RecruitingNot ApplicableNCT06219889

Short-term And Longer-term Cognitive Impact Of Neurochecks

Short-term And Longer-term Cognitive Impact Of Hourly Neurochecks In Acute Brain Injury

Sponsor

University of California, San Diego

Enrollment

120 participants

Start Date

Jul 8, 2024

Study Type

INTERVENTIONAL

Conditions

Intracerebral Hemorrhage

Summary

The proposed research plan seeks to understand the impact of sleep disruption in the Neurological Intensive Care Unit (ICU) on older patients with acute brain injury (ABI). In current practice, the neurocritical care community performs frequent serial neurological examinations ("neurochecks") in an effort to monitor patients for neurological deterioration following brain injury. Many neurocritical patients are older and/or cognitively fragile, and delirium is common. Although ICU delirium is multifaceted, frequent neurochecks may represent a modifiable risk factor if the investigators can better understand the risks and benefits of various neurocheck frequencies. This project will randomize patients with acute spontaneous intracerebral hemorrhage (ICH) to either hourly (Q1) or every-other-hour (Q2) neurochecks and evaluate the impact of neurocheck frequency on delirium. Second, longer-term cognitive outcomes will be investigated in patients with ICH randomized to Q1 versus Q2 neurochecks with the goal of identifying whether hourly neurochecks increase the risk for dementia.

Eligibility

Min Age: 18 YearsMax Age: 100 Years

Inclusion Criteria4

Adult patients (age >18 years) with spontaneous acute <45cc in volume with radiographic and clinical stability for ≥6 hours following admission to the ICU. These criteria are based on the literature and experience of the investigative team.
Additional intraventricular hemorrhage (with or without external ventricular drain) is allowable.
Only first admission to the NeuroICU during the hospitalization will be eligible.
a. any patient included in part 1 alive at 6 months post-discharge

Exclusion Criteria10

Patients with unstable intracranial bleeding
Patients with known history of intracranial neurological injury
Pre-existing cognitive impairment (known or highly suspected based on family-provided history, Activities of Daily Living Questionnaire)
Pre-existing diagnosed sleep disorder
Comatose or heavily sedated
Death expected within 30 days or other terminal illness
ICH score >4 (equivalent to mortality risk >72%)
Pregnancy
Incarcerated
Non-English or non-Spanish speaking