An observational study in Subarachnoid Hemorrhage, Aneurysmal, Brain Injuries, Traumatic and Cerebral Hemorrhage, sponsored by University of Texas Southwestern Medical Center. Not yet recruiting at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-23.
Sponsored by University of Texas Southwestern Medical Center · Observational
This is a prospective observational cohort study of adult patients admitted to the Neurosciences Intensive Care Unit (NSICU) at UT Southwestern Medical Center. The study acquires multimodal neuromonitoring data - including SedLine quantitative EEG (qEEG) from standard-of-care monitoring, Brain4Care (B4C) noninvasive intracranial dynamics monitoring, and near-infrared spectroscopy (NIRS)-derived cerebral autoregulation (CA) indices where NIRS is already in clinical use - and links these data to bedside physiologic, medication, diagnostic, and clinical outcome variables during standard care. No alteration of clinical management occurs. The study prioritizes aneurysmal subarachnoid hemorrhage (aSAH) patients to characterize the natural history of noninvasive CA parameter evolution through the delayed cerebral ischemia (DCI) window (admission through Day 14) and provides preliminary data for subsequent interventional study design.
BACKGROUND: Patients admitted to the NSICU undergo rapid physiologic changes related to primary neurologic injury, secondary brain injury, sedation, mechanical ventilation, and evolving systemic illness. Cerebral autoregulation (CA) - the brain's intrinsic mechanism for maintaining stable perfusion across a range of systemic arterial pressures - is measurably impaired in aSAH, traumatic brain injury (TBI), intracerebral hemorrhage (ICH), and acute ischemic stroke. In aSAH, CA impairment during the 4-14 day post-rupture window is independently associated with delayed cerebral ischemia (DCI), the leading cause of preventable death and disability in survivors. Approximately 75% of aSAH patients require an external ventricular drain (EVD), which prevents standard ICP-based CA monitoring. B4C extensometry and NIRS-derived CA indices offer EVD-independent monitoring approaches whose feasibility and signal characteristics in aSAH have not been prospectively described.
DESIGN: Single-center prospective observational cohort study at the UT Southwestern NSICU. Eligible subjects may undergo B4C extensometry monitoring (the sole research-specific device under this protocol) and/or have research data recorded from existing standard-of-care clinical monitoring including SedLine qEEG, full-montage long-term monitoring EEG (where clinically ordered), NIRS, invasive ICP/CPP from EVD monitors, transcranial Doppler (TCD; standard of care for aSAH at UT Southwestern), and NeurOptics NPi automated pupillometry. The Moberg Clinical Platform (Moberg Analytics; FDA-cleared) serves as the primary data acquisition hub in the NSICU, aggregating synchronized high-resolution physiologic waveforms from existing bedside monitors without placing any additional research devices.
MONITORING MODALITIES:
Research device placed specifically for research purposes under this protocol:
- Brain4Care (B4C) extensometry: skull-mounted noninvasive sensor recording cranial compliance-related waveform morphology (P2/P1 ratio, Time to Peak), from which surrogate CA indices (nPRx, nCPPopt, nMx) are derived.
Standard-of-care clinical data recorded for research purposes (no additional devices placed):
ASAH PRIORITY ENROLLMENT: For aSAH patients, the protocol prioritizes monitoring through ICU Day 14 to characterize the natural history of B4C-derived and NIRS-derived CA index evolution through the DCI window. An optional 90-day follow-up captures functional and neurological outcomes beyond hospital discharge.
DATA MANAGEMENT: Subjects are assigned unique study identifiers. Direct identifiers are removed from analytic datasets. De-identified data may be shared with qualified external collaborators under executed data use agreements and with applicable IRB approval. De-identified data from this study may be combined with data from the companion NSICU Autonomic Modulation Study for analyses within the approved scope of both protocols.
510 studies on the registry are indexed under Subarachnoid Hemorrhage; 128 are open to participants now.
This study's planned enrollment of 300 is above the median of 120 across 226 observational studies indexed under Subarachnoid Hemorrhage.
Browse Subarachnoid Hemorrhage studies →University of Texas Southwestern Medical Center is the lead sponsor of 1,010 studies on the registry; 199 are open to participants now.
Of its 139 completed or terminated interventional studies of FDA-regulated products, 105 (76%) have results posted.
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Adult patients age 18 years or older admitted to the Neurosciences Intensive Care Unit (NSICU) at UT Southwestern Medical Center. The population is intentionally broad to support observational analyses across common neurocritical care diagnoses. aSAH patients are a priority enrollment group given the scientific objectives related to characterizing the natural history of noninvasive CA parameter evolution through the DCI window.
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adult patients age 18 years or older admitted to the NSICU at UT Southwestern Medical Center. Diagnostic groups include but are not limited to aneurysmal subarachnoid hemorrhage, traumatic brain injury, intracerebral hemorrhage, acute ischemic stroke, seizure-related presentations, postoperative neurosurgical patients, disorders of consciousness, and encephalopathy. aSAH patients represent the priority enrollment group. All participants have at least one monitoring modality acquired: B4C extensometry placed by study personnel, and/or research data recorded from existing standard-of-care SedLine, NIRS, TCD, or long-term monitoring EEG monitoring.
Proportion of enrolled participants with analyzable Brain4Care extensometry (P2/P1 ratio) recording across NSICU diagnoses
Percentage of enrolled participants with at least one successful Brain4Care (B4C) extensometry monitoring session yielding analyzable P2/P1 ratio data. Signal quality assessed by artifact burden and adequate waveform morphology. Reported as a single proportion compared across primary NSICU diagnostic groups (aSAH, TBI, ICH, stroke, other).
Time frame: Through ICU Day 14 or hospital discharge, whichever occurs first
Proportion of Brain4Care extensometry sessions with computable cerebral autoregulation indices (nPRx) across NSICU diagnoses
Percentage of Brain4Care (B4C) extensometry monitoring sessions from which the noninvasive pressure reactivity index (nPRx) can be computed from B4C waveforms and concurrent arterial blood pressure data. Reported as a single proportion compared across primary NSICU diagnostic groups (aSAH, TBI, ICH, stroke, other).
Time frame: Through ICU Day 14 or hospital discharge, whichever occurs first
NIRS-derived cerebral oximetry index (COx) trajectory through the delayed cerebral ischemia window in aSAH
Prospective characterization of near-infrared spectroscopy (NIRS)-derived cerebral oximetry index (COx; unitless, range -1 to +1) trajectory from NSICU admission through Day 14 in aSAH patients. Correlation of COx trajectory with DCI onset (clinical and imaging-confirmed) and neurological outcome at discharge, reported as Spearman correlation coefficients.
Time frame: ICU admission through Day 14 post-rupture
NIRS-derived optimal mean arterial pressure (MAPopt) trajectory through the delayed cerebral ischemia window in aSAH
Prospective characterization of near-infrared spectroscopy (NIRS)-derived optimal mean arterial pressure (MAPopt; reported in mmHg) trajectory from NSICU admission through Day 14 in aSAH patients. Correlation of MAPopt trajectory with DCI onset (clinical and imaging-confirmed) and neurological outcome at discharge, reported as Spearman correlation coefficients.
Time frame: ICU admission through Day 14 post-rupture
SedLine Patient State Index values in relation to sedation exposure and clinical neurological status
Characterization of SedLine-derived Patient State Index (PSI; unitless, range 0-100) in relation to sedative medication exposure, clinical neurological status, primary NSICU diagnosis, and neurological outcome at discharge. PSI values reported as median with interquartile range stratified by sedation state and diagnostic group.
Time frame: Duration of ICU stay (expected 7-21 days for aSAH; varies by diagnosis)
SedLine Spectral Edge Frequency values in relation to sedation exposure and clinical neurological status
Characterization of SedLine-derived Spectral Edge Frequency (SEF95; reported in Hz) in relation to sedative medication exposure, clinical neurological status, primary NSICU diagnosis, and neurological outcome at discharge. SEF95 values reported as median with interquartile range stratified by sedation state and diagnostic group.
Time frame: Duration of ICU stay (expected 7-21 days for aSAH; varies by diagnosis)
Proportion of Brain4Care extensometry monitoring sessions successfully completed across NSICU clinical care states
Percentage of Brain4Care (B4C) extensometry monitoring sessions successfully completed, reported as a single proportion stratified by clinical care state (intubated/ventilated vs. extubated; sedated vs. awake; EVD present vs. absent). Duration of analyzable monitoring epochs reported in hours. Proportion of patients with multi-session longitudinal data reported as percentage.
Time frame: Through ICU Day 14 or hospital discharge
Correlation between transcranial Doppler (TCD) mean flow velocity and Brain4Care-derived noninvasive pressure reactivity index (nPRx) in aSAH
Spearman correlation coefficient between daily transcranial Doppler (TCD)-derived mean flow velocity (cm/s) and concurrently computed Brain4Care (B4C)-derived noninvasive pressure reactivity index (nPRx) in aSAH patients. Temporal association between TCD-defined vasospasm severity (Lindegaard ratio) and nPRx deterioration characterized as time-lagged cross-correlation.
Time frame: ICU Day 1 through Day 14
Functional status at 90 days post-discharge assessed by modified Rankin Scale via medical record review
Functional and neurological status assessed by modified Rankin Scale (mRS) score via medical record review and/or optional structured contact at 90 days. Reported as ordinal mRS score (0-6). This component is not required for protocol completion; omission does not constitute a protocol deviation.
Time frame: 90 days post-hospital discharge
Plan to share: No
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