocrit Care. 2010 Apr;12(2):188-98. doi: 10.1007/s12028-010-9330-9.
Results Reference
background
PubMed Identifier
12626974
Citation
Bourgoin A, Albanese J, Wereszczynski N, Charbit M, Vialet R, Martin C. Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil. Crit Care Med. 2003 Mar;31(3):711-7. doi: 10.1097/01.CCM.0000044505.24727.16.
Results Reference
background
PubMed Identifier
15891344
Citation
Bourgoin A, Albanese J, Leone M, Sampol-Manos E, Viviand X, Martin C. Effects of sufentanil or ketamine administered in target-controlled infusion on the cerebral hemodynamics of severely brain-injured patients. Crit Care Med. 2005 May;33(5):1109-13. doi: 10.1097/01.ccm.0000162491.26292.98.
Results Reference
background
PubMed Identifier
20113156
Citation
Chamoun R, Suki D, Gopinath SP, Goodman JC, Robertson C. Role of extracellular glutamate measured by cerebral microdialysis in severe traumatic brain injury. J Neurosurg. 2010 Sep;113(3):564-70. doi: 10.3171/2009.12.JNS09689.
Results Reference
background

Learn more about this trial

Ketamine and Glutamate After Brain Injury : a Microdialysis Study

We'll reach out to this number within 24 hrs