Effects of Selective Brain Cooling in Patients with Severe Traumatic Brain Injury: A Preliminary Study

Abstract

We prospectively investigated noninvasive selective brain cooling (SBC) in patients with severe traumatic brain injury.Sixty-six in-patients were randomized into three groups. In one group, brain temperature was maintained at 33 -35°C by cooling the head and neck (SBC); in a second group, mild systemic hypothermia (MSH; rectal temperature 33 -35°C) was produced with a cooling blanket; and a control group was not exposed to hypothermia. Natural rewarming began after 3 days. Mean intracranial pressure 24, 48 or 72 h after injury was significantly lower in the SBC group than in the control group. Mean serum superoxide dismutase levels on Days 3 and 7 after injury in the SBC and MSH groups were significantly higher than in the control group. The percentage of patients with a good neurological outcome 2 years after injury was 72.7%, 57.1% and 34.8% in the SBC, MSH and control groups, respectively. Complications were managed without severe sequelae. Non-invasive SBC was safe and effective.

Global neurotrauma research challenges and opportunities

“…Finally, patients who received systemic cooling (full body) were compared with those who received selective brain cooling (head only) and normothermia. Pneumonia rates were lowest and 2-year GOS scores were highest in patients who received selective cooling 64 . Although the results of these studies are promising, the findings are tempered by contradictory findings from similar studies conducted in other countries.…”

Treatment of Resistant Fever: New Method of Local Cerebral Cooling

“…The idea to develop new devices for selective neuroprotective cooling of the brain parenchyma has already been published [12,[26][27][28][29][30][31][32]. In each of the studies, the device became more specific and smaller [33].…”

Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review

“…No difference in the development of pneumonia between control and hypothermia groups was reported in 5 trials, [26][27][28]32 and sepsis or pneumonia were more commonly reported in hypothermic patients in 2 trials. 17,31 No study reported an increase in hemorrhagic complications with hypothermia (either intracranial or systemic), though 4 reported thrombocytopenia 19,27,31,33 and 3 reported slight prolongations in the partial thromboplastin time or prothrombin time. 17,19,26 Although hypokalemia was the most common electrolyte abnormality, reported in 6 trials, 8,17,19,25,26,28 it was treated without serious sequelae in all studies.…”