Therapeutic Hypothermia in Children and Adults with Severe Traumatic Brain Injury
TLDR
It is concluded that scientific support as a first-tier therapy for the use of therapeutic hypothermia in TBI patients for both adults and children still lacks scientific support, but it may still be an option as a second- tier therapy for refractory intracranial hypertension.Abstract:
Great expectations have been raised about neuroprotection of therapeutic hypothermia in patients with traumatic brain injury (TBI) by analogy with its effects after heart arrest, neonatal asphyxia, and drowning in cold water. The aim of this study is to review our present knowledge of the effect of therapeutic hypothermia on outcome in children and adults with severe TBI. A literature search for relevant articles in English published from year 2000 up to December 2013 found 19 studies. No signs of improvement in outcome from hypothermia were seen in the five pediatric studies. Varied results were reported in 14 studies on adult patients, 2 of which reported a tendency of higher mortality and worse neurological outcome, 4 reported lower mortality, and 9 reported favorable neurological outcome with hypothermia. The quality of several trials was low. The best-performed randomized studies showed no improvement in outcome by hypothermia-some even indicated worse outcome. TBI patients may suffer from hypothermia-induced pulmonary and coagulation side effects, from side effects of vasopressors when re-establishing the hypothermia-induced lowered blood pressure, and from a rebound increase in intracranial pressure (ICP) during and after rewarming. The difference between body temperature and temperature set by the biological thermostat may cause stress-induced worsening of the circulation and oxygenation in injured areas of the brain. These mechanisms may counteract neuroprotective effects of therapeutic hypothermia. We conclude that we still lack scientific support as a first-tier therapy for the use of therapeutic hypothermia in TBI patients for both adults and children, but it may still be an option as a second-tier therapy for refractory intracranial hypertension.read more
Citations
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Journal ArticleDOI
Traumatic Brain Injury: Current Treatment Strategies and Future Endeavors
Michael A. Galgano,Gentian Toshkezi,Xuecheng Qiu,Xuecheng Qiu,Thomas Russell,Lawrence S. Chin,Li-Ru Zhao,Li-Ru Zhao +7 more
TL;DR: The current status of treatment for TBI in both clinical practice and basic research is summarized, with a brief overview of the various subtypes of traumatic injuries, optimal medical management, and both the noninvasive and invasive monitoring modalities, in addition to the surgical interventions necessary in particular instances.
Journal ArticleDOI
Traumatic Brain Injury and Mitochondrial Dysfunction
TL;DR: The purpose of this review is to examine the mitochondrial alterations after TBI, specifically increased reactive oxygen species production, decreased bioenergetics and apoptosis and current TBI treatments.
Journal ArticleDOI
Hypothermia for Neuroprotection in Convulsive Status Epilepticus
Stéphane Legriel,Virginie Lemiale,Maleka Schenck,Jonathan Chelly,Virginie Laurent,Fabrice Daviaud,Mohamed Srairi,Aicha Hamdi,Guillaume Geri,Thomas Rossignol,Julia Hilly-Ginoux,Julie Boisramé-Helms,Benjamin Louart,Isabelle Malissin,Nicolas Mongardon,Benjamin Planquette,Marina Thirion,Sybille Merceron,Emmanuel Canet,Fernando Pico,Yves-Roger Tran-Dinh,Jean-Pierre Bedos,Elie Azoulay,Matthieu Resche-Rigon,Alain Cariou +24 more
TL;DR: In this trial, induced hypothermia added to standard care was not associated with significantly better 90-day outcomes than standard care alone in patients with convulsive status epilepticus.
Journal ArticleDOI
Capillary Transit Time Heterogeneity and Flow-Metabolism Coupling after Traumatic Brain Injury
Leif Østergaard,Thorbjørn S Engedal,Rasmus Aamand,Ronni Mikkelsen,Nina K. Iversen,Maryam Anzabi,Erhard Trillingsgaard Næss-Schmidt,Kim Ryun Drasbek,Vibeke Bay,Jakob Udby Blicher,Anna Tietze,Irene Klærke Mikkelsen,Brian Hansen,Sune Nørhøj Jespersen,Niels Juul,Jens Christian Sørensen,Mads Rasmussen +16 more
TL;DR: A biophysical model of oxygen transport in tissue is used to examine how capillary flow disturbances may contribute to the profound changes in CBF after TBI, and suggests that elevated capillary transit time heterogeneity can cause critical reductions in oxygen availability in the absence of ‘classic’ ischemia.
Journal ArticleDOI
Hypothermia in Traumatic Brain Injury
TL;DR: Current evidence on hypothermia in patients with severe TBI is summarized, and recommendations based upon the conclusions are given.
References
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Journal ArticleDOI
Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia
A. B Ernard,Imothy W. G Ray,D. B Uist,M. J Ones,W Illiam S Ilvester,G Eoff G Utteridge,K Aren S Mith +6 more
TL;DR: This randomized, controlled trial compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest to survive to hospital discharge and be discharged to home or to a rehabilitation facility.
Journal ArticleDOI
Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest
Michael Holzer,Fritz Sterz,J. M. Darby,S. A. Padosch,Karl B. Kern,Bernd W. Böttiger,Kees H. Polderman,Armand R. J. Girbes,Michael Holzer,Stephen Bernard,M. D. Buist,Peter Safar,Patrick M. Kochanek +12 more
TL;DR: In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality.
Journal ArticleDOI
Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia☆
TL;DR: Treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest, according to preliminary observations.
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TL;DR: Quantification of cerebral perfusion by monitoring of intracranial pressure and treatment of cerebral hypoperfusion decrease secondary injury and an organised trauma system that allows rapid resuscitation and transport directly to an experienced trauma centre significantly lowers mortality and morbidity.
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Mild Therapeutic Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest
TL;DR: In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality.
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