Literature DB >> 26060880

Therapeutic Hypothermia Reduces Intracranial Pressure and Partial Brain Oxygen Tension in Patients with Severe Traumatic Brain Injury: Preliminary Data from the Eurotherm3235 Trial.

Liam M C Flynn1, Jonathan Rhodes2, Peter J D Andrews1.   

Abstract

Traumatic brain injury (TBI) is a significant cause of disability and death and a huge economic burden throughout the world. Much of the morbidity associated with TBI is attributed to secondary brain injuries resulting in hypoxia and ischemia after the initial trauma. Intracranial hypertension and decreased partial brain oxygen tension (PbtO2) are targeted as potentially avoidable causes of morbidity. Therapeutic hypothermia (TH) may be an effective intervention to reduce intracranial pressure (ICP), but could also affect cerebral blood flow (CBF). This is a retrospective analysis of prospectively collected data from 17 patients admitted to the Western General Hospital, Edinburgh. Patients with an ICP >20 mmHg refractory to initial therapy were randomized to standard care or standard care and TH (intervention group) titrated between 32°C and 35°C to reduce ICP. ICP and PbtO2 were measured using the Licox system and core temperature was recorded through rectal thermometer. Data were analyzed at the hour before cooling, the first hour at target temperature, 2 consecutive hours at target temperature, and after 6 hours of hypothermia. There was a mean decrease in ICP of 4.3±1.6 mmHg (p<0.04) from 15.7 to 11.4 mmHg, from precooling to the first epoch of hypothermia in the intervention group (n=9) that was not seen in the control group (n=8). A decrease in ICP was maintained throughout all time periods. There was a mean decrease in PbtO2 of 7.8±3.1 mmHg (p<0.05) from 30.2 to 22.4 mmHg, from precooling to stable hypothermia, which was not seen in the control group. This research supports others in demonstrating a decrease in ICP with temperature, which could facilitate a reduction in the use of hyperosmolar agents or other stage II interventions. The decrease in PbtO2 is not below the suggested treatment threshold of 20 mmHg, but might indicate a decrease in CBF.

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Year:  2015        PMID: 26060880      PMCID: PMC4575517          DOI: 10.1089/ther.2015.0002

Source DB:  PubMed          Journal:  Ther Hypothermia Temp Manag        ISSN: 2153-7658            Impact factor:   1.286


  61 in total

1.  Lack of effect of induction of hypothermia after acute brain injury.

Authors:  G L Clifton; E R Miller; S C Choi; H S Levin; S McCauley; K R Smith; J P Muizelaar; F C Wagner; D W Marion; T G Luerssen; R M Chesnut; M Schwartz
Journal:  N Engl J Med       Date:  2001-02-22       Impact factor: 91.245

Review 2.  A systematic review of brain injury epidemiology in Europe.

Authors:  F Tagliaferri; C Compagnone; M Korsic; F Servadei; J Kraus
Journal:  Acta Neurochir (Wien)       Date:  2006-03       Impact factor: 2.216

3.  Treatment of elevated intracranial pressure in experimental intracerebral hemorrhage: comparison between mannitol and hypertonic saline.

Authors:  A I Qureshi; D A Wilson; R J Traystman
Journal:  Neurosurgery       Date:  1999-05       Impact factor: 4.654

4.  Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study.

Authors:  W G Liu; W S Qiu; Y Zhang; W M Wang; F Lu; X F Yang
Journal:  J Int Med Res       Date:  2006 Jan-Feb       Impact factor: 1.671

5.  Use of hypertonic saline/acetate infusion in treatment of cerebral edema in patients with head trauma: experience at a single center.

Authors:  A I Qureshi; J I Suarez; A Castro; A Bhardwaj
Journal:  J Trauma       Date:  1999-10

6.  Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain.

Authors:  A I Qureshi; J I Suarez; A Bhardwaj; M Mirski; M S Schnitzer; D F Hanley; J A Ulatowski
Journal:  Crit Care Med       Date:  1998-03       Impact factor: 7.598

7.  Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects.

Authors:  C Metz; M Holzschuh; T Bein; C Woertgen; A Frey; I Frey; K Taeger; A Brawanski
Journal:  J Neurosurg       Date:  1996-10       Impact factor: 5.115

8.  Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction.

Authors:  S Schwab; S Schwarz; M Spranger; E Keller; M Bertram; W Hacke
Journal:  Stroke       Date:  1998-12       Impact factor: 7.914

9.  Clinical experience with 118 brain tissue oxygen partial pressure catheter probes.

Authors:  J Dings; J Meixensberger; A Jäger; K Roosen
Journal:  Neurosurgery       Date:  1998-11       Impact factor: 4.654

10.  The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury.

Authors:  M Smrcka; M Vidlák; K Máca; V Smrcka; R Gál
Journal:  Acta Neurochir Suppl       Date:  2005
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  15 in total

Review 1.  Monitoring the Brain After Cardiac Arrest: a New Era.

Authors:  Niraj Sinha; Sam Parnia
Journal:  Curr Neurol Neurosci Rep       Date:  2017-08       Impact factor: 5.081

2.  [Recommendation on temperature management after cardiopulmonary arrest and severe traumatic brain injury in childhood beyond the neonatal period : Statement of the German Society for Neonatology and Pediatric Intensive Care Medicine (GNPI) and the scientific Working Group for Paediatric Anaesthesia (WAKKA) of the German Society of Anaesthesiology and Intensive Care (DGAI)].

Authors:  S Brenner; C Eich; G Rellensmann; M U Schuhmann; T Nicolai; F Hoffmann
Journal:  Anaesthesist       Date:  2017-02       Impact factor: 1.041

Review 3.  Therapeutic Hypothermia and Neuroprotection in Acute Neurological Disease.

Authors:  Kota Kurisu; Jong Youl Kim; Jesung You; Midori A Yenari
Journal:  Curr Med Chem       Date:  2019       Impact factor: 4.530

Review 4.  Therapeutic hypothermia and targeted temperature management in traumatic brain injury: Clinical challenges for successful translation.

Authors:  W Dalton Dietrich; Helen M Bramlett
Journal:  Brain Res       Date:  2015-12-30       Impact factor: 3.252

5.  Targeted temperature management at 33 degrees Celsius in patients with high-grade aneurysmal subarachnoid hemorrhage: a protocol for a multicenter randomized controlled study.

Authors:  Xin Qu; Feng Shang; Hao Zhao; Meng Qi; Weitao Cheng; Yueqiao Xu; Lidan Jiang; Wenjing Chen; Ning Wang; Hongqi Zhang
Journal:  Ann Transl Med       Date:  2021-04

Review 6.  Neuroprotective effect of therapeutic hypothermia versus standard care alone after convulsive status epilepticus: protocol of the multicentre randomised controlled trial HYBERNATUS.

Authors:  Stephane Legriel; Fernando Pico; Yves-Roger Tran-Dinh; Virginie Lemiale; Jean-Pierre Bedos; Matthieu Resche-Rigon; Alain Cariou
Journal:  Ann Intensive Care       Date:  2016-06-21       Impact factor: 6.925

7.  Therapeutic hypothermia versus normothermia in adult patients with traumatic brain injury: a meta-analysis.

Authors:  Youfeng Zhu; Haiyan Yin; Rui Zhang; Xiaoling Ye; Jianrui Wei
Journal:  Springerplus       Date:  2016-06-21

8.  Therapeutic Hypothermia for Increased Intracranial Pressure after Decompressive Craniectomy: A Single Center Experience.

Authors:  Hyun Taek Rim; Jun Hyong Ahn; Ji Hee Kim; Jae Keun Oh; Joon Ho Song; In Bok Chang
Journal:  Korean J Neurotrauma       Date:  2016-10-31

9.  Protocol based invasive intracranial pressure monitoring in acute liver failure: feasibility, safety and impact on management.

Authors:  Venkatakrishna Rajajee; Robert J Fontana; Anthony J Courey; Parag G Patil
Journal:  Crit Care       Date:  2017-07-11       Impact factor: 9.097

10.  Slow rewarming improved the neurological outcomes of prolonged mild therapeutic hypothermia in patients with severe traumatic brain injury and an evacuated hematoma.

Authors:  Tadashi Kaneko; Motoki Fujita; Susumu Yamashita; Yasutaka Oda; Eiichi Suehiro; Kenji Dohi; Shunji Kasaoka; Yasuhiro Kuroda; Hitoshi Kobata; Tsuyoshi Maekawa
Journal:  Sci Rep       Date:  2018-08-02       Impact factor: 4.379

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