Abstract
Mild therapeutic hypothermia (MTH) is expected to improve the neurological outcomes of patients with severe traumatic brain injury (TBI). However, there are no standard protocols for managing the temperature of patients with severe TBI in order to improve their neurological outcomes. We conducted a post hoc analysis of the B-HYPO study, a randomized controlled trial of MTH in patients with TBI in Japan. We evaluated the impact of MTH methods on neurological outcomes. Ninety-seven patients who received MTH were included in the present analyses. The neurological outcomes were compared among subgroups of patients divided by cutoff values for the induction, maintenance, and rewarming times of MTH in all patients, in patients with diffuse injury, and in patients with an evacuated hematoma. The proportion of patients with a good neurological outcome was significantly different between patients with an evacuated hematoma divided into subgroups by the cutoff value of rewarming time of 48 h (>48 h vs. ≤ 48 h: 65% vs. 22%; odds ratio: 6.61; 95% confidence interval: 1.13–38.7, P = 0.0498). Slow rewarming for >48 h might improve the neurological outcomes of prolonged MTH in patients with TBI and an evacuated hematoma. Further studies are needed to investigate the optimal rewarming protocol in patients with TBI.
Highlights
Mild therapeutic hypothermia (MTH) has long been expected to improve the neurological outcomes of patients with severe traumatic brain injury (TBI), two major randomized controlled trials (RCT) did not find any advantages of MTH in this setting[1,2]
The present post hoc analyses were performed under our desire to improve the temperature management of MTH, because the Brain Hypothermia (B-HYPO) study involved a long duration of hypothermia (≥72 h; median 75.5 h, range 68.9–84.0 h) and a long rewarming time owing to the slow rewarming rate of ≤1.0 °C/day in a well-controlled study in terms of age, GCS, hemodynamic control, and inter-/intra-center randomization
We found that a rewarming phase of ≥48 h was associated with a significantly greater rate of good neurological outcomes and significantly lower mortality rate compared with a rewarming period of
Summary
Mild therapeutic hypothermia (MTH) has long been expected to improve the neurological outcomes of patients with severe traumatic brain injury (TBI), two major randomized controlled trials (RCT) did not find any advantages of MTH in this setting[1,2]. There are no standard protocols for managing the temperature of patients with severe TBI in order to improve their neurological outcomes. Several post hoc analyses of major RCTs suggested that pre-surgical induction of MTH potentially improved the neurological outcomes in patients who had evacuation of a hematoma[3,4]. The Brain Hypothermia (B-HYPO) study was a Japanese RCT of MTH for severe TBI, in which the temperature management protocol involved a rapid induction phase (≤6 h), a prolonged maintenance phase (≥3 days), and a slow rewarming phase (
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