{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:47:19Z","timestamp":1791830839198,"version":"4.3.4"},"reference-count":20,"publisher":"BMJ","issue":"9","funder":[{"name":"European Society of Intensive Care Medicine small investigator award","award":["N\/A: awarded to M Aries"],"award-info":[{"award-number":["N\/A: awarded to M Aries"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,8,21]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"\n Introduction<\/jats:title>\n Individualising 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.<\/jats:p>\n <\/jats:sec>\n \n Methods and analysis<\/jats:title>\n CPPOpt 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\u2009hours of admission in neurocritical care unit. For the control arm, the CPP target is the Brain Trauma Foundation guidelines target (60\u201370\u2009mm Hg); for the intervention group an automated CPP target is provided as the CPP at which the patient\u2019s 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\u2009mm 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.<\/jats:p>\n <\/jats:sec>\n \n Ethics and dissemination<\/jats:title>\n Ethical approval has been obtained for each participating centre. The results will be presented at international scientific conferences and in peer-reviewed journals.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT02982122<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030727","type":"journal-article","created":{"date-parts":[[2019,9,21]],"date-time":"2019-09-21T07:05:32Z","timestamp":1569049532000},"page":"e030727","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":126,"title":["Feasibility of individualised severe traumatic brain injury management using an automated assessment of optimal cerebral perfusion pressure: the COGiTATE phase II study protocol"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct02982122","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8108-0000","authenticated-orcid":false,"given":"Erta","family":"Beqiri","sequence":"first","affiliation":[{"name":"Clinical Neuroscience, University of Cambridge, Cambridge, UK"},{"name":"Physiology and Transplantation, University of Milan, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Smielewski","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Robba","sequence":"additional","affiliation":[{"name":"Anaesthesia and Intensive Care,Policlinico San Martino, IRCCS for Oncology and Neuroscience, University of Genoa, Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Czosnyka","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel Teixeira","family":"Cabeleira","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette","family":"Tas","sequence":"additional","affiliation":[{"name":"Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Donnelly","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne G","family":"Outtrim","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Menon","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"Meyfroidt","sequence":"additional","affiliation":[{"name":"Intensieve geneeskunde, Universitaire Ziekenhuizen Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Depreitere","sequence":"additional","affiliation":[{"name":"Intensieve geneeskunde, Universitaire Ziekenhuizen Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel J","family":"Aries","sequence":"additional","affiliation":[{"name":"Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari","family":"Ercole","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,9,20]]},"reference":[{"key":"2025101810131835000_9.9.e030727.1","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/S1474-4422(17)30118-7","article-title":"Severe traumatic brain injury: targeted management in the intensive care unit","volume":"16","author":"Stocchetti","year":"2017","journal-title":"Lancet Neurol"},{"key":"2025101810131835000_9.9.e030727.2","article-title":"Guidelines for the management of severe traumatic brain injury, fourth edition","volume":"80","author":"Carney","year":"2016","journal-title":"Neurosurgery"},{"key":"2025101810131835000_9.9.e030727.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30371-X"},{"key":"2025101810131835000_9.9.e030727.4","doi-asserted-by":"crossref","unstructured":"Menon DK , Ercole A . 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