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. 2014 Jul-Sep;9(3):115-23.
doi: 10.4103/1793-5482.142690.

Better Glasgow outcome score, cerebral perfusion pressure and focal brain oxygenation in severely traumatized brain following direct regional brain hypothermia therapy: A prospective randomized study

Zamzuri Idris  1 , Mohd Sofan Zenian  2 , Mustapha Muzaimi  1 , Wan Zuraida Wan Abdul Hamid  3
Affiliations

Better Glasgow outcome score, cerebral perfusion pressure and focal brain oxygenation in severely traumatized brain following direct regional brain hypothermia therapy: A prospective randomized study

Zamzuri Idris et al. Asian J Neurosurg. 2014 Jul-Sep.

Abstract

Background: Induced hypothermia for treatment of traumatic brain injury is controversial. Since many pathways involved in the pathophysiology of secondary brain injury are temperature dependent, regional brain hypothermia is thought capable to mitigate those processes. The objectives of this study are to assess the therapeutic effects and complications of regional brain cooling in severe head injury with Glasgow coma scale (GCS) 6-7.

Materials and methods: A prospective randomized controlled pilot study involving patients with severe traumatic brain injury with GCS 6 and 7 who required decompressive craniectomy. Patients were randomized into two groups: Cooling and no cooling. For the cooling group, analysis was made by dividing the group into mild and deep cooling. Brain was cooled by irrigating the brain continuously with cold Hartmann solution for 24-48 h. Main outcome assessments were a dichotomized Glasgow outcome score (GOS) at 6 months posttrauma.

Results: A total of 32 patients were recruited. The cooling-treated patients did better than no cooling. There were 63.2% of patients in cooling group attained good GOS at 6 months compared to only 15.4% in noncooling group (P = 0.007). Interestingly, the analysis at 6 months post-trauma disclosed mild-cooling-treated patients did better than no cooling (70% vs. 15.4% attained good GOS, P = 0.013) and apparently, the deep-cooling-treated patients failed to be better than either no cooling (P = 0.074) or mild cooling group (P = 0.650).

Conclusion: Data from this pilot study imply direct regional brain hypothermia appears safe, feasible and maybe beneficial in treating severely head-injured patients.

Keywords: Brain oxygenation; brain temperature; head injury; hypothermia; trauma.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Neurointensive care monitoring and therapy for patients in this study. (b) External ventricular drainage with multiple side-holes for surface irrigation of the brain with cold solution
Figure 2
Figure 2
Trends of mean intracranial pressures for three different groups within 48 h of monitoring and therapy
Figure 3
Figure 3
Trends of mean cerebral perfusion pressures for three different groups within 48 h of monitoring and therapy
Figure 4
Figure 4
Trends of mean focal brain oxygenation for three different groups within 48 h of monitoring and therapy
Figure 5
Figure 5
Trends of mean difference between brain and body temperature (brain – body temperature) for three different groups within 48 h of monitoring and therapy
Figure 6
Figure 6
Brain temperature is higher (0.1-2°C higher) than body (axillary) temperature. The figures depicted in such way that the scales were aligned and therefore, the figures were comparable
See this image and copyright information in PMC

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