Contemporary Management of Traumatic Intracranial Hypertension: Is There a Role for Therapeutic Hypothermia?
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Intracranial hypertension (ICH) remains the single most difficult therapeutic challenge for the acute management of severe traumatic brain injury (TBI). We reviewed the published trials of therapeutic moderate hypothermia to determine its effect on ICH and compared its efficacy to other commonly used therapies for ICH.
A PubMed database search was done using various combinations of the search terms “brain injury,” “therapeutic hypothermia,” “intracranial hypertension,” “barbiturates,” “mannitol,” “hypertonic saline,” “hyperventilation,” “decompressive craniectomy,” and “CSF drainage.”
We identified 11 prospective randomized clinical TBI trials comparing hypothermia vs. normothermia treatment for which intracranial pressure (ICP) data was provided, and 6 prospective cohort studies that provided ICP data before and during hypothermia treatment. In addition, we identified 37 clinical TBI studies of lumbar CSF drainage, mannitol, hyperventilation, barbiturates, hypertonic saline, and decompressive craniectomy that provided pre- and posttreatment ICP data. Hypothermia was at least as effective as the traditional therapies for ICH (hyperventilation, mannitol, and barbiturates), but was less effective than hypertonic saline, lumbar CSF drainage, and decompressive craniectomy. Ultimately, however, therapeutic hypothermia does appear to have a favorable risk/benefit profile.
Therapeutic moderate hypothermia is as effective, or more effective, than most other treatments for ICH. If used for 2–3 days or less there is no evidence that it causes clinically significant adverse events. The lack of consistent evidence that hypothermia improves long-term neurologic outcome should not preclude consideration of its use for the primary treatment of ICH since no other ICP therapy is held to this standard.
- Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006;104:469–79.
- Abadal-Centellas JM, Llompart-Pou JA, Homar-Ramirez J, Perez-Barcena J, Rossello-Ferrer A, Ibanez-Juve J. Neurologic outcome of posttraumatic refractory intracranial hypertension treated with external lumbar drainage. J Trauma. 2007;62:282–6; discussion 286.
- Adelson PD, Ragheb J, Kanev P, Brockmeyer D, Beers SR, Brown SD, et al. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery. 2005;56:740–54; discussion 740–54.
- Aslam AF, Aslam AK, Vasavada BC, Khan IA. Hypothermia: evaluation, electrocardiographic manifestations, and management. Am J Med. 2006;119:297–301.
- Atkins CM, Oliva AA Jr, Alonso OF, Chen S, Bramlett HM, Hu BR, et al. Hypothermia treatment potentiates ERK1/2 activation after traumatic brain injury. Eur J Neurosci. 2007;26:810–9.
- Battison C, Andrews PJ, Graham C, Petty T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med. 2005;33:196–202; discussion 257–198.
- Battistella FD, Wisner DH. Combined hemorrhagic shock and head injury: effects of hypertonic saline (7.5%) resuscitation. J Trauma. 1991;31:182–8.
- Bayir H, Clark RS, Kochanek PM. Promising strategies to minimize secondary brain injury after head trauma. Crit Care Med. 2003;31:S112–7.
- Biswas AK, Bruce DA, Sklar FH, Bokovoy JL, Sommerauer JF. Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension. Crit Care Med. 2002;30:2742–51.
- Clifton GL, Jiang JY, Lyeth BG, Jenkins LW, Hamm RJ, Hayes RL. Marked protection by moderate hypothermia after experimental traumatic brain injury. J Cereb Blood Flow Metab. 1991;11:114–21.
- Clifton GL, Allen S, Barrodale P, Plenger P, Berry J, Koch S, et al. A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma. 1993;10:263–71.
- Clifton GL, Miller ER, Choi SC, Levin HS, McCauley S, Smith KR Jr, et al. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med. 2001;344:556–63.
- Coimbra R, Hoyt DB, Junger WG, Angle N, Wolf P, Loomis W, et al. Hypertonic saline resuscitation decreases susceptibility to sepsis after hemorrhagic shock. J Trauma. 1997;42:602–6; discussion 606–7.
- Coles JP, Minhas PS, Fryer TD, Smielewski P, Aigbirihio F, Donovan T, et al. Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med. 2002;30:1950–9.
- Cremer OL. Hypothermia and cerebrovascular reactivity. Br J Anaesth. 2007;99:593; author reply 593–4.
- Cruz J. Adverse effects of pentobarbital on cerebral venous oxygenation of comatose patients with acute traumatic brain swelling: relationship to outcome. J Neurosurg. 1996;85:758–61.
- Davies AR. Hypothermia improves outcome from traumatic brain injury. Crit Care Resusc. 2005;7:238–43.
- Diringer MN, Videen TO, Yundt K, Zazulia AR, Aiyagari V, Dacey RG Jr, et al. Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury. J Neurosurg. 2002;96:103–8.
- Dixon CE, Markgraf CG, Angileri F, Pike BR, Wolfson B, Newcomb JK, et al. Protective effects of moderate hypothermia on behavioral deficits but not necrotic cavitation following cortical impact injury in the rat. J Neurotrauma. 1998;15:95–103.
- Doyle JA, Davis DP, Hoyt DB. The use of hypertonic saline in the treatment of traumatic brain injury. J Trauma. 2001;50:367–83.
- Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg. 1988;69:15–23.
- Fisher B, Thomas D, Peterson B. Hypertonic saline lowers raised intracranial pressure in children after head trauma. J Neurosurg Anesthesiol. 1992;4:4–10.
- Fortune JB, Feustel PJ, Graca L, Hasselbarth J, Kuehler DH. Effect of hyperventilation, mannitol, and ventriculostomy drainage on cerebral blood flow after head injury. J Trauma. 1995;39:1091–7; discussion 1097–99.
- Gal R, Cundrle I, Zimova I, Smrcka M. Mild hypothermia therapy for patients with severe brain injury. Clin Neurol Neurosurg. 2002;104:318–21.
- Gunnar W, Jonasson O, Merlotti G, Stone J, Barrett J. Head injury and hemorrhagic shock: studies of the blood brain barrier and intracranial pressure after resuscitation with normal saline solution, 3% saline solution, and dextran-40. Surgery. 1988;103:398–407.
- Hartl R, Bardt TF, Kiening KL, Sarrafzadeh AS, Schneider GH, Unterberg AW. Mannitol decreases ICP but does not improve brain-tissue pO2 in severely head-injured patients with intracranial hypertension. Acta Neurochir Suppl. 1997;70:40–2.
- Hartl R, Ghajar J, Hochleuthner H, Mauritz W. Hypertonic/hyperoncotic saline reliably reduces ICP in severely head-injured patients with intracranial hypertension. Acta Neurochir Suppl. 1997;70:126–9.
- Hashiguchi N, Shiozaki T, Ogura H, Tanaka H, Koh T, Noborio M, et al. Mild hypothermia reduces expression of heat shock protein 60 in leukocytes from severely head-injured patients. J Trauma. 2003;55:1054–60.
- Heier T, Caldwell JE. Impact of hypothermia on the response to neuromuscular blocking drugs. Anesthesiology. 2006;104:1070–80.
- Henderson WR, Dhingra VK, Chittock DR, Fenwick JC, Ronco JJ. Hypothermia in the management of traumatic brain injury. A systematic review and meta-analysis. Intensive Care Med. 2003;29:1637–44.
- Hildebrand F, Giannoudis PV, van Griensven M, Chawda M, Pape HC. Pathophysiologic changes and effects of hypothermia on outcome in elective surgery and trauma patients. Am J Surg. 2004;187:363–71.
- Horn P, Munch E, Vajkoczy P, Herrmann P, Quintel M, Schilling L, et al. Hypertonic saline solution for control of elevated intracranial pressure in patients with exhausted response to mannitol and barbiturates. Neurol Res. 1999;21:758–64.
- Hutchison JS, Ward RE, Lacroix J, Hebert PC, Barnes MA, Bohn DJ, et al. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;358:2447–56.
- Ichai C, Armando G, Orban JC, Berthier F, Rami L, Samat-Long C, et al. Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Intensive Care Med. 2009;35:471–9.
- Iida K, Kurisu K, Arita K, Ohtani M. Hyperemia prior to acute brain swelling during rewarming of patients who have been treated with moderate hypothermia for severe head injuries. J Neurosurg. 2003;98:793–9.
- Imberti R, Bellinzona G, Langer M. Cerebral tissue PO2 and SjvO2 changes during moderate hyperventilation in patients with severe traumatic brain injury. J Neurosurg. 2002;96:97–102.
- Jalan R, Olde Damink SW, Deutz NE, Hayes PC, Lee A. Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension. Gastroenterology. 2004;127:1338–46.
- Jiang J, Yu M, Zhu C. Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg. 2000;93:546–9.
- Jiang JY, Xu W, Li WP, Gao GY, Bao YH, Liang YM, et al. Effect of long-term mild hypothermia or short-term mild hypothermia on outcome of patients with severe traumatic brain injury. J Cereb Blood Flow Metab. 2006;26:771–6.
- Josan VA, Sgouros S. Early decompressive craniectomy may be effective in the treatment of refractory intracranial hypertension after traumatic brain injury. Childs Nerv Syst. 2006;22:1268–74.
- Kawanishi M, Kawai N, Nakamura T, Luo C, Tamiya T, Nagao S. Effect of delayed mild brain hypothermia on edema formation after intracerebral hemorrhage in rats. J Stroke Cerebrovasc Dis. 2008;17:187–95.
- Kettner SC, Sitzwohl C, Zimpfer M, Kozek SA, Holzer A, Spiss CK, et al. The effect of graded hypothermia (36 degrees C-32 degrees C) on hemostasis in anesthetized patients without surgical trauma. Anesth Analg. 2003;96:1772–6; table of comments.
- Knapp JM. Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline. AACN Clin Issues. 2005;16:199–211. CrossRef
- Lavinio A, Timofeev I, Nortje J, Outtrim J, Smielewski P, Gupta A, et al. Cerebrovascular reactivity during hypothermia and rewarming. Br J Anaesth. 2007;99:237–44.
- Lescot T, Abdennour L, Boch AL, Puybasset L. Treatment of intracranial hypertension. Curr Opin Crit Care. 2008;14:129–34.
- Levin HS, Eisenberg HM, Gary HE, Marmarou A, Foulkes MA, Jane JA, et al. Intracranial hypertension in relation to memory functioning during the first year after severe head injury. Neurosurgery. 1991;28:196–9; discussion 200.
- Levy DI, Rekate HL, Cherny WB, Manwaring K, Moss SD, Baldwin HZ. Controlled lumbar drainage in pediatric head injury. J Neurosurg. 1995;83:453–60.
- Levy ML, Aranda M, Zelman V, Giannotta SL. Propylene glycol toxicity following continuous etomidate infusion for the control of refractory cerebral edema. Neurosurgery. 1995;37:363–9; discussion 369–71.
- Lin KC, Chou CH, Chang WL, Ke DS, Kuo JR. The early response of mannitol infusion in traumatic brain injury. Acta Neurol Taiwan. 2008;17:26–32.
- Liu WG, Qiu WS, Zhang Y, Wang WM, Lu F, Yang XF. Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study. J Int Med Res. 2006;34:58–64.
- Lumpkins KM, Bochicchio GV, Keledjian K, Simard JM, McCunn M, Scalea T. Glial fibrillary acidic protein is highly correlated with brain injury. J Trauma. 2008;65:778–82; discussion 782–774.
- Lundberg N, Kjallquist A, Bien C. Reduction of increased intracranial pressure by hyperventilation. A therapeutic aid in neurological surgery. Acta Psychiatr Scand Suppl. 1959;34:1–64.
- Marion DW, Penrod LE, Kelsey SF, Obrist WD, Kochanek PM, Palmer AM, et al. Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med. 1997;336:540–6.
- Marmarou A. Increased intracranial pressure in head injury and influence of blood volume. J Neurotrauma. 1992;9 Suppl 1:S327–32.
- Marshall LF, Smith RW, Shapiro HM. The outcome with aggressive treatment in severe head injuries. Part II: acute and chronic barbiturate administration in the management of head injury. J Neurosurg. 1979;50:26–30.
- Matsui T, Kakeda T. IL-10 production is reduced by hypothermia but augmented by hyperthermia in rat microglia. J Neurotrauma. 2008;25:709–15.
- Metz C, Holzschuh M, Bein T, Woertgen C, Frey A, Frey I, et al. Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects. J Neurosurg. 1996;85:533–41.
- Mickell JJ, Reigel DH, Cook DR, Binda RE, Safar P. Intracranial pressure: monitoring and normalization therapy in children. Pediatrics. 1977;59:606–13.
- Muizelaar JP, Lutz HA 3rd, Becker DP. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg. 1984;61:700–6.
- Munch EC, Bauhuf C, Horn P, Roth HR, Schmiedek P, Vajkoczy P. Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage. Crit Care Med. 2001;29:976–81.
- Nordstrom CH, Messeter K, Sundbarg G, Schalen W, Werner M, Ryding E. Cerebral blood flow, vasoreactivity, and oxygen consumption during barbiturate therapy in severe traumatic brain lesions. J Neurosurg. 1988;68:424–31.
- Olivecrona M, Rodling-Wahlstrom M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma. 2007;24:927–35.
- Palma L, Bruni G, Fiaschi AI, Mariottini A. Passage of mannitol into the brain around gliomas: a potential cause of rebound phenomenon. A study on 21 patients. J Neurosurg Sci. 2006;50:63–6.
- Perez-Barcena J, Llompart-Pou JA, Homar J, Abadal JM, Raurich JM, Frontera G, et al. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial. Crit Care. 2008;12:R112.
- Polderman KH, Tjong Tjin Joe R, Peerdeman SM, Vandertop WP, Girbes AR. Effects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury. Intensive Care Med. 2002;28:1563–73.
- Pollay M, Fullenwider C, Roberts PA, Stevens FA. Effect of mannitol and furosemide on blood-brain osmotic gradient and intracranial pressure. J Neurosurg. 1983;59:945–50.
- Pomeranz S, Safar P, Radovsky A, Tisherman SA, Alexander H, Stezoski W. The effect of resuscitative moderate hypothermia following epidural brain compression on cerebral damage in a canine outcome model. J Neurosurg. 1993;79:241–51.
- Qiu WS, Liu WG, Shen H, Wang WM, Hang ZL, Zhang Y, et al. Therapeutic effect of mild hypothermia on severe traumatic head injury. Chin J Traumatol. 2005;8:27–32.
- Qiu W, Zhang Y, Sheng H, Zhang J, Wang W, Liu W, et al. Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy. J Crit Care. 2007;22:229–35.
- Qureshi AI, Suarez JI, Bhardwaj A, Mirski M, Schnitzer MS, Hanley DF, et al. Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: effect on intracranial pressure and lateral displacement of the brain. Crit Care Med. 1998;26:440–6.
- Rangel-Castillo L, Robertson CS. Management of intracranial hypertension. Crit Care Clin. 2006;22:713–32. abstract ix.
- Resnick DK, Marion DW, Darby JM. The effect of hypothermia on the incidence of delayed traumatic intracerebral hemorrhage. Neurosurgery. 1994;34:252–5; discussion 255–6.
- Rosomoff HL. Protective effects of hypothermia against pathological processes of the nervous system. Ann N Y Acad Sci. 1959;80:475–86.
- Ruf B, Heckmann M, Schroth I, Hugens-Penzel M, Reiss I, Borkhardt A, et al. Early decompressive craniectomy and duraplasty for refractory intracranial hypertension in children: results of a pilot study. Crit Care. 2003;7:R133–8.
- Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT. Classification of traumatic brain injury for targeted therapies. J Neurotrauma. 2008;25:719–38.
- Sahuquillo J, Vilalta A. Cooling the injured brain: how does moderate hypothermia influence the pathophysiology of traumatic brain injury. Curr Pharm Des. 2007;13:2310–22.
- Sahuquillo J, Perez-Barcena J, Biestro A, Zavala E, Merino MA, Vilalta A, et al. Intravascular cooling for rapid induction of moderate hypothermia in severely head-injured patients: results of a multicenter study (IntraCool). Intensive Care Med. 2009;35:890–8.
- Sakowitz OW, Stover JF, Sarrafzadeh AS, Unterberg AW, Kiening KL. Effects of mannitol bolus administration on intracranial pressure, cerebral extracellular metabolites, and tissue oxygenation in severely head-injured patients. J Trauma. 2007;62:292–8.
- Schalen W, Sonesson B, Messeter K, Nordstrom G, Nordstrom CH. Clinical outcome and cognitive impairment in patients with severe head injuries treated with barbiturate coma. Acta Neurochir (Wien). 1992;117:153–9.
- Schatzmann C, Heissler HE, Konig K, Klinge-Xhemajli P, Rickels E, Muhling M, et al. Treatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients. Acta Neurochir Suppl. 1998;71:31–3.
- Schell RM, Applegate RL 2nd, Cole DJ. Salt, starch, and water on the brain. J Neurosurg Anesthesiol. 1996;8:178–82.
- Schmoker JD, Shackford SR, Wald SL, Pietropaoli JA. An analysis of the relationship between fluid and sodium administration and intracranial pressure after head injury. J Trauma. 1992;33:476–81.
- Schneider GH, Bardt T, Lanksch WR, Unterberg A. Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome. Acta Neurochir Suppl. 2002;81:77–9.
- Schwab S, Schwarz S, Aschoff A, Keller E, Hacke W. Moderate hypothermia and brain temperature in patients with severe middle cerebral artery infarction. Acta Neurochir Suppl. 1998;71:131–4.
- Schwab S, Georgiadis D, Berrouschot J, Schellinger PD, Graffagnino C, Mayer SA. Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke. 2001;32:2033–5.
- Shackford SR, Zhuang J, Schmoker J. Intravenous fluid tonicity: effect on intracranial pressure, cerebral blood flow, and cerebral oxygen delivery in focal brain injury. J Neurosurg. 1992;76:91–8.
- Shiozaki T, Sugimoto H, Taneda M, Yoshida H, Iwai A, Yoshioka T, et al. Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg. 1993;79:363–8.
- Shiozaki T, Hayakata T, Taneda M, Nakajima Y, Hashiguchi N, Fujimi S, et al. A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan. J Neurosurg. 2001;94:50–4.
- Shiozaki T, Nakajima Y, Taneda M, Tasaki O, Inoue Y, Ikegawa H, et al. Efficacy of moderate hypothermia in patients with severe head injury and intracranial hypertension refractory to mild hypothermia. J Neurosurg. 2003;99:47–51.
- Skoglund TS, Eriksson-Ritzen C, Jensen C, Rydenhag B. Aspects on decompressive craniectomy in patients with traumatic head injuries. J Neurotrauma. 2006;23:1502–9.
- Smrcka M, Vidlak M, Maca K, Smrcka V, Gal R. The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury. Acta Neurochir Suppl. 2005;95:273–5.
- Sorani MD, Morabito D, Rosenthal G, Giacomini KM, Manley GT. Characterizing the dose-response relationship between mannitol and intracranial pressure in traumatic brain injury patients using a high-frequency physiological data collection system. J Neurotrauma. 2008;25:291–8.
- Soustiel JF, Mahamid E, Chistyakov A, Shik V, Benenson R, Zaaroor M. Comparison of moderate hyperventilation and mannitol for control of intracranial pressure control in patients with severe traumatic brain injury—a study of cerebral blood flow and metabolism. Acta Neurochir (Wien). 2006;148:845–51; discussion 851.
- Sprung J, Cheng EY, Gamulin S, Kampine JP, Bosnjak ZJ. Effects of acute hypothermia and beta-adrenergic receptor blockade on serum potassium concentration in rats. Crit Care Med. 1991;19:1545–51.
- Steiner LA, Balestreri M, Johnston AJ, Coles JP, Smielewski P, Pickard JD, et al. Predicting the response of intracranial pressure to moderate hyperventilation. Acta Neurochir (Wien). 2005;147:477–83; discussion 483.
- Stiefel MF, Heuer GG, Smith MJ, Bloom S, Maloney-Wilensky E, Gracias VH, et al. Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg. 2004;101:241–7.
- Stocchetti N, Colombo A, Ortolano F, Videtta W, Marchesi R, Longhi L, et al. Time course of intracranial hypertension after traumatic brain injury. J Neurotrauma. 2007;24:1339–46.
- Suarez JI, Qureshi AI, Bhardwaj A, Williams MA, Schnitzer MS, Mirski M, et al. Treatment of refractory intracranial hypertension with 23.4% saline. Crit Care Med. 1998;26:1118–22.
- Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001;17:154–62.
- Thorat JD, Wang EC, Lee KK, Seow WT, Ng I. Barbiturate therapy for patients with refractory intracranial hypertension following severe traumatic brain injury: its effects on tissue oxygenation, brain temperature and autoregulation. J Clin Neurosci. 2008;15:143–8.
- Tiainen M, Kovala TT, Takkunen OS, Roine RO. Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia. Crit Care Med. 2005;33:1736–40.
- Timofeev I, Czosnyka M, Nortje J, Smielewski P, Kirkpatrick P, Gupta A, et al. Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury. J Neurosurg. 2008;108:66–73.
- Tokutomi T, Morimoto K, Miyagi T, Yamaguchi S, Ishikawa K, Shigemori M. Optimal temperature for the management of severe traumatic brain injury: effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. Neurosurgery. 2003;52:102–11; discussion 111–102.
- Tomosvari A, Mencser Z, Futo J, Hortobagyi A, Bodosi M, Barzo P. Preliminary experience with controlled lumbar drainage in medically refractory intracranial hypertension. Orv Hetil. 2005;146:159–64.
- Tortorici MA, Kochanek PM, Poloyac SM. Effects of hypothermia on drug disposition, metabolism, and response: a focus of hypothermia-mediated alterations on the cytochrome P450 enzyme system. Crit Care Med. 2007;35:2196–204.
- Tyagi R, Donaldson K, Loftus CM, Jallo J. Hypertonic saline: a clinical review. Neurosurg Rev. 2007;30:277–89; discussion 289–90.
- Vaquero J, Rose C, Butterworth RF. Keeping cool in acute liver failure: rationale for the use of mild hypothermia. J Hepatol. 2005;43:1067–77.
- Vialet R, Albanese J, Thomachot L, Antonini F, Bourgouin A, Alliez B, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med. 2003;31:1683–7.
- Wang Q, Li AL, Zhi DS, Huang HL. Effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury. Chin J Traumatol. 2007;10:246–9.
- Ware ML, Nemani VM, Meeker M, Lee C, Morabito DJ, Manley GT. Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study. Neurosurgery. 2005;57:727–36; discussion 727–36.
- White H, Cook D, Venkatesh B. The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth Analg. 2006;102:1836–46.
- Wisner DH, Schuster L, Quinn C. Hypertonic saline resuscitation of head injury: effects on cerebral water content. J Trauma. 1990;30:75–8.
- Yan Y, Tang W. Changes of evoked potentials and evaluation of mild hypothermia for treatment of severe brain injury. Chin J Traumatol. 2001;4:8–13.
- Zhi D, Zhang S, Lin X. Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury. Surg Neurol. 2003;59:381–5.
- Contemporary Management of Traumatic Intracranial Hypertension: Is There a Role for Therapeutic Hypothermia?
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