CONFOCAL-2: Cerebral Oxygenation and Neurological Outcomes FOllowing CriticAL Illness-2

Sponsor
Queen's University (Other)
Overall Status
Recruiting
CT.gov ID
NCT03141619
Collaborator
University Health Network, Toronto (Other), Vancouver General Hospital (Other), University of Western Ontario, Canada (Other), University of Ottawa (Other), Université de Montréal (Other), University of Calgary (Other), University of Pittsburgh (Other)
500
1
91.6
5.5

Study Details

Study Description

Brief Summary

This study is designed to test the hypothesis that poor cerebral perfusion during critical illness is a risk factor for acute and long-term neurological dysfunction among survivors. We use near-infrared spectroscopy to measure brain tissue oxygenation as a non-invasive surrogate marker for cerebral perfusion. Acute neurological dysfunction is defined as the presence of delirium, which is assessed using the Confusion Assessment Method-Intensive Care Unit (CAM-ICU). Chronic neurological dysfunction is defined as having quantitative impairments on robotic testing (KINARM robot) and traditional neuropsychological screening (Repeatable Battery for the Assessment of Neuropsychological Status).

Condition or Disease Intervention/Treatment Phase

    Study Design

    Study Type:
    Observational
    Anticipated Enrollment :
    500 participants
    Observational Model:
    Cohort
    Time Perspective:
    Prospective
    Official Title:
    Cerebral Oxygenation and Neurological Outcomes FOllowing CriticAL Illness-2
    Actual Study Start Date :
    Oct 13, 2017
    Anticipated Primary Completion Date :
    Jun 1, 2024
    Anticipated Study Completion Date :
    Jun 1, 2025

    Arms and Interventions

    Arm Intervention/Treatment
    Respiratory failure and/or shock

    All enrolled patients will undergo 72 hours of monitoring of cerebral oxygenation with near-infrared spectroscopy.

    Outcome Measures

    Primary Outcome Measures

    1. Regional cerebral oxygenation (rSO2) and delirium [30 days]

      Multivariate linear regression will be used to characterize the association between poor cerebral perfusion (as measured using duration of time (minutes) outside of MAPOPT, mean rSO2, and duration of disturbed cerebral autoregulation) and delirium severity to determine if poor cerebral perfusion is an independent predictor of delirium severity. We will estimate the unadjusted effect of each individual predictor on delirium severity (i.e., cumulative CAM-7 scores per patient). The simultaneous multivariate regression model will adjust for the following covariates (sex, a history of hypertension, a history of alcohol abuse, total sedative dose (in midazolam equivalents), total narcotic dose (fentanyl equivalents), severity of illness (APACHE II scores), pre-existing cognitive impairment (CDR score), length of ICU stay, and blood urea nitrogen. The multivariable model will provide the adjusted regression coefficients after controlling for all predictors included in the model.

    Secondary Outcome Measures

    1. Assessment of secondary outcomes-physiological determinants of cerebral oxygenation [72 hours]

      To assess the physiological determinants of rSO2, multiple linear regression will be performed using the patient average of each variable over the 72 hour data collection period. The following predictors will be included in the regression model: heart rate (HR), arterial oxygen saturation (SpO2), MAP, arterial blood gas data (i.e., pH, partial pressure of oxygen, and partial pressure of carbon dioxide), central venous oxygen saturation, and hemoglobin concentration (Hb). In addition, the multivariate model will control for the following covariates associated with cerebral perfusion: sex, age, as well as total sedative, narcotic, and vasopressor dosing. Simultaneous multiple linear regression with adjustment for all aforementioned covariates will be implemented. A within patient repeated measures analysis will also be performed by using the linear mixed effects model with 6 observations per subject reflecting each 12 hour period during the 72 hour data collection period.

    2. Cerebral oxygenation as an independent risk factor for long-term cognitive impairment-RBANS [3 months and 12 months]

      Multiple linear regression analysis will be used to assess if poor cerebral perfusion (i.e. time below MAPOPT, mean rSO2, duration of disturbed cerebral autoregulation) is associated with RBANS global cognition scores at 3- and 12-months post-ICU discharge. We will use the following clinical covariates collected on admission (i.e., pre-existing cognitive impairment, age, severity of illness) and data collected within the first 72 hours of the patients' ICU stay (i.e., narcotic dosing and benzodiazepine dosing). All covariates will be adjusted for in separate regression models for the cognitive outcomes at 3- and 12-months post-ICU discharge. If global cognition is significantly predicted by the impaired cerebral perfusion, we will conduct an exploratory analysis of the RBANS subdomains of cognition (i.e., delay and immediate memory, language, attention, visuospatial/constructional) adjusting for the aforementioned covariates to further explore specific domains of impairment.

    Other Outcome Measures

    1. Time outside optimal MAP [72h, 3- and 12-months]

      We define the optimal MAP as the MAP at which there is no statistically significant correlation between MAP and rSO2. The time outside the optimal MAP will be calculated, and will be assessed as an independent predictor of delirium, and 3- and 12-month cognitive outcomes.

    2. Robotic quantification of neurological recovery [3 and 12 months]

      A the Kingston site, participants will undergo additional neurological assessments with the KINARM robot and associated tasks. This data will be analyzed descriptively

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No

    Inclusion

    1. Adults ≥ 18 years old

    2. Admitted to a critical care unit requiring one or more of the following:

    (a) Respiratory failure requiring invasive mechanical ventilation with an expected duration >24 hours (b) Shock of any etiology. Shock is defined by the need for one of the following vasopressors/inotropes: (i) Dopamine ≥7.5 mcg/kg/min (ii) Dobutamine ≥5 mcg/kg/min (iii) Norepinephrine ≥5 mcg/min (iv) Phenylephrine ≥75 mcg/min (v) Epinephrine at any dose (vi) Milrinone at any dose (if used in conjunction with another agent) (vii) Vasopressin ≥0.03 u/min(if used in conjunction with another agent)

    Exclusion:
    1. Admission to the ICU > 24 hours

    2. Life expectancy <24 hours

    3. Admitting diagnosis that affects the central nervous system

    4. Any reason that the subject may not be able to participate in the follow up assessments (i.e. limb amputation, paresis, neuromuscular disorders)

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Kingston General Hospital Kingston Ontario Canada K7L3V7

    Sponsors and Collaborators

    • Queen's University
    • University Health Network, Toronto
    • Vancouver General Hospital
    • University of Western Ontario, Canada
    • University of Ottawa
    • Université de Montréal
    • University of Calgary
    • University of Pittsburgh

    Investigators

    • Principal Investigator: J. Gordon Boyd, MD, PhD, Queen's University

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Dr. Gordon Boyd, Assistant Professor, Queen's University
    ClinicalTrials.gov Identifier:
    NCT03141619
    Other Study ID Numbers:
    • CTO Project ID 0815
    First Posted:
    May 5, 2017
    Last Update Posted:
    Aug 19, 2022
    Last Verified:
    Aug 1, 2022
    Individual Participant Data (IPD) Sharing Statement:
    Undecided
    Plan to Share IPD:
    Undecided
    Studies a U.S. FDA-regulated Drug Product:
    No
    Studies a U.S. FDA-regulated Device Product:
    No
    Product Manufactured in and Exported from the U.S.:
    No
    Keywords provided by Dr. Gordon Boyd, Assistant Professor, Queen's University
    Additional relevant MeSH terms:

    Study Results

    No Results Posted as of Aug 19, 2022