Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension

Biswas, Abhik K.; Bruce, Derek A.; Sklar, Fred H.; Bokovoy, Joanna; Sommerauer, John

doi:10.1097/00003246-200212000-00020

Cited by 127 publications

(67 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, some were preliminary studies involving insufficient numbers of patients, some were not properly randomised and others suffered from shortcomings in protocols and methodology. Two relatively well-performed randomised studies in children 13,15 could not demonstrate any beneficial effect of hypothermia on outcome. In a single-centre randomised trial by Marion et al 16 on adults, they found that a 24 h treatment with hypothermia improved outcome only in a subgroup of patients with a Glasgow Coma Score (GCS) of 5-7.…”

Section: Key Studies From the Past Decadesmentioning

confidence: 86%

“…Perhaps the rebound increase in ICP during the rewarming phase abolishes this positive effect, which may explain why there are still no data to support the view that the hypothermia-induced ICP reduction improves outcome. 13 The question may be raised as to whether an intracranial blood volume-reducing therapy induced by hypothermia would be as effective as the established ICP-reducing therapies, which mainly act by reducing brain oedema. [24][25][26][27] Ongoing studies…”

Section: Can Alternative Protocols Improve Outcome?mentioning

confidence: 99%

“…7 Hypothermia is also believed to be a valuable tool in controlling an elevated intracranial pressure (ICP) and a way of moderating the biochemical cascade involved in secondary brain injury. 12,13 However, in spite of several clinical trials from mainly high-quality modern intensive care units, we still lack any evidence for the view that hypothermia is a successful treatment after focal ischaemia, such as after a TBI. An overview of the use of hypothermia after a brain injury was recently published in a special hypothermia issue of the Journal of Neurotrauma.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Active cooling in traumatic brain‐injured patients: a questionable therapy?

Grände

Reinstrup

Romner

2009

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Hypothermia is shown to be beneficial for the outcome after a transient global brain ischaemia through its neuroprotective effect. Whether this is also the case after focal ischaemia, such as following a severe traumatic brain injury (TBI), has been investigated in numerous studies, some of which have shown a tendency towards an improved outcome, whereas others have not been able to demonstrate any beneficial effect. A Cochrane report concluded that the majority of the trials that have already been published have been of low quality, with unclear allocation concealment. If only high-quality trials are considered, TBI patients treated with active cooling were more likely to die, a conclusion supported by a recent high-quality Canadian trial on children. Still, there is a belief that a modified protocol with a shorter time from the accident to the start of active cooling, longer cooling and rewarming time and better control of blood pressure and intracranial pressure would be beneficial for TBI patients. This belief has led to the instigation of new trials in adults and in children, including these types of protocol adjustments. The present review provides a short summary of our present knowledge of the use of active cooling in TBI patients, and presents some tentative explanations as to why active cooling has not been shown to be effective for outcome after TBI. We focus particularly on the compromised circulation of the penumbra zone, which may be further reduced by the stress caused by the difference in thermostat and body temperature and by the hypothermia-induced more frequent use of vasoconstrictors, and by the increased risk of contusional bleedings under hypothermia. We suggest that high fever should be reduced pharmacologically.

show abstract

Section: Key Studies From the Past Decadesmentioning

confidence: 86%

Section: Can Alternative Protocols Improve Outcome?mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Active cooling in traumatic brain‐injured patients: a questionable therapy?

Grände

Reinstrup

Romner

2009

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“…In children, 2 randomized trials could not demonstrate any beneficial effect of hypothermia on outcome [110,111]. Recently, a large, multicenter, randomized, placebocontrolled trial involving 225 children with severe TBI (GCS≤8) did not reveal a difference between groups, with a tendency toward worse outcome in the hypothermia group (mean temperature, 33.1°C ± 1.2°C) due to a higher mortality rate in patients >7 years of age [112].…”

Section: Tbimentioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

View full text Add to dashboard Cite

Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

show abstract

“…Brain swelling is an important problem in pediatric TBI, and hypothermia has been shown to reduce intracranial pressure in adult and pediatric patients and to reduce cerebral swelling in animal models [81,82]. Induced hypothermia has also been shown to decrease mortality and improve outcome in neonates with hypoxic-ischemic injury [83].…”

Section: Hypothermiamentioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

View full text Add to dashboard Cite

Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

show abstract

Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension

Cited by 127 publications

References 43 publications

Active cooling in traumatic brain‐injured patients: a questionable therapy?

Active cooling in traumatic brain‐injured patients: a questionable therapy?

Therapeutic Hypothermia for Acute Neurological Injuries

Pediatric Neurocritical Care

Contact Info

Product

Resources

About