@article{0cec85bdb6884fdb89228b9661a920aa,
title = "Targeting Autoregulation-Guided Cerebral Perfusion Pressure after Traumatic Brain Injury (COGiTATE): A Feasibility Randomized Controlled Clinical Trial",
abstract = "Managing traumatic brain injury (TBI) patients with a cerebral perfusion pressure (CPP) near to the cerebral autoregulation (CA)-guided {"}optimal{"} CPP (CPPopt) value is associated with improved outcome and might be useful to individualize care, but has never been prospectively evaluated. This study evaluated the feasibility and safety of CA-guided CPP management in TBI patients requiring intracranial pressure monitoring and therapy (TBIicp patients). The CPPopt Guided Therapy: Assessment of Target Effectiveness (COGiTATE) parallel two-arm feasibility trial took place in four tertiary centers. TBIicp patients were randomized to either the Brain Trauma Foundation (BTF) guideline CPP target range (control group) or to the individualized CA-guided CPP targets (intervention group). CPP targets were guided by six times daily software-based alerts for up to 5 days. The primary feasibility end-point was the percentage of time with CPP concordant (+/- 5 mm Hg) with the set CPP targets. The main secondary safety end-point was an increase in therapeutic intensity level (TIL) between the control and intervention group. Twenty-eight patients were randomized to the control and 32 patients to the intervention group. CPP in the intervention group was in the target range for 46.5% (interquartile range, 41.2-58) of the monitored time, significantly higher than the feasibility target specified in the published protocol (36%; p < 0.001). There were no significant differences between groups for TIL or for other safety end-points. Conclusively, targeting an individual and dynamic CA-guided CPP is feasible and safe in TBIicp patients. This encourages a prospective trial powered for clinical outcomes.",
keywords = "ADULT, CARE, HYPERTENSION, MANAGEMENT, REACTIVITY, cerebral autoregulation, cerebral perfusion, intensive care, optimal cerebral perfusion pressure, precision medicine, traumatic brain injury",
author = "Jeanette Tas and Erta Beqiri and {van Kaam}, {Ruud C.} and Marek Czosnyka and Joseph Donnelly and Haeren, {Roel H.} and {van der Horst}, {Iwan C. C.} and Hutchinson, {Peter J.} and {van Kuijk}, {Sander M. J.} and Liberti, {Analisa L.} and Menon, {David K.} and Hoedemaekers, {Cornelia W. E.} and Bart Depreitere and Peter Smielewski and Geert Meyfroidt and Ari Ercole and Aries, {Marcel J. H.}",
note = "Funding Information: Jeanette Tas is supported by {\textquoteleft}{\textquoteleft}HersenStrijd fonds{\textquoteright}{\textquoteright} (translated as {\textquoteleft}{\textquoteleft}Brain Battle foundation{\textquoteright}{\textquoteright}), a non-profit foundation of the University Maastricht, Maastricht, The Netherlands. Funding Information: Erta Beqiri is supported by the Medical Research Council (grant no.: MR N013433-1) and by the Gates Cambridge Scholarship. Funding Information: Marek Czosnyka is supported by National Institute for Health Research (NIHR), Cambridge Biomedical Research Centre. Funding Information: Peter J. Hutchinson is supported by the National Institute for Health Research (NIHR): research professorship, Biomedical Research Centre and Global Neurotrauma Research group and the Royal College of Surgeons of England. Funding Information: Geert Meyfroidt is supported by the Research Foundation, Flanders (FWO) as a senior clinical researcher (1843118N) and receives project funding from the KU Leuven (C24/17/072) and the Belgian Health Care Knowledge Center (COV201003). Funding Information: This research was supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Funding Information: The COGiTATE study was funded with a grant from the European Society of Intensive Care (ESICM). Funding Information: David K. Menon is supported by the National Institute for Health Research (NIHR), Cambridge Biomedical Research Centre, an NIHR Senior Investigator Award, and by a European Union Foundation Program 7 Grant (CENTER-TBI; award no.: 602150). Publisher Copyright: {\textcopyright} Jeanette Tas et al., 2021; Published by Mary Ann Liebert, Inc.",
year = "2021",
month = oct,
day = "15",
doi = "10.1089/neu.2021.0197",
language = "English",
volume = "38",
pages = "2790--2800",
journal = "Journal of Neurotrauma",
issn = "0897-7151",
publisher = "Mary Ann Liebert Inc.",
number = "20",
}