Induced mild hypothermia in children

Rimantas Kėvalas ,Vaidotas Gurskis ,Algimantas Matukevičius ,Vytautas Ragaišis ,Dovilė Evalda Grinkevičiūtė ,Vidmantas Barauskas

doi:10.22514/sv72.102012.2

Abstract

The objective of this study was to measure outcomes and to determine the safety and effectiveness of mild induced hypothermia in children after traumatic and posthypoxic brain injury. Methods. Forty patients, following traumatic or posthypoxic brain injury, were involved in the study. Mean age was 10.7 ± 0.8 years. Median GCS (Glasgow Coma Scale) was 6.0 (4-7) and mean PIM2 (Pediatric Index of Mortality) 14.6 ± 3.8 %. Results. GOS (Glasgow Outcome Scale) of 5 was assigned for 15 (37.5%) patients, GOS 4 for 14 (35.0%), GOS 3 for 7 (17.5%) and GOS 2 for 4 (10%) patients. The average GOS in patients after severe head trauma was 3.6 ± 0.9 points and in patients with posthypoxic brain injury 5 points, (p < 0.05). No life threatening complications occurred. Conclusion. Mild induced hypothermia can be safely used in pediatric patents after severe traumatic or posthypoxic brain injury. This method may be of benefit while improving outcomes in children.

Highlights

Brain injury is a significant cause of death and disability in children
Mild induced hypothermia can be safely used in pediatric patents after severe traumatic or posthypoxic brain injury
This method may be of benefit while improving outcomes in children

Summary

Introduction

Brain injury is a significant cause of death and disability in children. At least one third of survivors sustain moderate to severe neurological sequelae. In case of strangulation or neardrowning, primary brain injury is initially associated with tissue hypoxia and ischemia, secondary injury occurs from reperfusion, sustained acidosis, cerebral edema, hyperglycemia, release of excitatory neurotransmitters, seizures, hypotension and impaired cerebral autoregulation. [1] Secondary injury is represented by systemic and intracranial events that occur in response to the primary injury and further contribute to neuronal damage and cell death. One highly promising therapy that targets multiple pathological mechanisms caused by traumatic or posthypoxic brain injury is mild induced hypothermia (MIH). [5] There is clear evidence of a beneficial effect of induced hypothermia on neurological outcome in patients following cardiac arrest [6,7] or in neonates with hypoxic – ischemic encephalopathy, [8] but things in traumatic brain injury are controversial. We know that hypothermia reduces global cerebral metabolism, cerebral oxygen demands, lactic acid accumulation, calcium influx in neurocytes, free radicals production, lipid peroxidation, posttraumatic level of excitatory neurotransmitter, inhibition of apoptosis, and lowers the damage of cytoskeletal structure. [5] There is clear evidence of a beneficial effect of induced hypothermia on neurological outcome in patients following cardiac arrest [6,7] or in neonates with hypoxic – ischemic encephalopathy, [8] but things in traumatic brain injury are controversial. [9] In our study we aimed to determine the safety and effectiveness of MIH for pediatric patients after traumatic or posthypoxic brain injury

Objectives

Methods

Results

Conclusion