Prophylactic and Therapeutic Hypothermia in Severe Traumatic Brain Injury

Abstract

This review aims to synthesize knowledge on the efficacy and safety of prophylactic hypothermia (PH—cooling started shortly after trauma) and therapeutic hypothermia (TH—cooling started to treat increased intracranial pressure (ICP)) in severe traumatic brain injury (TBI). Current evidence on the use of hypothermia in severe TBI is conflicting. Recent multicenter trials on the topic have demonstrated no improvement in functional outcome or mortality in patients treated with PH. Certain patient subgroups seem to benefit from this therapy, such as individuals undergoing craniotomy. TH appears to be ineffective as a stage 2 therapy, but evidence supports its use in stage 3 ICP management. Higher risks of complications occur with hypothermia, but they can be mitigated by using milder cooling, selective brain cooling, and gradual rewarming. Short-term PH appears to be ineffective in improving outcome for severe TBI. However, PH may still be useful as a longer-duration therapy and in specific patient subgroups. In addition, optimal rate of rewarming and ideal target temperature need to be established. TH as a stage 3 ICP control therapy has only shown benefit in small trials. Higher-quality studies that shed light on these questions are required.