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Feasibility of individualised severe traumatic brain injury management using an automated assessment of optimal cerebral perfusion pressure: the COGiTATE phase II study protocol
- Source :
- BMJ Open, 9(9):030727. BMJ Publishing Group, BMJ Open
- Publication Year :
- 2019
- Publisher :
- BMJ, 2019.
-
Abstract
- IntroductionIndividualising therapy is an important challenge for intensive care of patients with severe traumatic brain injury (TBI). Targeting a cerebral perfusion pressure (CPP) tailored to optimise cerebrovascular autoregulation has been suggested as an attractive strategy on the basis of a large body of retrospective observational data. The objective of this study is to prospectively assess the feasibility and safety of such a strategy compared with fixed thresholds which is the current standard of care from international consensus guidelines.Methods and analysisCPPOpt Guided Therapy: Assessment of Target Effectiveness (COGiTATE) is a prospective, multicentre, non-blinded randomised, controlled trial coordinated from Maastricht University Medical Center, Maastricht (The Netherlands). The other original participating centres are Cambridge University NHS Foundation Trust, Cambridge (UK), and University Hospitals Leuven, Leuven (Belgium). Adult severe TBI patients requiring intracranial pressure monitoring are randomised within the first 24 hours of admission in neurocritical care unit. For the control arm, the CPP target is the Brain Trauma Foundation guidelines target (60–70 mm Hg); for the intervention group an automated CPP target is provided as the CPP at which the patient’s cerebrovascular reactivity is best preserved (CPPopt). For a maximum of 5 days, attending clinicians review the CPP target 4-hourly. The main hypothesis of COGiTATE are: (1) in the intervention group the percentage of the monitored time with measured CPP within a range of 5 mm Hg above or below CPPopt will reach 36%; (2) the difference in between groups in daily therapy intensity level score will be lower or equal to 3.Ethics and disseminationEthical approval has been obtained for each participating centre. The results will be presented at international scientific conferences and in peer-reviewed journals.Trial registration numberNCT02982122
- Subjects :
- Traumatic
law.invention
0302 clinical medicine
Injury Severity Score
Randomized controlled trial
law
COGiTATE
Brain Injuries, Traumatic
Protocol
Medicine
Multicenter Studies as Topic
Autoregulation
Prospective Studies
intensive care
Randomized Controlled Trials as Topic
autoregulation
General Medicine
REACTIVITY INDEX
3. Good health
Optimal CPP
individualised TBI management
precision medicine
Clinical Trials, Phase II as Topic
Feasibility Studies
Humans
Neurophysiological Monitoring
Cerebrovascular Circulation
Intracranial pressure monitoring
medicine.medical_specialty
Traumatic brain injury
03 medical and health sciences
Intensive care
Clinical Trials
Cerebral perfusion pressure
BEDSIDE
business.industry
Phase II as Topic
Neurointensive care
030208 emergency & critical care medicine
CARE
medicine.disease
REACTIVITY
Brain Injuries
Emergency medicine
Observational study
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 20446055
- Database :
- OpenAIRE
- Journal :
- BMJ Open, 9(9):030727. BMJ Publishing Group, BMJ Open
- Accession number :
- edsair.doi.dedup.....01cdb287fc97d1d352e10f7c5dd54a7c