Hypothermia in the management of traumatic brain injury
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.
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.
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).
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.
KeywordsBrain injury Hypothermia Controlled trial
- 4.Ishikura H YK, Akahori M, Shoji Y, Fukui H, Tanaka T (1998) Changes in blood platelet count and serum thrombopoietin (TPO) level under moderate hypothermic therapy in traumatic severe closed head injury. Crit Care Med Vol. 26, No.1 (Suppl.)Google Scholar
- 5.Meissner WFH, Dohrn B, Specht M, Reinhart K (1998) Influence of hypothermia on cytokine concentrations in head injured patients. Crit Care Med Vol. 26, No.1 (Suppl.)Google Scholar
- 14.Shiozaki T, Hayakata T, Taneda M, Nakajima Y, Hashiguchi N, Fujimi S, Nakamori Y, Tanaka H, Shimazu T, Sugimoto H (2001) 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. Journal of Neurosurgery 94(1), 50–54PubMedGoogle Scholar
- 15.Aibiki M, Maekawa S, Yokono S (2000) Moderate hypothermia improves imbalances of thromboxane A2 and prostaglandin I2 production after traumatic brain injury in humans. Critical Care Medicine 28(12), 3902–3906Google Scholar
- 17.Dietrich W (1996) Nonpharmacological strategies: Moderate hypothermia. Neurotrauma, 1491–1506Google Scholar
- 18.Lyeth BG JJ, Liu S (1993) Behavioral protection by moderate hypothermia initiated after experimental traumatic brain injury. J Neurotrauma(10), 57–64Google Scholar
- 24.Minamisawa H, Smith ML, Siesjo BK (1990) The effect of mild hyperthermia and hypothermia on brain damage following 5, 10, and 15 minutes of forebrain ischemia. Annals of Neurology. 28(1), 26–33Google Scholar
- 26.Shiozaki T, Hayakata T, Taneda M, Nakajima Y, Hashiguchi N, Fujimi S, Nakamori Y, Tanaka H, Shimazu T, Sugimoto H (2001). 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. Journal of Neurosurgery 94(1), 50–54PubMedGoogle Scholar
- 34.Hayashi N, Hirayama T, Udagawa A, Daimon W, Ohata M (1994) Systemic management of cerebral edema based on a new concept in severe head injury patients. Acta Neurochirurgica-Supplementum 60, 541–543Google Scholar
- 37.Gadkary CS, Alderson P, Signorini DF (XXXX) Therapeutic Hypothermia for Head Injury, Cochrane Database Syst Rev, pp CD001048Google Scholar