BOOST 2: Brain Tissue Oxygen Monitoring in Traumatic Brain Injury (TBI)

• Sponsor: University of Pennsylvania (Other)
• Overall Status: Completed
• CT.gov ID: NCT00974259
• Collaborator: University of Washington (Other), University of Miami (Other), University of Pittsburgh (Other), Duke University (Other), Ohio State University (Other), Temple University (Other), Thomas Jefferson University (Other), University of Cincinnati (Other), National Institute of Neurological Disorders and Stroke (NINDS) (NIH)
• Enrollment: 122
• Locations: 10
• Arms: 2
• Duration (Months): 62
• Patients Per Site: 12.2
• Patients Per Site Per Month: 0.2

Study Details

Study Description

Brief Summary

Traumatic brain injury (TBI) is a major cause of death and disability, with an estimated cost of 45 billion dollars a year in the United States alone. Every year, approximately 1.4 million sustain a TBI, of which 50,000 people die, and another 235,000 are hospitalized and survive the injury. As a result, 80,000-90,000 people experience permanent disability associated with TBI. This project is designed to determine whether a device designed to measure brain tissue oxygenation and thus detect brain ischemia while it is still potentially treatable shows promise in reducing the duration of brain ischemia, and to obtain information required to conduct a definitive clinical trial of efficacy.

A recently approved device makes it feasible to directly and continuously monitor the partial pressure of oxygen in brain tissue (pBrO2). Several observational studies indicate that episodes of low pBrO2 are common and are associated with a poor outcome, and that medical interventions are effective in improving pBrO2 in clinical practice. However, as there have been no randomized controlled trials carried out to determine whether pBrO2 monitoring results in improved outcome after severe TBI, use of this technology has not so far been widely adopted in neurosurgical intensive care units (ICUs). This study is the first randomized, controlled clinical trial of pBrO2 monitoring, and is designed to obtain data required for a definitive phase III study, such as efficacy of physiologic maneuvers aimed at treating pBrO2, and feasibility of standardizing a complex intensive care unit management protocol across multiple clinical sites.

Patients with severe TBI will be monitored with Intracranial pressure monitoring (ICP) and pBrO2 monitoring, and will be randomized to therapy based on ICP along (control group) or therapy based on ICP in addition to pBrO2 values (treatment group). 182 participants will be enrolled at four clinical sites, the University of Texas Southwestern Medical Center/Parkland Memorial Hospital, the University of Washington/Harborview Medical Center, the University of Miami/Jackson Memorial Hospital, and the University of Pennsylvania/Hospital of the University of Pennsylvania. Functional outcome will be assessed at 6-months after injury.

Condition or Disease	Intervention/Treatment	Phase
Severe Traumatic Brain Injury	Device: Management protocol based on pBrO2 and ICP values.; Device: Management protocol based on ICP values only.	Phase 2

Detailed Description

Design and Outcomes

This study is a two-arm, single-blind, randomized, controlled, phase II, multi-center pilot trial of the efficacy of pBrO2 monitoring, and is designed to obtain data required for a definitive phase III study, such as efficacy of physiologic maneuvers aimed at normalizing pBrO2. 182 patients with severe TBI who require ICP monitoring will be recruited into this study at 4 clinical sites in the US (Univ. of Texas Southwestern/Parkland Memorial Hospital, Univ. of Washington/Harborview Medical Center, Univ. of Miami/Jackson Memorial Hospital, and Univ. of Pennsylvania/Hospital of the Univ. of Pennsylvania). All patients will have both ICP monitors and pBrO2 monitors inserted through the same burr hole. Half of the patients will be randomized to a treatment protocol based on both ICP and pBrO2 readings, while the control group will be randomized to a treatment protocol based only on ICP readings. The pBrO2monitors of the control arm will be masked, so that the treating physicians will be unaware of the pBrO2 information. Patients will have telephone follow-up interview to assess their level of recovery 6 months post injury, using the Glasgow Outcome Scale-Extended.

Interventions and Duration

Patients randomized to the control group will have pBrO2 implanted in a similar fashion as patients in the treatment group, but after calibration of the device, the display will be covered with opaque tape. Patients in the control will be treated with a protocol based on ICP measures only. Patients in the treatment group (both ICP and pBrO2 measures are visible) will be treated according to a protocol that incorporates both ICP and pBrO2 measures. The treatment protocols are based on current standards of care, but are described in detail to insure uniformity in treatments across the 4 study sites.

The probe will remain in place for a maximum or 5 days, until all values are normal for 48 hours, or sooner if a complication arises. If the patient has normal values, monitors will be removed after 48 hours.

Objectives

Primary Objective: The prescribed treatment protocol, based on pBrO2 monitoring, results in reduction of the fraction of time that brain oxygen levels are below the critical threshold of 20 mm Hg in patients with severe traumatic brain injury.

Secondary Objectives:

• Safety hypotheses: Adverse events associated with pBrO2 monitoring are rare.

• Feasibility hypotheses: Episodes of decreased pBrO2 can be identified and treatment protocol instituted comparably across 4 clinical sites, and protocol violations will be low (<10%) and uniform across different clinical sites.

• Non-futility hypothesis: A relative risk of good outcome measured by the Glasgow Outcome Scale-Extended 6 months after injury of 2.0 is consistent with the results of this phase II study.

Study Design

• Study Type: Interventional
• Actual Enrollment: 122 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Phase 2, Randomized Clinical Trial of the Safety and Efficacy of Brain Tissue Oxygen Monitoring in the Management of Severe Traumatic Brain Injury.
• Study Start Date: Oct 1, 2009
• Actual Primary Completion Date: Mar 1, 2014
• Actual Study Completion Date: Dec 1, 2014

Arms and Interventions

Arm	Intervention/Treatment
Experimental: pBrO2 and ICP management Treatment protocol based on pBrO2 and ICP values.	Device: Management protocol based on pBrO2 and ICP values.; For patients who experience falls in pBrO2 below 20 mm Hg, a hierarchical treatment algorithm will be instituted, adapted from published recommendations49. In principle, episodes requiring therapy will fall into one of 4 scenarios (scenario A, B, C, and D, defined in figure 7), which will require different management strategies. The treatment protocol depends on which type of episode is being treated. Treatment is triggered by abnormalities in either ICP (> 20 mm Hg) or pBrO2 (< 20 mm Hg) are noted. Elevations in ICP above 20 mm Hg or decline in pBrO2 below 20 mm Hg for more than 5 minutes will trigger a treatment intervention. Treatment is directed to an episode. Patients may start in one type of episode and move to another. Therapy will depend on which type of episode they are in at any given time.; Other Names: Licox Camino
Active Comparator: ICP management Treatment protocol based on ICP values only.	Device: Management protocol based on ICP values only.; For the patients randomized to ICP treatment alone, only Scenario A and Scenario B episodes are relevant.; Other Names: Camino

Outcome Measures

Primary Outcome Measures

1. Fraction of Time That Brain Oxygen Levels Are Below the Critical Threshold of 20 mm Hg . [5 days]

   Proportion of time PbtO2 below 20 mm Hg

Secondary Outcome Measures

1. Total Number Participants With Adverse Events Associated With PbtO2 Monitoring. [5 days]

   Total number participants with PbtO2 directed intervention-related Serious Adverse Events

2. Adherence to PbtO2 and ICP-directed Treatment Protocol [5 days]

   Number of protocol deviations and violations for ICP/PbtO2 group and ICP only group. The unit of measure for this outcome is number of events, where an event can be either a deviation or a violation.

3. Relative Risk of Good Outcome of ICP/PbtO2 Group Compared to ICP Only Group. [6 months]

   Dichotomized Glagow Outcome Score-Extended: GOSE 1-4 = Poor Outcome GOSE 5-8 = Good Outcome GOSE is a 8-point scale, with 1 = death, 8 = full recovery.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years to 70 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

1. Non-penetrating traumatic brain injury

2. Requirement for intracranial pressure monitoring according to Guidelines for the

Management of Severe TBI, as operationalized below:

• GCS 3-8 (measured off sedatives or paralytics) with abnormal CT scan. If patient is intubated, motor GCS < 4 required.

• If CT scan normal, motor GCS < 4 (measured off sedatives or paralytics)

• Intoxication is not a reason for deferring ICP monitoring if above criteria are met.

• If the patient has a witnessed seizure, wait 30 minutes to evaluate GCS.

1. Randomization and placement of monitors within 12 hours of injury.

2. Males and females Age 18-70 years, English or Spanish speaking patients.

Exclusion Criteria:

1. Specific clinical contraindications:

• GCS motor score > 4 with normal CT scan

• Bilaterally absent pupillary responses

1. Laboratory contraindications per safety considerations:

Coagulopathy that makes insertion of parenchymal monitors contraindicated (Platelets < 50,000/mL, INR > 1.4) (Enrollment allowed if coagulopathy can be corrected before 12 hour post-injury deadline).

1. Pregnant females will be excluded. Blood test for pregnancy is a routine part of care in ED's. However, if not done, a urine or blood test will be done as a safety precaution after consent but prior to study treatment.

2. Monitoring with pBrO2 monitor prior to randomization.

3. Clinical, demographic and other characteristics that precludes appropriate diagnosis, treatment or follow-up in the trial.

• Systemic sepsis at the time of screening

• Refractory hypotension (SBP < 70 mm Hg for > 30 minutes)

• Refractory systemic hypoxia (paO2 < 60 mm Hg on FiO2 < 0.5)

• Evidence of premorbid disabling conditions that interfere with outcome assessment. These include diagnosis of Alzheimer's disease, Parkinson's disease, multiple sclerosis, spinal cord injury with deficits, history of stroke, brain tumors, chronic use of medication for disabling neurologic or psychiatric disorder, or history of suicide attempt within the past year.

• Imminent death or current life-threatening disease

• Prisoner

• Individuals who hold religious beliefs against blood transfusion

• Previous TBI hospitalization greater than 1 day

• Patients who are unlikely to be available for follow-up interview, even by telephone. for example, patients who are homeless, illegal aliens, or live in foreign countries and those with whom future personal (including family) or telephone contact is unlikely.

1. Active drug or alcohol use or dependence that, in the opinion of the stie investigator, would interfere with follow-up.

2. Imminent death or current life-threatening disease

3. Inability or unwillingness of subject or legal guardian/representative to give written informed consent

4. Participation in other observational or interventional clinical trials is allowed as long as the PI of each study agree ahead of time to allow co-enrollment.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Miami/Jackson Memorial Hospital	Miami	Florida	United States	33136
2	Duke University	Durham	North Carolina	United States	27710
3	University of Cincinnati	Cincinnati	Ohio	United States
4	Ohio State University	Columbus	Ohio	United States
5	University of Pennsylvania	Philadelphia	Pennsylvania	United States	19107
6	Temple University	Philadelphia	Pennsylvania	United States
7	Thomas Jefferson University	Philadelphia	Pennsylvania	United States
8	University of Pittsburgh	Pittsburgh	Pennsylvania	United States
9	University of Texas Southwestern Medical Center	Dallas	Texas	United States	75390
10	University of Washington/Harborview Medical Center	Seattle	Washington	United States	98104

Sponsors and Collaborators

• University of Pennsylvania
• University of Washington
• University of Miami
• University of Pittsburgh
• Duke University
• Ohio State University
• Temple University
• Thomas Jefferson University
• University of Cincinnati
• National Institute of Neurological Disorders and Stroke (NINDS)

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Ramon Diaz-Arrastia, Professor of Neurology, University of Pennsylvania
• ClinicalTrials.gov Identifier: NCT00974259
• Other Study ID Numbers: R01NS061860; R01NS061860; R01NS061860-01A2
• First Posted: Sep 10, 2009
• Last Update Posted: Sep 26, 2019
• Last Verified: Sep 1, 2019

• Keywords provided by Ramon Diaz-Arrastia, Professor of Neurology, University of Pennsylvania: Hypoxia; Ischemia; Intracranial hypertension; Neurocritical care
• Additional relevant MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Wounds and Injuries

Study Results

Participant Flow

Recruitment Details	Patients with severe TBI who required ICP monitoring were screened at 10 Level 1 trauma centers . Patients admitted with an initial GCS greater than 8 who deteriorated neurologically (within 48 hr of injury) from a presumptive could also be enrolled provided randomization and ICP monitor placement occurred within 12 hours of deterioration.

Arm/Group Title	pBrO2 and ICP Management	ICP Management
Arm/Group Description	Treatment protocol based on pBrO2 and ICP values. Management protocol based on pBrO2 and ICP values.: For patients who experience falls in pBrO2 below 20 mm Hg, a hierarchical treatment algorithm will be instituted, adapted from published recommendations49. In principle, episodes requiring therapy will fall into one of 4 scenarios (scenario A, B, C, and D, defined in figure 7), which will require different management strategies. The treatment protocol depends on which type of episode is being treated. Treatment is triggered by abnormalities in either ICP (> 20 mm Hg) or pBrO2 (< 20 mm Hg) are noted. Elevations in ICP above 20 mm Hg or decline in pBrO2 below 20 mm Hg for more than 5 minutes will trigger a treatment intervention. Treatment is directed to an episode. Patients may start in one type of episode and move to another. Therapy will depend on which type of episode they are in at any given time.	Treatment protocol based on ICP values only. Management protocol based on ICP values only.: For the patients randomized to ICP treatment alone, only Scenario A and Scenario B episodes are relevant.
Period Title: Overall Study
STARTED	59	63
COMPLETED	57	62
NOT COMPLETED	2	1

Baseline Characteristics

Arm/Group Title	pBrO2 and ICP Management	ICP Management	Total
Arm/Group Description	Treatment protocol based on pBrO2 and ICP values. Management protocol based on pBrO2 and ICP values.: For patients who experience falls in pBrO2 below 20 mm Hg, a hierarchical treatment algorithm will be instituted, adapted from published recommendations49. In principle, episodes requiring therapy will fall into one of 4 scenarios (scenario A, B, C, and D, defined in figure 7), which will require different management strategies. The treatment protocol depends on which type of episode is being treated. Treatment is triggered by abnormalities in either ICP (> 20 mm Hg) or pBrO2 (< 20 mm Hg) are noted. Elevations in ICP above 20 mm Hg or decline in pBrO2 below 20 mm Hg for more than 5 minutes will trigger a treatment intervention. Treatment is directed to an episode. Patients may start in one type of episode and move to another. Therapy will depend on which type of episode they are in at any given time.	Treatment protocol based on ICP values only. Management protocol based on ICP values only.: For the patients randomized to ICP treatment alone, only Scenario A and Scenario B episodes are relevant.	Total of all reporting groups
Overall Participants	57	62	119
Age (Count of Participants)
<=18 years	0 0%	0 0%	0 0%
Between 18 and 65 years	57 100%	62 100%	119 100%
>=65 years	0 0%	0 0%	0 0%
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	37.8 (17.2)	36.2 (17.5)	37.0 (17.3)
Sex: Female, Male (Count of Participants)
Female	11 19.3%	16 25.8%	27 22.7%
Male	46 80.7%	46 74.2%	92 77.3%
Race/Ethnicity, Customized (Count of Participants)
White	47 82.5%	53 85.5%	100 84%
Black	9 15.8%	11 17.7%	20 16.8%
Other	2 3.5%	2 3.2%	4 3.4%
Unknown	3 5.3%	0 0%	3 2.5%
Injury Type--Closed Head Injury (Count of Participants)
Count of Participants [Participants]	56 98.2%	62 100%	118 99.2%
Glasgow Come Scale-Motor (units on a scale) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [units on a scale]	3.6 (1.5)	3.7 (1.5)	3.7 (1.5)
Craniectomy (Count of Participants)
Count of Participants [Participants]	12 21.1%	18 29%	30 25.2%

Outcome Measures

1. Primary Outcome

Title	Fraction of Time That Brain Oxygen Levels Are Below the Critical Threshold of 20 mm Hg .
Description	Proportion of time PbtO2 below 20 mm Hg
Time Frame	5 days

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	pBrO2 and ICP Management	ICP Management
Arm/Group Description	Treatment protocol based on pBrO2 and ICP values. Management protocol based on pBrO2 and ICP values.: For patients who experience falls in pBrO2 below 20 mm Hg, a hierarchical treatment algorithm will be instituted, adapted from published recommendations49. In principle, episodes requiring therapy will fall into one of 4 scenarios (scenario A, B, C, and D, defined in figure 7), which will require different management strategies. The treatment protocol depends on which type of episode is being treated. Treatment is triggered by abnormalities in either ICP (> 20 mm Hg) or pBrO2 (< 20 mm Hg) are noted. Elevations in ICP above 20 mm Hg or decline in pBrO2 below 20 mm Hg for more than 5 minutes will trigger a treatment intervention. Treatment is directed to an episode. Patients may start in one type of episode and move to another. Therapy will depend on which type of episode they are in at any given time.	Treatment protocol based on ICP values only. Management protocol based on ICP values only.: For the patients randomized to ICP treatment alone, only Scenario A and Scenario B episodes are relevant.
Measure Participants	57	62
Mean (Standard Deviation) [Proportion]	0.15 (0.21)	0.44 (0.31)

2. Secondary Outcome

Title	Total Number Participants With Adverse Events Associated With PbtO2 Monitoring.
Description	Total number participants with PbtO2 directed intervention-related Serious Adverse Events
Time Frame	5 days

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	pBrO2 and ICP Management	ICP Management
Arm/Group Description	Treatment protocol based on pBrO2 and ICP values. Management protocol based on pBrO2 and ICP values.: For patients who experience falls in pBrO2 below 20 mm Hg, a hierarchical treatment algorithm will be instituted, adapted from published recommendations49. In principle, episodes requiring therapy will fall into one of 4 scenarios (scenario A, B, C, and D, defined in figure 7), which will require different management strategies. The treatment protocol depends on which type of episode is being treated. Treatment is triggered by abnormalities in either ICP (> 20 mm Hg) or pBrO2 (< 20 mm Hg) are noted. Elevations in ICP above 20 mm Hg or decline in pBrO2 below 20 mm Hg for more than 5 minutes will trigger a treatment intervention. Treatment is directed to an episode. Patients may start in one type of episode and move to another. Therapy will depend on which type of episode they are in at any given time.	Treatment protocol based on ICP values only. Management protocol based on ICP values only.: For the patients randomized to ICP treatment alone, only Scenario A and Scenario B episodes are relevant.
Measure Participants	57	62
Cardiovascular SAEs	9 15.8%	8 12.9%
Gastro-intestinal SAEs	1 1.8%	1 1.6%
Neurological SAEs	5 8.8%	10 16.1%
Respiratory SEAs	4 7%	1 1.6%
Other SAEs	8 14%	17 27.4%
Death Following withdrawal of medical care	8 14%	14 22.6%

3. Secondary Outcome

Title	Adherence to PbtO2 and ICP-directed Treatment Protocol
Description	Number of protocol deviations and violations for ICP/PbtO2 group and ICP only group. The unit of measure for this outcome is number of events, where an event can be either a deviation or a violation.
Time Frame	5 days

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	pBrO2 and ICP Management	ICP Management
Arm/Group Description	Treatment protocol based on pBrO2 and ICP values. Management protocol based on pBrO2 and ICP values.: For patients who experience falls in pBrO2 below 20 mm Hg, a hierarchical treatment algorithm will be instituted, adapted from published recommendations49. In principle, episodes requiring therapy will fall into one of 4 scenarios (scenario A, B, C, and D, defined in figure 7), which will require different management strategies. The treatment protocol depends on which type of episode is being treated. Treatment is triggered by abnormalities in either ICP (> 20 mm Hg) or pBrO2 (< 20 mm Hg) are noted. Elevations in ICP above 20 mm Hg or decline in pBrO2 below 20 mm Hg for more than 5 minutes will trigger a treatment intervention. Treatment is directed to an episode. Patients may start in one type of episode and move to another. Therapy will depend on which type of episode they are in at any given time.	Treatment protocol based on ICP values only. Management protocol based on ICP values only.: For the patients randomized to ICP treatment alone, only Scenario A and Scenario B episodes are relevant.
Measure Participants	57	62
Deviation: ICP 20-25 for > 30 min w/o Rx	95	71
Deviation: PbtO2 15-19 for > 30 min w/o Rx	24	0
Violation: ICP > 25 for > 30 min w/o Rx	7	14
Violation: PbtO2 < 15 for > 30 min w/o Rx	17	0

4. Secondary Outcome

Title	Relative Risk of Good Outcome of ICP/PbtO2 Group Compared to ICP Only Group.
Description	Dichotomized Glagow Outcome Score-Extended: GOSE 1-4 = Poor Outcome GOSE 5-8 = Good Outcome GOSE is a 8-point scale, with 1 = death, 8 = full recovery.
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	pBrO2 and ICP Management	ICP Management
Arm/Group Description	Treatment protocol based on pBrO2 and ICP values. Management protocol based on pBrO2 and ICP values.: For patients who experience falls in pBrO2 below 20 mm Hg, a hierarchical treatment algorithm will be instituted, adapted from published recommendations49. In principle, episodes requiring therapy will fall into one of 4 scenarios (scenario A, B, C, and D, defined in figure 7), which will require different management strategies. The treatment protocol depends on which type of episode is being treated. Treatment is triggered by abnormalities in either ICP (> 20 mm Hg) or pBrO2 (< 20 mm Hg) are noted. Elevations in ICP above 20 mm Hg or decline in pBrO2 below 20 mm Hg for more than 5 minutes will trigger a treatment intervention. Treatment is directed to an episode. Patients may start in one type of episode and move to another. Therapy will depend on which type of episode they are in at any given time.	Treatment protocol based on ICP values only. Management protocol based on ICP values only.: For the patients randomized to ICP treatment alone, only Scenario A and Scenario B episodes are relevant.
Measure Participants	57	62
GOSE 1	13 22.8%	18 29%
GOSE 2	1 1.8%	2 3.2%
GOSE 3	7 12.3%	5 8.1%
GOSE 4	10 17.5%	12 19.4%
GOSE 5	4 7%	4 6.5%
GOSE 6	5 8.8%	5 8.1%
GOSE 7	6 10.5%	4 6.5%
GOSE 8	7 12.3%	2 3.2%

Adverse Events

Arm/Group Title	pBrO2 and ICP Management		ICP Management
Arm/Group Description	Treatment protocol based on pBrO2 and ICP values. Management protocol based on pBrO2 and ICP values.: For patients who experience falls in pBrO2 below 20 mm Hg, a hierarchical treatment algorithm will be instituted, adapted from published recommendations49. In principle, episodes requiring therapy will fall into one of 4 scenarios (scenario A, B, C, and D, defined in figure 7), which will require different management strategies. The treatment protocol depends on which type of episode is being treated. Treatment is triggered by abnormalities in either ICP (> 20 mm Hg) or pBrO2 (< 20 mm Hg) are noted. Elevations in ICP above 20 mm Hg or decline in pBrO2 below 20 mm Hg for more than 5 minutes will trigger a treatment intervention. Treatment is directed to an episode. Patients may start in one type of episode and move to another. Therapy will depend on which type of episode they are in at any given time.		Treatment protocol based on ICP values only. Management protocol based on ICP values only.: For the patients randomized to ICP treatment alone, only Scenario A and Scenario B episodes are relevant.
All Cause Mortality
	pBrO2 and ICP Management		ICP Management
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	13/57 (22.8%)		18/62 (29%)
Serious Adverse Events
	pBrO2 and ICP Management		ICP Management
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	27/57 (47.4%)		34/62 (54.8%)
Cardiac disorders
Cardiovascular	9/57 (15.8%)	9	5/62 (8.1%)	5
Gastrointestinal disorders
Gastro-intestinal	1/57 (1.8%)	1	1/62 (1.6%)	1
General disorders
Pulmonary	4/57 (7%)	4	1/62 (1.6%)	1
Other	8/57 (14%)	8	17/62 (27.4%)	17
Nervous system disorders
Neurological	5/57 (8.8%)	5	10/62 (16.1%)	10
Other (Not Including Serious) Adverse Events
	pBrO2 and ICP Management		ICP Management
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	48/57 (84.2%)		55/62 (88.7%)
General disorders
Other	48/57 (84.2%)	48	55/62 (88.7%)	55

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.