Abstract：
Spontaneous hyperventilation (SHV) is common in aneurysmal subarachnoid haemorrhage (aSAH). The reduction in arterial partial pressure of carbon dioxide (PaCO2) may change the brain physiology, such as haemodynamics, oxygenation, metabolism and may lead to secondary brain injury. However, how to correct SHV safely and effectively in patients with aSAH has not been well investigated. The aim of this study is to investigate the efficacy and safety of remifentanil dose titration to correct hyperventilation in aSAH, as well as the effect of changes in PaCO2 on cerebral blood flow (CBF).
This study is a prospective, single-centre, physiological study in patients with aSAH. The patients who were mechanically ventilated and who meet with SHV (tachypnoea combined with PaCO2 <35 mm Hg and pH >7.45) will be enrolled. The remifentanil will be titrated to correct the SHV. The predetermined initial dose of remifentanil is 0.02 μg/kg/min and will be maintained for 30 min, and PaCO2 and CBF will be measured. After that, the dose of remifentanil will be sequentially increased to 0.04, 0.06, and 0.08 μg/kg/min, and the measurements for PaCO2 and CBF will be repeated 30 min after each dose adjustment and will be compared with their baseline values.
This study has been approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University (KY 2021-006-02) and has been registered at ClinicalTrials.gov. The results of this study will be disseminated through peer-reviewed publications and conference presentations.
NCT04940273.
This study is a prospective, single-centre, physiological study in patients with aSAH. The patients who were mechanically ventilated and who meet with SHV (tachypnoea combined with PaCO2 <35 mm Hg and pH >7.45) will be enrolled. The remifentanil will be titrated to correct the SHV. The predetermined initial dose of remifentanil is 0.02 μg/kg/min and will be maintained for 30 min, and PaCO2 and CBF will be measured. After that, the dose of remifentanil will be sequentially increased to 0.04, 0.06, and 0.08 μg/kg/min, and the measurements for PaCO2 and CBF will be repeated 30 min after each dose adjustment and will be compared with their baseline values.
This study has been approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University (KY 2021-006-02) and has been registered at ClinicalTrials.gov. The results of this study will be disseminated through peer-reviewed publications and conference presentations.
NCT04940273.
摘要：
自发性过度通气（SHV）常见于动脉瘤性蛛网膜下腔出血（aSAH）。二氧化碳的动脉分压（PaCO2）的降低可能会改变大脑的生理机能，比如血液动力学，氧合，代谢，并可能导致继发性脑损伤。然而,如何安全有效地纠正aSAH患者的SHV尚未得到很好的研究.这项研究的目的是探讨瑞芬太尼剂量滴定纠正aSAH过度通气的有效性和安全性。以及PaCO2变化对脑血流量（CBF）的影响。
这项研究是前瞻性的，单中心,aSAH患者的生理研究。将招募机械通气并符合SHV（呼吸急促伴PaCO2<35mmHg和pH>7.45）的患者。瑞芬太尼将被滴定以校正SHV。瑞芬太尼的预定初始剂量为0.02μg/kg/min，并将维持30分钟，将测量PaCO2和CBF。之后,瑞芬太尼的剂量将依次增加到0.04、0.06和0.08μg/kg/min，PaCO2和CBF的测量将在每次剂量调整后30分钟重复进行，并将其与基线值进行比较。
本研究已获北京天坛医院机构审查委员会批准，首都医科大学（KY2021-006-02），并已在ClinicalTrials.gov注册。这项研究的结果将通过同行评审的出版物和会议演讲进行传播。
NCT04940273。
这项研究是前瞻性的，单中心,aSAH患者的生理研究。将招募机械通气并符合SHV（呼吸急促伴PaCO2<35mmHg和pH>7.45）的患者。瑞芬太尼将被滴定以校正SHV。瑞芬太尼的预定初始剂量为0.02μg/kg/min，并将维持30分钟，将测量PaCO2和CBF。之后,瑞芬太尼的剂量将依次增加到0.04、0.06和0.08μg/kg/min，PaCO2和CBF的测量将在每次剂量调整后30分钟重复进行，并将其与基线值进行比较。
本研究已获北京天坛医院机构审查委员会批准，首都医科大学（KY2021-006-02），并已在ClinicalTrials.gov注册。这项研究的结果将通过同行评审的出版物和会议演讲进行传播。
NCT04940273。
