Hypothermia Therapy after Traumatic Brain Injury in Children

Hutchison, James S.; Ward, Roxanne; Lacroix, Jacques; Hébert, Paul C.; Barnes, Marcia A.; Bohn, Desmond; Dirks, Peter B.; Doucette, Steve; Fergusson, Dean; Gottesman, Ronald; Joffe, Ari R.; Kirpalani, Haresh; Meyer, Philippe; Morris, Kevin; Moher, David; Singh, Richa; Skippen, Peter

doi:10.1056/nejmoa0706930

Cited by 603 publications

(301 citation statements)

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“…Obtaining informed consent for research in critically ill patients involves a complex interplay between patient, legal guardian, consent process, and study-related factors. A review of the literature showed limited data on the consent process and consent rates in pediatric critical care research which have varied from 42 to 94% in recent large trials [4][5][6][7][8]. The factors that affect these consent rates are poorly understood and may lead to delays in trial completion and obtaining results that may influence patient care [6], difficulty with planning and financing of clinical studies [4], and questions about the reliability and generalizability of trial results [7].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting consent in pediatric critical care research

et al. 2011

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Section: Introductionmentioning

confidence: 99%

Factors affecting consent in pediatric critical care research

et al. 2011

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“…44 Another recently published study on hypothermia in pediatric brain injury, which cooled for only 24 hours and then rewarmed regardless of ICP, showed a negative effect of the intervention on functional outcomes. 45 Indeed, given what is known about rebound increases in ICP and timing of cerebral edema, it is not surprising that this protocol was found to be harmful. It would be of great value for Western researchers to attempt to reproduce the success of prophylactic long-term hypothermia achieved in Asia, where most of the long-term cooling studies were performed.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review

Fox

Doyle‐Waters

et al. 2010

CJEM

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Introduction: During the past 7 years, considerable new evidence has accumulated supporting the use of prophylactic hypothermia for traumatic brain injury (TBI). Studies can be divided into 2 broad categories: studies with protocols for cooling for a short, predetermined period (e.g., 24-48 h), and those that cool for longer periods and/or terminate based on the normalization of intracranial pressure (ICP). There have been no systematic reviews of hypothermia for TBI that include this recent new evidence. Methods: This analysis followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and the QUOROM (quality of reporting of meta-analyses) statement. We developed a comprehensive search strategy to identify all randomized controlled trials (RCTs) comparing therapeutic hypothermia with standard management in TBI patients. We searched Embase, MEDLINE, Web of Science, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, ProceedingsFirst and PapersFirst. Additional relevant articles were identified by hand-searching conference proceedings and bibliographies. All stages of study identification and selection, quality assessment and analysis were conducted according to prospectively defined criteria. Study quality was determined by assessment of each study for the use of allocation concealment and outcome assessment blinding. Studies were divided into 2 a priori-defined subgroups for analysis based on cooling strategy: short term (≤ 48 h), and long term or goal-directed (> 48 h and/or continued until normalization of ICP). Outcomes included mortality and good neurologic outcome (defined as Glasgow Outcome Scale score of 4 or 5). Pooling of primary outcomes was completed using relative risk (RR) and reported with 95% confidence intervals (CIs). Results: Of 1709 articles, 12 studies with 1327 participants were selected for quantitative analysis. Eight of these studies cooled according to a long-term or goal-directed strategy, and 4 used a short-term strategy. Summary results demonstrated lower mortality (RR 0.73, 95% CI 0.62-0.85) and more

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“…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]. A current ongoing trial enrolling children <16 years of age is attempting to show benefit by extending the cooling period (32°C to 33°C) to 48 h with a slow re-warming phase of 1°C every 12 to 24 h [113].…”

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confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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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.

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Hypothermia Therapy after Traumatic Brain Injury in Children

Abstract: In children with severe traumatic brain injury, hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality. (Current Controlled Trials number, ISRCTN77393684 [controlled-trials.com].).

Cited by 603 publications

References 27 publications

Factors affecting consent in pediatric critical care research

Factors affecting consent in pediatric critical care research

Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review

Therapeutic Hypothermia for Acute Neurological Injuries

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