Review

Intensive Care Medicine

, Volume 29, Issue 10, pp 1637-1644

First online:

Hypothermia in the management of traumatic brain injury

A systematic review and meta-analysis
  • William R. HendersonAffiliated withProgram of Critical Care Medicine, University of British Columbia , Vancouver Hospital and Health Sciences CentreDepartment of Critical Care Medicine, Suite 360 Echelon Building , Vancouver Hospital and Health Sciences Centre Email author 
  • , Vinay K. DhingraAffiliated withProgram of Critical Care Medicine, University of British Columbia , Vancouver Hospital and Health Sciences Centre
  • , Dean R. ChittockAffiliated withProgram of Critical Care Medicine, University of British Columbia , Vancouver Hospital and Health Sciences CentreCentre for Clinical Epidemiology and Evaluation, Vancouver Hospital and Health Sciences Centre
  • , John C. FenwickAffiliated withProgram of Critical Care Medicine, University of British Columbia , Vancouver Hospital and Health Sciences Centre
  • , Juan J. RoncoAffiliated withProgram of Critical Care Medicine, University of British Columbia , Vancouver Hospital and Health Sciences Centre

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Abstract

Objective

Brain injury remains the leading cause of death in cases of trauma in North America and Europe. This article critically appraised and summarised all published and peer-reviewed, randomised, controlled trials of the use of hypothermia in traumatic brain injury.

Design

To be included, a study had to be a published, randomised, controlled trial of the use of hypothermia in the management of traumatic brain injury. Pooling of data and meta-analysis of results occurred.

Setting

Conducted at a tertiary level Canadian teaching hospital.

Patients and participants

Patients were combined from eight randomised, controlled trials to generate a population of 748 severely head-injured patients.

Measurements and results

Eight studies provided data on the efficacy of hypothermia in the management of traumatic brain injury. The pooled odds ratio of mortality in the hypothermic group was 0.81 (95%CI =0.59–1.13, p=0.22). The OR of a poor neurological outcome (GOS 1,2 or 3) was 0.75 (95% CI=0.56–1.01, p=0.06). The odds ratio for pneumonia in the normothermic group was 0.42 (95%CI =0.25–0.70, p=0.001).

Conclusions

Although meta-analysis suggests that iatrogenic hypothermia may confer a marginal benefit in neurological outcome, there does not appear to be clear evidence of lower mortality rates in unselected traumatic brain injury patients. Prolonged hypothermia may confer a benefit, particularly in patients with elevated intracranial pressure refractory to conventional manipulations. Conclusions regarding the use of hypothermia are controversial and not strongly supported by the available evidence.

Keywords

Brain injury Hypothermia Controlled trial