PURPOSE: Hypothermia therapy shows its unique potential for reducing mortality in animal study and improving neurologic outcome in patients with traumatic brain injury. However, therapeutic hypothermia for pediatric traumatic brain injury remains a controversial issue. To determine the effectiveness and safety of hypothermia treatment for pediatric traumatic brain injury patients, we conducted this meta-analysis. PATIENTS AND METHODS: We analyzed the data from MEDLINE, Pubmed, EMBASE, and Cochrane Library by electronic searching. No limitation of language was selected for analysis. We extracted the mortality and adverse events from the published trials. RESULTS: Six clinical trials and 366 pediatric patients met our inclusion criteria. Pediatric patients with traumatic brain injury treated with hypothermia had more unfavorable outcome than those in the normothermia group (RR 1.73, 95 % CI 1.06 to 2.84), and this increased risk is statistically significant. Patients with therapeutic hypothermia are slightly likely to be induced by cardiac arrhythmia, and the likelihood is also significant (RR 2.57, 95 % CI 1.01 to 6.54). Risk of pneumonia has no statistical difference between normothermia and hypothermia arms (RR 0.90, 95 % CI 0.73 to 1.12). Two of the included trials have reported their detail randomization assignment. CONCLUSIONS: Hypothermia may slightly increase the risk of mortality in children with traumatic brain injury and the ratio of cardiac arrhythmia after this hypothermia therapy is slightly higher than that in normothermia groups. In the future, more randomized controlled trials and multicenter studies on the mechanism of therapeutic hypothermia are required.
PURPOSE:Hypothermia therapy shows its unique potential for reducing mortality in animal study and improving neurologic outcome in patients with traumatic brain injury. However, therapeutic hypothermia for pediatric traumatic brain injury remains a controversial issue. To determine the effectiveness and safety of hypothermia treatment for pediatric traumatic brain injurypatients, we conducted this meta-analysis. PATIENTS AND METHODS: We analyzed the data from MEDLINE, Pubmed, EMBASE, and Cochrane Library by electronic searching. No limitation of language was selected for analysis. We extracted the mortality and adverse events from the published trials. RESULTS: Six clinical trials and 366 pediatric patients met our inclusion criteria. Pediatric patients with traumatic brain injury treated with hypothermia had more unfavorable outcome than those in the normothermia group (RR 1.73, 95 % CI 1.06 to 2.84), and this increased risk is statistically significant. Patients with therapeutic hypothermia are slightly likely to be induced by cardiac arrhythmia, and the likelihood is also significant (RR 2.57, 95 % CI 1.01 to 6.54). Risk of pneumonia has no statistical difference between normothermia and hypothermia arms (RR 0.90, 95 % CI 0.73 to 1.12). Two of the included trials have reported their detail randomization assignment. CONCLUSIONS:Hypothermia may slightly increase the risk of mortality in children with traumatic brain injury and the ratio of cardiac arrhythmia after this hypothermia therapy is slightly higher than that in normothermia groups. In the future, more randomized controlled trials and multicenter studies on the mechanism of therapeutic hypothermia are required.
Authors: Patrick M Kochanek; Nancy Carney; P David Adelson; Stephen Ashwal; Michael J Bell; Susan Bratton; Susan Carson; Randall M Chesnut; Jamshid Ghajar; Brahm Goldstein; Gerald A Grant; Niranjan Kissoon; Kimberly Peterson; Nathan R Selden; Robert C Tasker; Karen A Tong; Monica S Vavilala; Mark S Wainwright; Craig R Warden Journal: Pediatr Crit Care Med Date: 2012-01 Impact factor: 3.624
Authors: Rosanne Salonia; Philip E Empey; Samuel M Poloyac; Stephen R Wisniewski; Megan Klamerus; Haishin Ozawa; Amy K Wagner; Randall Ruppel; Michael J Bell; Keri Feldman; P David Adelson; Robert S B Clark; Patrick M Kochanek Journal: J Neurotrauma Date: 2010-09-17 Impact factor: 5.269
Authors: I R Chambers; P A Jones; T Y M Lo; R J Forsyth; B Fulton; P J D Andrews; A D Mendelow; R A Minns Journal: J Neurol Neurosurg Psychiatry Date: 2005-08-15 Impact factor: 10.154
Authors: P A Jones; I R Chambers; T Y M Lo; P J D Andrews; W Chaudhry; A Clark; J Croft; R Forsyth; B Fulton; A D Mendelow; G Wilson; R A Minns Journal: Acta Neurochir Suppl Date: 2005
Authors: Jose Roberto Tude Melo; Federico Di Rocco; Laudenor Pereira Lemos-Júnior; Thomas Roujeau; Bertrand Thélot; Christian Sainte-Rose; Philippe Meyer; Michel Zerah Journal: Childs Nerv Syst Date: 2009-06-24 Impact factor: 1.475