Moderate hypothermia improves imbalances of thromboxane A2 and prostaglandin I2 production after traumatic brain injury in humans

Aibiki, Mayuki; Maekawa, Soichi; Yokono, Satoshi

doi:10.1097/00003246-200012000-00029

Cited by 99 publications

(50 citation statements)

References 25 publications

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“…The 2 papers for which there was disagreement were considered for exclusion because some of the patients were pediatric. 27,34 As these studies reported individual patient data, we were able to exclude the pediatric data and we included only the adult data in our final analysis. During a later stage of analysis it was discovered that both of these studies were reporting the same set of patient results; therefore, only the most recent one was included.…”

Section: Resultsmentioning

confidence: 99%

“…17,19,25 A rebound increase in ICP associated with rewarming was reported in 3 of the short-term cooling studies; 17,25,26 however, this adverse event was not reported in any of the long-term cooling studies. No difference in the development of pneumonia between control and hypothermia groups was reported in 5 trials, [26][27][28]32 and sepsis or pneumonia were more commonly reported in hypothermic patients in 2 trials. 17,31 No study reported an increase in hemorrhagic complications with hypothermia (either intracranial or systemic), though 4 reported thrombocytopenia 19,27,31,33 and 3 reported slight prolongations in the partial thromboplastin time or prothrombin time.…”

Section: Prophylactic Hypothermia For Traumatic Brain Injurymentioning

confidence: 96%

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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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Section: Resultsmentioning

confidence: 99%

Section: Prophylactic Hypothermia For Traumatic Brain Injurymentioning

confidence: 96%

Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review

Fox

Doyle‐Waters

et al. 2010

CJEM

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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%

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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“…All observed decreases in ICP during cooling. Thirteen of these studies reported significant improvements in outcome associated with hypothermia [10,12-14,16,17,19-25]. All of these were performed in specialised neurotrauma centres, with experience in applying hypothermia and managing its side effects.…”

Section: Introductionmentioning

confidence: 99%

“…All of these were performed in specialised neurotrauma centres, with experience in applying hypothermia and managing its side effects. Ten were single centre studies [10,12,14,16,17,20,22-25], three (all performed in China) [14,20,22] were multi-centre. Four additional studies [11,15,18,21] observed a trend to improved outcome, but these differences were not statistically significant.…”

Section: Introductionmentioning

confidence: 99%

European society of intensive care medicine study of therapeutic hypothermia (32-35°C) for intracranial pressure reduction after traumatic brain injury (the Eurotherm3235Trial)

Andrews

Sinclair

Battison

et al. 2011

Trials

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BackgroundTraumatic brain injury is a major cause of death and severe disability worldwide with 1,000,000 hospital admissions per annum throughout the European Union.Therapeutic hypothermia to reduce intracranial hypertension may improve patient outcome but key issues are length of hypothermia treatment and speed of re-warming. A recent meta-analysis showed improved outcome when hypothermia was continued for between 48 hours and 5 days and patients were re-warmed slowly (1°C/4 hours). Previous experience with cooling also appears to be important if complications, which may outweigh the benefits of hypothermia, are to be avoided.Methods/designThis is a pragmatic, multi-centre randomised controlled trial examining the effects of hypothermia 32-35°C, titrated to reduce intracranial pressure <20 mmHg, on morbidity and mortality 6 months after traumatic brain injury. The study aims to recruit 1800 patients over 41 months. Enrolment started in April 2010.Participants are randomised to either standard care or standard care with titrated therapeutic hypothermia. Hypothermia is initiated with 20-30 ml/kg of intravenous, refrigerated 0.9% saline and maintained using each centre's usual cooling technique. There is a guideline for detection and treatment of shivering in the intervention group. Hypothermia is maintained for at least 48 hours in the treatment group and continued for as long as is necessary to maintain intracranial pressure <20 mmHg. Intracranial hypertension is defined as an intracranial pressure >20 mmHg in accordance with the Brain Trauma Foundation Guidelines, 2007.DiscussionThe Eurotherm3235Trial is the most important clinical trial in critical care ever conceived by European intensive care medicine, because it was launched and funded by the European Society of Intensive Care Medicine and will be the largest non-commercial randomised controlled trial due to the substantial number of centres required to deliver the target number of patients. It represents a new and fundamental step for intensive care medicine in Europe. Recruitment will continue until January 2013 and interested clinicians from intensive care units worldwide can still join this important collaboration by contacting the Trial Coordinating Team via the trial website http://www.eurotherm3235trial.eu.Trial registrationCurrent Controlled Trials ISRCTN34555414

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Moderate hypothermia improves imbalances of thromboxane A2 and prostaglandin I2 production after traumatic brain injury in humans

Cited by 99 publications

References 25 publications

Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review

Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review

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

European society of intensive care medicine study of therapeutic hypothermia (32-35°C) for intracranial pressure reduction after traumatic brain injury (the Eurotherm3235Trial)

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