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Review
. 2010;14(1):204.
doi: 10.1186/cc8220. Epub 2010 Feb 15.

Bench-to-bedside review: Hypothermia in traumatic brain injury

Affiliations
Review

Bench-to-bedside review: Hypothermia in traumatic brain injury

H Louise Sinclair et al. Crit Care. 2010.

Abstract

Traumatic brain injury remains a major cause of death and severe disability throughout the world. Traumatic brain injury leads to 1,000,000 hospital admissions per annum throughout the European Union. It causes the majority of the 50,000 deaths from road traffic accidents and leaves 10,000 patients severely handicapped: three quarters of these victims are young people. Therapeutic hypothermia has been shown to improve outcome after cardiac arrest, and consequently the European Resuscitation Council and American Heart Association guidelines recommend the use of hypothermia in these patients. Hypothermia is also thought to improve neurological outcome after neonatal birth asphyxia. Cardiac arrest and neonatal asphyxia patient populations present to health care services rapidly and without posing a diagnostic dilemma; therefore, therapeutic systemic hypothermia may be implemented relatively quickly. As a result, hypothermia in these two populations is similar to the laboratory models wherein systemic therapeutic hypothermia is commenced very soon after the injury and has shown so much promise. The need for resuscitation and computerised tomography imaging to confirm the diagnosis in patients with traumatic brain injury is a factor that delays intervention with temperature reduction strategies. Treatments in traumatic brain injury have traditionally focussed on restoring and maintaining adequate brain perfusion, surgically evacuating large haematomas where necessary, and preventing or promptly treating oedema. Brain swelling can be monitored by measuring intracranial pressure (ICP), and in most centres ICP is used to guide treatments and to monitor their success. There is an absence of evidence for the five commonly used treatments for raised ICP and all are potential 'double-edged swords' with significant disadvantages. The use of hypothermia in patients with traumatic brain injury may have beneficial effects in both ICP reduction and possible neuro-protection. This review will focus on the bench-to-bedside evidence that has supported the development of the Eurotherm3235Trial protocol.

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Figures

Figure 1
Figure 1
Hypothermia for traumatic brain injury. Immediate hypothermia is compared with normothermia. The outcome was death at final follow-up stratified by trial quality. CI, confidence interval; M-H, Mantel-Haenszel. Reproduced with permission from [80]. Copyright 2009, The Cochrane Collaboration.
Figure 2
Figure 2
Stages of therapeutic management after traumatic brain injury. These 'stages' have been developed for use in the Eurotherm3235Trial using evidence synthesis from the Brain Trauma Foundation [73] and the European Brain Injury Consortium [81]. CSF, cerebrospinal fluid; PaCO2, arterial partial pressure of carbon dioxide; PaO2, arterial partial pressure of oxygen.

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