Abstract
PurposeTherapeutic hypothermia management remains controversial in patients with traumatic brain injury. We conducted a meta-analysis to evaluate the risks and benefits of therapeutic hypothermia management in patients with traumatic brain injury.MethodsWe searched the Web of Science, PubMed, Embase, Cochrane (Central) and Clinical Trials databases from inception to January 17, 2019. Eligible studies were randomised controlled trials that investigated therapeutic hypothermia management versus normothermia management in patients with traumatic brain injury. We collected the individual data of the patients from each included study. Meta-analyses were performed for 6-month mortality, unfavourable functional outcome and pneumonia morbidity. The risk of bias was evaluated using the Cochrane Risk of Bias tool.ResultsTwenty-three trials involving a total of 2796 patients were included. The randomised controlled trials with a high quality show significantly more mortality in the therapeutic hypothermia group [risk ratio (RR) 1.26, 95% confidence interval (CI) 1.04 to 1.53, p = 0.02]. Lower mortality in the therapeutic hypothermia group occurred when therapeutic hypothermia was received within 24 h (RR 0.83, 95% CI 0.71 to 0.96, p = 0.01), when hypothermia was received for treatment (RR 0.66, 95% CI 0.49 to 0.88, p = 0.006) or when hypothermia was combined with post-craniectomy measures (RR 0.69, 95% CI 0.48 to 1.00, p = 0.05). The risk of unfavourable functional outcome following therapeutic hypothermia management appeared to be significantly reduced (RR 0.78, 95% CI 0.67 to 0.91, p = 0.001). The meta-analysis suggested that there was a significant increase in the risk of pneumonia with therapeutic hypothermia management (RR 1.48, 95% CI 1.11 to 1.97, p = 0.007).ConclusionsOur meta-analysis demonstrated that therapeutic hypothermia did not reduce but might increase the mortality rate of patients with traumatic brain injury in some high-quality studies. However, traumatic brain injury patients with elevated intracranial hypertension could benefit from hypothermia in therapeutic management instead of prophylaxis when initiated within 24 h.
Highlights
Traumatic brain injury (TBI) is a great challenge to public health; more than 50 million people suffer from TBI every year worldwide [1]
When we conducted a subgroup analysis according to different populations, we find that Therapeutic hypothermia (TH) is more beneficial for patients in Eastern countries (RR 0.70, 95% confidence interval (CI) 0.58–0.84, p = 0.0002) (Additional file 5: Figure S5)
M-H, Mantel–Haenszel method; CI, confidence interval we find TBI patients benefit from TH when hypothermia is used for therapy instead of prophylaxis
Summary
Traumatic brain injury (TBI) is a great challenge to public health; more than 50 million people suffer from TBI every year worldwide [1]. TBI can cause swelling (oedema) in the brain, can increase intracranial hypertension (ICP) and can worsen the injury. Therapeutic hypothermia (TH) can reduce ICP [3] and, to some extent, play the role of a neuroprotective agent, thereby protecting the function of neurons, improving the prognosis of patients and achieving the goal of reducing mortality [4]. The results of a large number of animal experiments support TH management [5], and numerous studies have shown that TH can improve neurological outcomes and reduce mortality [6, 7]. A large multicentre trial showed that TH played a negative role in the mortality rate and functional outcome [2]. We can see that the TH strategies remain controversial in patients with TBI
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