Effect of Long-Term Mild Hypothermia or Short-Term Mild Hypothermia on Outcome of Patients with Severe Traumatic Brain Injury

Abstract

To compare the effect of long-term mild hypothermia versus short-term mild hypothermia on the outcome of 215 severe traumatic brain injured patients with cerebral contusion and intracranial hypertension. At three medical centers, 215 patients aged 18 to 45 years old with an admission Glasgow Coma Scale <-8 within 4 h after injury were randomly divided into two groups: long-term mild hypothermia group (n = 108) for 5 +-1.3 days mild hypothermia therapy and short-term mild hypothermia group (n = 107) for 2 +-0.6 days mild hypothermia therapy. All patients had intracranial hypertension and frontotemporoparietal contusion with midline shift > 1 cm confirmed on computed tomographic scan. Glasgow Outcome Scale at 6-month follow-up, 47 cases had favorable outcome (43.5%), and other 61 cases had unfavorable outcome (56.5%) in the long-term mild hypothermia group. However, only 31 cases had favorable outcome (29.0%), and other 76 cases had unfavorable outcome (71.0%) in the short-term mild hypothermia group (P < 0.05). The intracranial pressure significantly rebounded after rewarming in the short-term mild hypothermia group, but not in the long-term mild hypothermia (P < 0.05). Furthermore, the incidence of stress ulcer, epilepsy, pulmonary infection, intracranial infection did not significantly differ between the two groups (P > 0.05). Compared with short-term mild hypothermia, long-term mild hypothermia significantly improves the outcome of severe traumatic brain injured patients with cerebral contusion and intracranial hypertension without significant complications. Our data suggest that 5 days of longterm cooling is more efficacious than 2 days of short-term cooling when mild hypothermia is used to control refractory intracranial hypertension in patients with severe traumatic brain injury.

The Adverse Pial Arteriolar and Axonal Consequences of Traumatic Brain Injury Complicated by Hypoxia and Their Therapeutic Modulation with Hypothermia in Rat

“…c Significant differences compared with the values in groups 1, 4, and 5 at same time point (P < 0.001). premise is partially supported by the clinical studies of Jiang et al (2006) who have showed the benefits of more prolonged (4 to 5 days) hypothermic intervention, a strategy whose benefits may, in part, be related to the attenuation of the damaging consequences of secondary insults described above.…”

Global neurotrauma research challenges and opportunities

“…In a comparison of a longer course of mild hypothermia (33-35°C for 3-14 days) with normothermia, mortality was found to be lower and 1-year GOS scores were better for the hypothermia group 62 . A subsequent study that compared short-term (1-3 days) and longterm (4-6 days) mild hypothermia found that patients given a course of hypothermia for 5 days had significantly better 6-month GOS scores than those given a 2-day course 63 . Finally, patients who received systemic cooling (full body) were compared with those who received selective brain cooling (head only) and normothermia.…”

Clinical Trials in Traumatic Brain Injury: Past Experience and Current Developments

“…This is important, for example, because of various trials conducted in mainland China that have shown beneficial effects of decompressive craniectomy, hypothermia, and progesterone. 10,[12][13][14][15] These were all well-designed, high-quality studies. However, it is conceivable that differences may exist in referral policies, potential for selection bias, access to health care, acute and post-acute treatments, and outcome.…”