Abstract
Improved understanding of the molecular mechanisms of secondary brain injury has informed the optimum depth and duration of cooling and led to increased clinical interest in the therapeutic moderate hypothermia for severe traumatic brain injury over the past two decades. Although several large multi-center clinical trials have not found a treatment effect, multiple single-center trials have, and a recent meta-analysis by Crossley and colleagues now finds that the cumulative findings of those single-center trials dilute the multi-center trial results and show an overall reduction in mortality and poor outcomes associated with cooling. The need for consistent support of key physiologic parameters during cooling is emphasized by this finding.
Highlights
A recent meta-analysis of clinical trials of the use of hypothermia to treat severe traumatic brain injury (TBI) is the first report in nearly 15 years to suggest improved outcomes associated with cooling [1]
Therapeutic moderate hypothermia (32 to 35°C) for the acute care of patients with severe TBI has been evaluated in multiple clinical trials during the past 20 years, especially in the US, Japan, and China
A review of 11 prospective randomized clinical trials that compared intracranial pressure (ICP) levels with hypothermia versus normothermia treatment and six prospective cohort studies that provided ICP data before and during hypothermia treatment found that therapeutic moderate hypothermia was surpassed only by hypertonic saline, lumbar cerebrospinal fluid drainage, and decompressive craniectomy in the level of ICP reduction [2]
Summary
A recent meta-analysis of clinical trials of the use of hypothermia to treat severe traumatic brain injury (TBI) is the first report in nearly 15 years to suggest improved outcomes associated with cooling [1]. Introduction A recent meta-analysis of clinical trials of the use of hypothermia to treat severe traumatic brain injury (TBI) is the first report in nearly 15 years to suggest improved outcomes associated with cooling [1].
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