• Jeanette Tas, Erta Beqiri, Ruud C van Kaam, Marek Czosnyka, Joseph Donnelly, Roel H Haeren, van der HorstIwan C CICCDepartment of Intensive Care Medicine, University Maastricht (KEMTA), Maastricht University Medical Center+, Maastricht, The Netherlands.Cardiovascular Research Institute Maastricht (CARIM), University Maastricht (KEMTA), Maastrich, Peter J Hutchinson, van KuijkSander M JSMJDepartment of Clinical Epidemiology and Medical Technology Assessment, University Maastricht (KEMTA), Maastricht University Medical Center+, Maastricht, The Netherlands., Analisa L Liberti, David K Menon, HoedemaekersCornelia W ECWEDepartment of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands., Bart Depreitere, Peter Smielewski, Geert Meyfroidt, Ari Ercole, and AriesMarcel J HMJHDepartment of Intensive Care Medicine, University Maastricht (KEMTA), Maastricht University Medical Center+, Maastricht, The Netherlands.School for Mental Health and Neuroscience (MHeNS), University Maastricht (KEMTA), Maastricht Univers.
• Department of Intensive Care Medicine, University Maastricht (KEMTA), Maastricht University Medical Center+, Maastricht, The Netherlands.
• J. Neurotrauma. 2021 Oct 15; 38 (20): 279028002790-2800.

AbstractManaging 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.

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