DOI: http://dx.doi.org/10.18203/2349-3259.ijct20162792

Assessing the relationship between brain tissue oxygenation and neurological dysfunction in critically ill patients: study protocol

Michael D. Wood, David Maslove, John Muscedere, Stephen H. Scott, Andrew Day, J. Gordon Boyd

Abstract


Background: Acute and chronic neurological complications amongst survivors of critical illness is common, however, the underlying etiology of this neurological dysfunction is unknown. This is the first study to use near-infrared spectroscopy to non-invasively measure brain tissue oxygenation, as a surrogate marker of cerebral perfusion, and correlate these values with subsequent neurological dysfunction.  We will test the hypothesis that poor cerebral oxygenation during the first 24 hours of critical illness is correlated with acute and chronic neurological complications.

Methods: This single-centre prospective observational study will be performed in a 33-bed medical/surgical intensive care unit (ICU).  Adult patients are eligible for enrolment if they are admitted to the ICU within 24 hours, require mechanical ventilation, and/or vasopressor support.  For 24 hours, cerebral oxygenation levels will be measured with the FORESIGHT oximeter; vital signs and tissue oxygenation will be captured with data monitoring software.  Participants will be screened daily for delirium with the confusion assessment method-ICU.  Long-term neurological function will be assessed with the Repeatable Battery for the Assessment of Neuropsychological Status and the kinesiological instrument for normal and altered reaching movements (KINARM) robot.

Conclusions: This study will provide novel information regarding the determinants of cerebral oxygenation during the acute phase (i.e. 24 hours) of critical illness, and its potential relationship with subsequent neurological complications.  Should a relationship exist between cerebral oxygenation and neurological complications, future studies will be aimed at using brain tissue oxygenation as a therapeutic target to prevent acute and chronic neurological dysfunction.

 

Clinical Trial Registration: This trial is registered on clinicaltrials.gov (Identifier: NCT02344043), retrospectively registered January 8, 2015.


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References


Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill. Curr. Opin Crit Care. 2005;11:360-8.

Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the Intensive Care Unit: executive summary. Am J Health Syst. Pharm. 2013;70,53-8.

Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care. 2008;12(3):3.

Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306-16.

Suchyta MR, Jephson A, Hopkins RO. Neurologic changes during critical illness: brain imaging findings and neurobehavioral outcomes. Brain Imaging Behav. 2010;4:22-34.

Semmler A, Widmann CN, Okulla T, Urbach H, Kaiser M, Widman G, et al. Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. J Neurol Neurosurg Psychiatry. 2013;84:62-9.

Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787-94.

Zhang K, Mao X, Fang Q, Jin Y, Cheng B,Xie G, et al. Impaired long-term quality of life in survivors of severe sepsis : Chinese multicenter study over 6 years. Anaesthesist. 2013;62:995-1002.

Wilcox ME, Brummel NE, Archer K, Ely EW, Jackson JC, Hopkins RO. Cognitive dysfunction in ICU patients: risk factors, predictors, and rehabilitation interventions. Crit Care Med. 2013;41;81-98.

Wolters AE, Slooter AJC, van der Kooi AW, Van Dijk D. Cognitive impairment after intensive care unit admission: a systematic review. Intensive Care Med. 2013;39:376-6.

Coderre AM, Zeid AA, Dukelow SP, Demmer MJ, Moore KD, Demers MJ, et al. Assessment of upper-limb sensorimotor function of subacute stroke patients using visually guided reaching. Neurorehabil Neural Repair. 2010;24:528-41.

Dukelow SP, Herter TM, Moore KD, Demers MJ, Glasgow JI, Bagg SD, et al. Quantitative assessment of limb position sense following stroke. Neurorehabil Neural Repair. 2010;24:178-87.

Dukelow SP, Herter TM, Bagg SD, Scott SH. The independence of deficits in position sense and visually guided reaching following stroke. J Neuroeng Rehabil. 2012;9:72.

Debert CT, Herter TM, Scott SH, Dukelow S. Robotic assessment of sensorimotor deficits after traumatic brain injury. J Neurol Phys Ther. 2012;36:58-67.

Williams L, Jackson CPT, Choe N, Pelland L, Scott SH, Reynolds JN. Sensory-motor deficits in children with fetal alcohol spectrum disorder assessed using a robotic virtual reality platform. Alcohol Clin Exp Res. 2014;38:116-25.

Taillefer MC, Denault AY. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anaesth. 2005;52:79-87.

Wood MD, Song A, Maslove D, Ferri C, Howes D. Muscedere J, et al. Brain tissue oxygenation in patients with septic shock: a feasibility study. Can J Neurol Sci. 2016;43(1):65-73.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2013;39:165-228.

Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, Lisa May RN, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286:2703-10.

Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29:1370-9.

Gusmao-Flores D, Figueira Salluh JI, Chalhub R, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care. 2012;16:115.

Randolph C, Tierney MC, Mohr E, Chase TN. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol. 1998;20:310-9.

Tyryshkin K, Coderre AM, Glasgow JI, Herter TM, Bagg SD, et al. A robotic object hitting task to quantify sensorimotor impairments in participants with stroke. J Neuroeng Rehabil. 2014;11:47.

Lowrey CR, Jackson C, Jackson CPT, Bagg SD, Dukelow SP, Scott SH. A Novel Robotic Task for Assessing Impairments in Bimanual Coordination Post-Stroke. Int J Phys Med. 2014;3:2-10.

Berch DB, Krikorian R, Huha EM. The Corsi block-tapping task: methodological and theoretical considerations. Brain Cogn. 1998;38:317-38.

Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the Intensive Care Unit: executive summary. Am J Heal Syst Pharm. 2013;70:53-8.