Critical Care| September 01 2008 Hypothermia for Traumatic Brain Injury AAP Grand Rounds (2008) 20 (3): 28–29. https://doi.org/10.1542/gr.20-3-28 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Hypothermia for Traumatic Brain Injury. AAP Grand Rounds September 2008; 20 (3): 28–29. https://doi.org/10.1542/gr.20-3-28 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: hypothermia, induced, traumatic brain injuries, hypothermia, natural Source: Hutchison JS, Ward RE, Lacroix J, et al. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;358(23):2447–2456; doi:10.1056/NEJMoa0706930 Canadian investigators performed a randomized trial between 1999 and 2004 to determine if elective hypothermia is better than normothermia (37.0° C) at preventing adverse outcomes in children with severe traumatic brain injury (TBI). Children aged 1–17 years with a Glasgow Coma Scale (GCS) of ≤ 8 were enrolled. Patients randomized to hypothermia were cooled with surface cooling techniques until they had esophageal temperatures of 32.5° ± 0.5°C for 24 hours. After rewarming those in the hypothermia group (at a rate of 0.5°C every two hours), and beginning immediately for the normothermia group, core temperature was maintained at 37.0° ± 0.5°C until intracranial hypertension resolved. The primary outcome was an unfavorable outcome defined as severe disability, a persistent vegetative state, or death within six months. The six-point Pediatric Cerebral Performance Category Scale was utilized to assess the level of neurologic function.1 A total of 225 children were enrolled; mean age was 10 years and 70% were male. The mean time to initiation of cooling was 6.3 hours after injury and the mean time to attainment of target temperature was 3.9 hours after cooling began. Patients in the treatment groups were similar in age, GCS score, presence of hypotension or hypoxia at the time of intensive care unit (ICU) admission, cranial computed tomography finding, and other organ injuries. During the following three days after the injury, the hypothermia group had significantly lower cerebral perfusion pressure (61 vs 66 mmHg), increased need for vasoactive infusions (85% vs 56%), and more episodes of hypotension (45% vs 32%). Hospital mortality was 21% in the hypothermia group and 22% in the normothermia group. Length of hospital stay was similar in both groups. At six months, there was no statistically significant difference in unfavorable outcomes (31% in the hypothermia group vs 22% in the normothermic group, P=.14). There were 23 deaths (21%) in the hypothermia group and 14 deaths (12%) in the normothermia group (P=.06). The authors concluded that moderate hypothermia for 24 hours was not effective in treating children with severe TBI. Dr. Zebrack has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. In animal models TBI hypothermia has been beneficial,2,3 but results in human studies have been equivocal. Four recent systematic reviews of therapeutic hypothermia in adults illustrate the complexity of the issue, with two reporting no benefit4,5 and two suggesting some benefit.6,7 One of the reviews, a 2008 evidence report performed to update guidelines from the Brain Trauma Foundation/American Association of Neurological Surgeons Task Force, led to a recommendation for optional and cautious use of hypothermia in adults with severe TBI.7 Given the differing conclusions regarding the use of therapeutic hypothermia in adults, the current study on... You do not currently have access to this content.