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Moderate-to-Severe Traumatic Brain InjuryICP-TBINCT07678216

Comparing Sedatives for Intracranial Pressure Control in Traumatic Brain Injury

A study testing propofol, midazolam and Dexmedetomidine in people with Moderate-to-Severe Traumatic Brain Injury, run by Aswan University at 1 site in Egypt.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to compare the effects of propofol, midazolam, and dexmedetomidine on intracranial pressure control and clinical outcomes in adults with moderate-to-severe traumatic brain injury undergoing urgent neurosurgical intervention. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
propofol, midazolam and Dexmedetomidine
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
210 participants
Where
1 siteEgypt
Study dates
1 Jul 2026to 1 Jun 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥18 years
  • Moderate to severe traumatic brain injury with post-resuscitation Glasgow Coma Scale (GCS) ≤12
  • Undergone urgent neurosurgical intervention (craniotomy, craniectomy, or ICP monitor placement) within 24 hours of injury
  • Admitted to ICU and expected to require continuous sedation
  • Hemodynamically stable or stabilized (defined as MAP ≥65 mmHg with vasopressor requirement ≤0.1 mcg/kg/min norepinephrine equivalent)
  • Informed consent obtained from legally authorized representative

Who cannot join

  • The Relative refusal to participate in the research.
  • Known allergy or contraindication to propofol, midazolam, or dexmedetomidine
  • Pre-existing neurological disorders (epilepsy, prior stroke, brain tumors, dementia) that may interfere with outcome assessment
  • Severe hepatic dysfunction (Child-Pugh Class C) or acute liver failure
  • Severe renal dysfunction (eGFR <30 mL/min/1.73m² or requiring renal replacement therapy)
  • Pregnancy or breastfeeding
Show all 11Show fewer
  • Hemodynamic instability requiring norepinephrine >0.1 mcg/kg/min or equivalent vasopressor support
  • Heart rate <50 bpm or second/third-degree AV block without pacemaker (relative contraindication for dexmedetomidine)
  • Clinical determination of brain death or expected survival <24 hours
  • Enrollment in another interventional trial
  • Severe polytrauma requiring ongoing surgical interventions that would interfere with protocol adherence

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Mohamed Abdelhamed, M.Sc contact

+201061651065

mohamed.said@med.aswu.edu.eg

Egypt1 site
  • Aswan University Hospital

    Asyut, Asyut Governorate, 81528

    Mohamed Abdelhamed, M.Sc., 01061651065, hamedo_2020@yahoo.com

Other trials in Egypt

About this study

Official title: Effect of Propofol, Midazolam, and Dexmedetomidine on Intracranial Pressure and Clinical Outcomes in Patients With Moderate-to-Severe Traumatic Brain Injury Undergoing Urgent Neurosurgical Intervention

The goal of this clinical trial is to compare the effects of propofol, midazolam, and dexmedetomidine on intracranial pressure control and clinical outcomes in adults with moderate-to-severe traumatic brain injury undergoing urgent neurosurgical intervention.

The main questions it aims to answer are:

Read more
  • Which sedative agent provides better control of intracranial pressure, assessed by optic nerve sheath diameter (ONSD), during the first 24 hours after neurosurgical intervention?
  • How do the three sedative agents compare in achieving target sedation depth, maintaining hemodynamic stability, and improving short-term clinical outcomes such as ICU mortality, duration of mechanical ventilation, and ICU length of stay?

Participants will be randomly assigned to receive propofol, midazolam, or dexmedetomidine for 24 hours of continuous sedation. Clinical, hemodynamic, and neurological outcomes will be assessed and compared among the three study groups.

Read the detailed description

Traumatic brain injury (TBI) is a major cause of mortality and long-term disability worldwide. Prevention of secondary brain injury through optimal control of intracranial pressure (ICP) is a key component of intensive care management in patients with moderate-to-severe TBI. Sedative agents are routinely used to facilitate mechanical ventilation, reduce cerebral metabolic demand, and improve ICP control. However, uncertainty remains regarding the optimal sedative agent for this patient population.

Propofol, midazolam, and dexmedetomidine are among the most commonly used sedatives in neurocritical care. Each agent has distinct pharmacological characteristics that may influence intracranial pressure, hemodynamic stability, neurological assessment, and clinical outcomes. Despite widespread use, direct comparative evidence between these agents remains limited.

This prospective randomized clinical trial aims to compare the effects of propofol, midazolam, and dexmedetomidine on intracranial pressure control and clinical outcomes in adult patients with moderate-to-severe traumatic brain injury undergoing urgent neurosurgical intervention. Intracranial pressure will be assessed noninvasively using serial optic nerve sheath diameter (ONSD) measurements obtained by ocular ultrasonography during the first 24 hours of continuous sedation.

Participants will be randomly assigned to receive one of the three sedative regimens according to a standardized protocol targeting a Richmond Agitation-Sedation Scale (RASS) score of -3 to -4. Standard neurocritical care management and analgesia protocols will be applied to all study groups.

The study will evaluate the comparative effects of the three sedative agents on intracranial pressure control, sedation quality, hemodynamic stability, adverse events, secondary brain injury, and short-term clinical outcomes. The findings are expected to provide evidence to guide sedative selection in patients with moderate-to-severe traumatic brain injury, particularly in settings where invasive intracranial pressure monitoring is not routinely available.

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • propofolDrug

    Continuous intravenous propofol infusion initiated at 1 mg/kg/h and titrated within a range of 1-4 mg/kg/h to maintain a target Richmond Agitation-Sedation Scale (RASS) score of -3 to -4 during the 24-hour study intervention period.

  • midazolamDrug

    Continuous intravenous midazolam infusion initiated at 0.03 mg/kg/h and titrated within a range of 0.02-0.1 mg/kg/h to maintain a target Richmond Agitation-Sedation Scale (RASS) score of -3 to -4 during the 24-hour study intervention period. An initial bolus dose of 0.05 mg/kg may be administered if rapid sedation is required.

  • DexmedetomidineDrug

    Continuous intravenous dexmedetomidine infusion initiated at 0.4 μg/kg/h and titrated within a range of 0.2-0.7 μg/kg/h to maintain a target Richmond Agitation-Sedation Scale (RASS) score of -3 to -4 during the 24-hour study intervention period. No loading dose will be administered.

Study groups in NCT07678216
Study groupRoleWhat they receive
PropofolExperimentalParticipants receive continuous intravenous propofol infusion initiated at 1 mg/kg/h and titrated to 1-4 mg/kg/h to maintain a target RASS score of -3 to -4 for 24 hours.
Receives: Drug: propofol
MidazolamExperimentalParticipants receive continuous intravenous midazolam infusion initiated at 0.03 mg/kg/h and titrated to 0.02-0.1 mg/kg/h to maintain a target RASS score of -3 to -4 for 24 hours.
Receives: Drug: midazolam
dexmedetomidineExperimentalParticipants receive continuous intravenous dexmedetomidine infusion initiated at 0.4 μg/kg/h and titrated to 0.2-0.7 μg/kg/h to maintain a target RASS score of -3 to -4 for 24 hours.
Receives: Drug: Dexmedetomidine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Intracranial Pressure Control Assessed by Optic Nerve Sheath Diameter (ONSD)

    Intracranial pressure control will be evaluated using serial optic nerve sheath diameter (ONSD) measurements obtained by ocular ultrasonography. The primary outcome will be the mean ONSD over the 24-hour intervention period, analyzed as a continuous measure of intracranial pressure control.

    Measured: Baseline, 6 hours, 12 hours, and 24 hours after initiation of sedation

Secondary outcomes (11)
  1. Proportion of Time at Target Sedation Level

    Percentage of assessment time during which patients maintained the target Richmond Agitation-Sedation Scale (RASS) score of -3 to -4. The Richmond Agitation-Sedation Scale ranges from +4 (combative) to -5 (unarousable). Higher scores indicate greater agitation, whereas lower scores indicate deeper sedation. The target sedation level for this study is RASS -3 to -4.

    Measured: 24 hours after initiation of sedation

  2. Mean Richmond Agitation-Sedation Scale (RASS) Score

    Mean Richmond Agitation-Sedation Scale (RASS) score during the 24-hour intervention period. The RASS ranges from +4 (combative) to -5 (unarousable), with target sedation defined as -3 to -4.

    Measured: 24 hours after initiation of sedation

  3. Need for Rescue Sedation

    Proportion of patients requiring rescue sedation due to failure to achieve target sedation despite maximum protocol dose.

    Measured: 24 hours after initiation of sedation

  4. Time to Achieve Target Sedation

    Time from initiation of study sedative infusion until achievement of target Richmond Agitation-Sedation Scale (RASS) score (-3 to -4).The RASS ranges from +4 (combative) to -5 (unarousable)

    Measured: 24 hours after initiation of sedation

  5. Incidence of Hypotension

    Incidence of hypotension, defined as mean arterial pressure (MAP) <65 mmHg or cerebral perfusion pressure (CPP) <60 mmHg.

    Measured: 24 hours after initiation of study sedation

  6. Vasopressor Requirements

    Vasopressor requirements assessed by the proportion of patients requiring vasopressor support.

    Measured: 24 hours after initiation of study sedation.

  7. Incidence of Bradycardia.

    Percentage of participants who develop bradycardia, defined as a sustained heart rate <50 beats per minute (bpm).

    Measured: 24 hours after initiation of study sedation.

  8. Percentage of Participants Who Developed Secondary Brain Injury ✅

    Secondary brain injury will be assessed by the presence of new or progressive findings on brain computed tomography (CT) compared with baseline imaging, including new intracranial hemorrhage, progression of cerebral edema (defined as >25% increase in midline shift or worsening basal cistern effacement), new cerebral infarction, or transtentorial or uncal herniation. Brain CT scans will be reviewed by a blinded neuroradiologist.

    Measured: Baseline and 24 hours after initiation of study sedation.

  9. Duration of Mechanical Ventilation

    Duration of invasive mechanical ventilation, measured as the number of days from initiation of mechanical ventilation until successful liberation from ventilatory support.

    Measured: From initiation of mechanical ventilation until successful extubation, assessed for up to 30 days.

  10. Time to Neurological Awakening

    Time from discontinuation of study sedation to achievement of a Glasgow Coma Scale (GCS) motor score of ≥5. The Glasgow Coma Scale motor component ranges from 1 (no motor response) to 6 (obeys commands), with higher scores indicating better neurological function.

    Measured: From discontinuation of study sedation until achievement of a Glasgow Coma Scale motor score of ≥5, assessed for up to 30 days.

  11. ICU Mortality

    Death from any cause during the ICU stay following urgent neurosurgical intervention for traumatic brain injury.

    Measured: From ICU admission until ICU discharge, assessed for up to 30 days.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Jul 2026
  2. Study start1 Jul 2026 (estimated)
  3. Primary completion1 Jun 2028 (estimated)
  4. Study completion1 Jun 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants will be randomly assigned in a 1:1:1 ratio to one of three parallel treatment groups receiving continuous sedation for 24 hours following urgent neurosurgical intervention for moderate-to-severe traumatic brain injury. Group A will receive propofol initiated at 1 mg/kg/h and titrated within a range of 1-4 mg/kg/h to maintain a target Richmond Agitation-Sedation Scale (RASS) score of -3 to -4. Group B will receive midazolam initiated at 0.03 mg/kg/h and titrated within a range of 0.02-0.1 mg/kg/h to maintain the target RASS score. An initial bolus dose of 0.05 mg/kg may be administered if rapid sedation is required. Group C will receive dexmedetomidine initiated at 0.4 μg/kg/h and titrated within a range of 0.2-0.7 μg/kg/h to maintain the target RASS score. Participants will remain in their assigned treatment group throughout the intervention period, and outcomes will be compared between groups. The trial uses a prospective randomized parallel-group design with blinded
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
210 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07678216
Sponsor's protocol ID
1230/3/26
Acronym
ICP-TBI
Status last verified
Jun 2026
First submitted
20 Jun 2026
Last updated
1 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data (IPD) will not be shared because the study contains sensitive clinical data, and sharing could compromise participant confidentiality. Data are subject to institutional policies and ethics committee restrictions.

Questions about this trial

What is this clinical trial studying?

A study testing propofol, midazolam and Dexmedetomidine in people with Moderate-to-Severe Traumatic Brain Injury, run by Aswan University at 1 site in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 1 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Mohamed Abdelhamed, M.Sc (+201061651065, mohamed.said@med.aswu.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intracranial Pressure Control Assessed by Optic Nerve Sheath Diameter (ONSD) (time frame: Baseline, 6 hours, 12 hours, and 24 hours after initiation of sedation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Jul 2026.

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