Effect of 35°C Hypothermia on Intracranial Pressure and Clinical Outcome in Patients With Severe Traumatic Brain Injury

Tokutomi, Takashi; Miyagi, Tomoya; Takeuchi, Yasuharu; Karukaya, Takashi; Katsuki, Hiroshi; Shigemori, Minoru

doi:10.1097/ta.0b013e318157dbec

Cited by 64 publications

(58 citation statements)

References 62 publications

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“…There is also a randomized trial evidence of benefit in human brain ischemia after cardiac arrest and neonatal hypoxia ischemia. [54][55][56][57] Hypothermia has been shown to decrease elevated ICP in several neurological disorders, [58][59][60][61] including several phase II stroke clinical trials. 62,63 These studies used long durations of cooling (24-72 hours) and often encountered problems of systemic infection and rebound ICP elevation during patient rewarming.…”

Section: Strokementioning

confidence: 99%

Intracranial Pressure and Collateral Blood Flow

Beard

Murtha

McLeod

et al. 2016

Stroke

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Section: Strokementioning

confidence: 99%

Intracranial Pressure and Collateral Blood Flow

Beard

Murtha

McLeod

et al. 2016

Stroke

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“…To this end, we revisit the utility of hypothermia, now moving from the moderate hypothermia used in our previous studies to mild hypothermia (35°C) to determine whether a relatively modest drop in temperature can exert any protective effects, which, obviously, could prove of clinical utility. [25][26][27] Additionally, to better understand the potential involvement of damaging oxygen radicals in the process of repetitive injury and the benefits of their therapeutic attenuation, we revisit our previous studies, 22,23 now using postrepetitive administration of either superoxide dismutase (SOD) or Tempol, based upon the recognition that SOD will dismutate the superoxide anion, whereas Tempol serves as a nitroxide antioxidant that decomposes both the superoxide radical and the peroxynitrite-derived radical species, all of which have been implicated in the pathogenesis of various forms of axonal and vascular change after TBI. [28][29][30][31][32][33] In the current communication, we report that the use of even mild hypothermia (35°C) exerts significant axonal and vascular protection when the hypothermia is initiated relatively late (1 h) after repetitive injury, with both SOD and Tempol providing comparable protection when administered in the same time frame.…”

mentioning

confidence: 99%

Evidence for the Therapeutic Efficacy of Either Mild Hypothermia or Oxygen Radical Scavengers after Repetitive Mild Traumatic Brain Injury

Miyauchi

Wei²,

Povlishock³

2014

Journal of Neurotrauma

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Repetitive brain injury, particularly that occurring with sporting-related injuries, has recently garnered increased attention in both the clinical and public settings. In the laboratory, we have demonstrated the adverse axonal and vascular consequences of repetitive brain injury and have demonstrated that moderate hypothermia and/or FK506 exerted protective effects after repetitive mild traumatic brain injury (mTBI) when administered within a specific time frame, suggesting a range of therapeutic modalities to prevent a dramatic exacerbation. In this communication, we revisit the utility of targeted therapeutic intervention to seek the minimal level of hypothermia needed to achieve protection while probing the role of oxygen radicals and their therapeutic targeting. Male Sprague-Dawley rats were subjected to repetitive mTBI by impact acceleration injury. Mild hypothermia (35°C, group 2), superoxide dismutase (group 3), and Tempol (group 4) were employed as therapeutic interventions administered 1 h after the repetitive mTBI. To assess vascular function, cerebral vascular reactivity to acetylcholine was evaluated 3 and 4 h after the repetitive mTBI, whereas to detect the burden of axonal damage, amyloid precursor protein (APP) density in the medullospinal junction was measured. Whereas complete impairment of vascular reactivity was observed in group 1 (without intervention), significant preservation of vascular reactivity was found in the other groups. Similarly, whereas remarkable increase in the APP-positive axon was observed in group 1, there were no significant increases in the other groups. Collectively, these findings indicate that even mild hypothermia or the blunting free radical damage, even when performed in a delayed period, is protective in repetitive mTBI.

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“…In AIS 3-4 patients who died from degeneration in intracerebral lesion, the period from admission to death was significantly shorter in the MTH group than in the fever control group (medians [IQR]: 10 [6-13] vs. 17 [13][14][15][16][17][18][19][20][21][22][23][24][25], p < 0.05).…”

Section: Period From Admission To Deathmentioning

confidence: 99%

Fever Control Management Is Preferable to Mild Therapeutic Hypothermia in Traumatic Brain Injury Patients with Abbreviated Injury Scale 3–4: A Multi-Center, Randomized Controlled Trial

Hifumi

Kuroda

Kawakita

et al. 2016

Journal of Neurotrauma

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In our prospective, multi-center, randomized controlled trial (RCT)-the Brain Hypothermia (B-HYPO) study-we could not show any difference on neurological outcomes in patients probably because of the heterogeneity in the severity of their traumatic condition. We therefore aimed to clarify and compare the effectiveness of the two therapeutic temperature management regimens in severe (Abbreviated Injury Scale [AIS] 3-4) or critical trauma patients (AIS 5). In the present post hoc B-HYPO study, we re-evaluated data based on the severity of trauma as AIS 3-4 or AIS 5 and compared Glasgow Outcome Scale score and mortality at 6 months by per-protocol analyses. Consequently, 135 patients were enrolled. Finally, 129 patients, that is, 47 and 31 patients with AIS 3-4 and 36 and 15 patients with AIS 5 were allocated to the mild therapeutic hypothermia (MTH) and fever control groups, respectively.No significant intergroup differences were observed with regard to age, gender, scores on head computed tomography (CT) scans, and surgical operation for traumatic brain injury (TBI), except for Injury Severity Score (ISS) in AIS 5. The fever control group demonstrated a significant reduction of TBI-related mortality compared with the MTH group (9.7% vs. 34.0%, p = 0.02) and an increase of favorable neurological outcomes (64.5% vs. 51.1%, p = 0.26) in patients with AIS 3-4, although the latter was not statistically significant. There was no difference in mortality or favorable outcome in patients with AIS 5.Fever control may be considered instead of MTH in patients with TBI (AIS 3-4).

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Effect of 35°C Hypothermia on Intracranial Pressure and Clinical Outcome in Patients With Severe Traumatic Brain Injury

Abstract: Cooling patients to 35 degrees C is safe and the ICP reduction effects of 35 degrees C hypothermia are similar to those of 33 degrees C hypothermia.

Cited by 64 publications

References 62 publications

Intracranial Pressure and Collateral Blood Flow

Intracranial Pressure and Collateral Blood Flow

Evidence for the Therapeutic Efficacy of Either Mild Hypothermia or Oxygen Radical Scavengers after Repetitive Mild Traumatic Brain Injury

Fever Control Management Is Preferable to Mild Therapeutic Hypothermia in Traumatic Brain Injury Patients with Abbreviated Injury Scale 3–4: A Multi-Center, Randomized Controlled Trial

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