Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases

Jiang, Jiyao; Yu, Mei; Zhu, Cheng

doi:10.3171/jns.2000.93.4.0546

Cited by 255 publications

(141 citation statements)

References 28 publications

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“…However, its influence on patient outcome is yet to be clearly demonstrated. In a comparison of a longer course of mild hypothermia (33-35°C for 3-14 days) with normothermia, mortality was found to be lower and 1-year GOS scores were better for the hypothermia group 62 . A subsequent study that compared short-term (1-3 days) and longterm (4-6 days) mild hypothermia found that patients given a course of hypothermia for 5 days had significantly better 6-month GOS scores than those given a 2-day course 63 .…”

Section: Chinamentioning

confidence: 88%

Global neurotrauma research challenges and opportunities

Rubiano

Carney

Chesnut

et al. 2015

Nature

382

277

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Section: Chinamentioning

confidence: 88%

Global neurotrauma research challenges and opportunities

Rubiano

Carney

Chesnut

et al. 2015

Nature

382

277

View full text Add to dashboard Cite

“…Clinical studies with moderate hypothermia of 32°C to 35°C for 1-14 days have shown a beneficial effect on outcome in TBI patients with lowering of ICP [81][82][83][84] and increase of cerebral perfusion pressure. 83 However, two multicenter studies have failed to show beneficial effects of hypothermia.…”

Section: Clinical Studies With Hypothermiamentioning

confidence: 99%

Use of Magnesium in Traumatic Brain Injury

Sen¹,

Gulati

2010

Neurotherapeutics

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Summary: Depletion of magnesium is observed in animal brain and in human blood after brain injury. Treatment with magnesium attenuates the pathological and behavioral changes in rats with brain injury; however, the therapeutic effect of magnesium has not been consistently observed in humans with traumatic brain injury (TBI). Secondary brain insults are observed in patients with brain injury, which adversely affect clinical outcome. Systemic administration studies in rats have shown that magnesium enters the brain; however, inducing hypermagnesemia in humans did not concomitantly increase magnesium levels in the CSF. We hypothesize that the neuroprotective effects of magnesium in TBI patients could be observed by increasing its brain bioavailability with mannitol. Here, we review the role of magnesium in brain injury, preclinical studies in brain injury, clinical safety and efficacy studies in TBI patients, brain bioavailability studies in rat, and pharmacokinetic studies in humans with brain injury. Neurodegeneration after brain injury involves multiple biochemical pathways. Treatment with a single agent has often resulted in poor efficacy at a safe dose or toxicity at a therapeutic dose. A successful neuroprotective therapy needs to be aimed at homeostatic control of these pathways with multiple agents. Other pharmacological agents, such as dexanabinol and progesterone, and physiological interventions, with hypothermia and hyperoxia, have been studied for the treatment of brain injury. Treatment with magnesium and hypothermia has shown favorable outcome in rats with cerebral ischemia. We conclude that coadministration of magnesium and mannitol with pharmacological and physiological agents could be an effective neuroprotective regimen for the treatment of TBI.

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“…A higher rate of infection and worsening of coagulation have been reported in some clinical studies of hypothermia in neurotrauma [158], [159] and [160]. These complications, however, have not constituted a major problem in the majority of randomized studies [19], [20], [24] and [161], have been absent so far in ALF patients [80], [81], [119] and [120] and, importantly, they can be prevented and managed. New therapies, such as recombinant factor VIIa [162] or granulocyte colony-stimulating factor [163] could also be helpful.…”

Section: Therapeutic Implicationsmentioning

confidence: 98%

“…In addition, the rapid decrease of ICP-induced by hypothermia [18], [20], [21], [23] and [24] suggests that the reduction of cerebral blood flow (CBF) and volume may account to a large part for the effect of hypothermia on ICP. The reduction of ICP has, in turn, beneficial effects on the preservation of brain tissue perfusion and blood-brain barrier integrity.…”

Section: Introductionmentioning

confidence: 99%

Keeping cool in acute liver failure: Rationale for the use of mild hypothermia

Vaquero

Rose

Butterworth

2005

Journal of Hepatology

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Encephalopathy, brain edema and intracranial hypertension are neurological complications responsible for substantial morbidity/mortality in patients with acute liver failure (ALF), where, aside from liver transplantation, there is currently a paucity of effective therapies. Mirroring its cerebro-protective effects in other clinical conditions, the induction of mild hypothermia may provide a potential therapeutic approach to the management of ALF. A solid mechanistic rationale for the use of mild hypothermia is provided by clinical and experimental studies showing its beneficial effects in relation to many of the key factors that determine the development of brain edema and intracranial hypertension in ALF, namely the delivery of ammonia to the brain, the disturbances of brain organic osmolytes and brain extracellular amino acids, cerebro-vascular haemodynamics, brain glucose metabolism, inflammation, subclinical seizure activity and alterations of gene expression. Initial uncontrolled clinical studies of mild hypothermia in patients with ALF suggest that it is an effective, feasible and safe approach. Randomized controlled clinical trials are now needed to adequately assess its efficacy, safety, clinical impact on global outcomes and to provide the guidelines for its use in ALF.

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Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases

Abstract: The data produced by this study demonstrate that long-term mild hypothermia therapy significantly improves outcomes in patients with severe TBI.

Cited by 255 publications

References 28 publications

Global neurotrauma research challenges and opportunities

Global neurotrauma research challenges and opportunities

Use of Magnesium in Traumatic Brain Injury

Keeping cool in acute liver failure: Rationale for the use of mild hypothermia

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