University of Pennsylvania
Traumatic brain injury (TBI) causes acute deficits in cerebral perfusion which may lead to secondary injury and worse outcomes. Inhaled nitric oxide (iNO) is a vasodilator that increases cerebral blood flow and is clinically used for hypoxic respiratory failure in neonates and adults. The investigators will perform a randomized controlled trial of iNO treatment in TBI patients acutely after injury. The investigators will then assess perfusion changes with optic neuromonitoring, blood biomarkers, and 6 month clinical outcomes.
The objective of this study is to show that inhaled nitric oxide can increase blood flow in the brain after traumatic brain injury, attenuating brain injury and resulting in improved long-term function. The investigators will use optical brain monitoring to determine changes in cerebral perfusion and metabolism by iNO treatment in TBI subjects. Within 24 hours of enrollment, TBI subjects meeting the inclusion criteria without exclusion criteria will undergo 8 hour sessions of monitoring (4 hours on iNO, 4 hours on standard respiratory therapy) for 4 days. During this time, Noninvasive Neuro-o…
Inclusion Criteria: 1. Aged 18-75 (inclusive) 2. GCS 9-12 or GCS 13-15 with an abnormal imaging scan 3. Radiologic findings indicative of primarily diffuse TBI Exclusion Criteria: 1. Severe cardiac dysfunction (e.g. elevation of pulmonary edema on chest xray, large elevation of cardiac enzymes) 2. Large focal injury (subdural hematoma, epidural hematoma, intraparenchymal hematoma, \>30mL aggregate volume). 3. Need for immediate neurosurgical intervention 4. Pre-existing disabling psychiatric or neurological disorders such as cortical stroke, brain tumor, disabling multiple sclerosis, dement…
iNO will be provided by ventilator or nasal cannula for 4 hours each day.
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