Temperature management in acute brain injury: A systematic review of clinical evidence

Pegoli, Marianna; Zurlo, Z.; Bilotta, Federico

doi:10.1016/j.clineuro.2020.106165

Cited by 24 publications

(16 citation statements)

References 73 publications

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“…A further study performed a secondary analysis using 10 years of data from the Pennsylvania Trauma Outcome Study (PTOS), which showed in more than 11,033 patients with severe TBI that spontaneous hypothermia at hospital admission was associated with a significant increase in the risk of mortality [ 201 ]. In addition, induced hypothermia in TBI with temperatures between 32 and 35 °C for at least 48 h was associated with either no improved outcome [ 202 – 204 ] or higher mortality in a general population with TBI [ 205 , 206 ]. Nevertheless, one meta-analysis showed that hypothermia in patients with increased intracranial pressure is beneficial, if used therapeutically rather than prophylactically [ 206 ].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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“…Maintenance of normothermia (36.5–37.5°C) is recommended, with active aggressive treatment of both hypo‐ and hyperthermia [29]. Hyperthermia occurs commonly in patients with TBI and is often seen soon after injury, even in the absence of infection [30].…”

Section: General Management Principlesmentioning

confidence: 99%

Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

et al. 2023

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Each year, approximately 70 million people suffer traumatic brain injury, which has a significant physical, psychosocial and economic impact for patients and their families. It is recommended in the UK that all patients with traumatic brain injury and a Glasgow coma scale ≤ 8 should be transferred to a neurosurgical centre. However, many patients, especially those in whom neurosurgery is not required, are not treated in, nor transferred to, a neurosurgical centre. This review aims to provide clinicians who work in non-neurosurgical centres with a summary of contemporary studies relevant to the critical care management of patients with traumatic brain injury. A targeted literature review was undertaken that included guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials (published in English between 1 January 2017 and 1 July 2022). Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also eligible for inclusion. Analysis of the topics identified during the review was then summarised. These included: fundamental critical care management approaches (including ventilation strategies, fluid management, seizure control and osmotherapy); use of processed electroencephalogram monitoring; non-invasive assessment of intracranial pressure; prognostication; and rehabilitation techniques. Through this process, we have formulated practical recommendations to guide clinical practice in non-specialist centres.

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“…Accidental hypothermia on hospital admission, which is common in patients who have suffered traumatic injuries, should also be actively managed as this is associated with an increased mortality risk after TBI ((OR 2.38 (95%CI 1.53–3.69)) [34]. These studies add to the evidence suggesting that normothermia is key in the management of many types of brain injury [35] and hypo‐ and hyperthermia should both be managed aggressively at hospital admission. Normothermia after TBI has been defined variably in different studies, but in clinical practice a typical target is 36.5–37.5°C.…”

Section: Therapeutic Hypothermiamentioning

confidence: 99%

Management of traumatic brain injury: a narrative review of current evidence

Wiles

2022

Anaesthesia

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Globally, approximately 70 million people sustain traumatic brain injury each year and this can have significant physical, psychosocial and economic consequences for patients, their families and society. The aim of this review is to provide clinicians with a summary of recent studies of direct relevance to the management of traumatic brain injury in order to promote best clinical practice. The use of tranexamic acid in the management of traumatic brain injury has been the focus of several studies, with one large randomised controlled trial suggesting a reduction in all-cause mortality within 24 h of injury. The use of therapeutic hypothermia does not improve neurological outcomes and maintenance of normothermia remains the optimal management strategy. For seizure management, levetiracetam appears to be as effective as phenytoin, but the optimal dose remains unclear. There has been a lack of clear outcome benefit for any individual osmotherapy agent, with no difference in mortality or neurological recovery. Early tracheostomy (< 7 days from injury) for patients with traumatic brain injury is associated with a reduction in the incidence of ventilator-associated pneumonia and duration of mechanical ventilation, critical care and hospital stay. Further research is needed in order to determine the optimal package of care and interventions. There is a need for research studies to focus on patient-centred outcome measures such as long-term neurological recovery and quality of life.

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Temperature management in acute brain injury: A systematic review of clinical evidence

Cited by 24 publications

References 73 publications

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

Management of traumatic brain injury: a narrative review of current evidence

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