The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury

Smrčka, Martin; Vidlák, Milan; Máca, Karel; Smrčka, Vladimír; Gál, Roman

doi:10.1007/3-211-32318-x_56

Cited by 46 publications

(50 citation statements)

References 6 publications

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“…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%

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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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Section: Clinical Studies With Hypothermiamentioning

confidence: 99%

“…83 However, two multicenter studies have failed to show beneficial effects of hypothermia. 85,86 In infants and children, hypothermia treatment has shown preservation of oxidative defenses in the CSF after TBI.…”

Section: Clinical Studies With Hypothermiamentioning

confidence: 99%

Use of Magnesium in Traumatic Brain Injury

Sen¹,

Gulati

2010

Neurotherapeutics

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“…Todo lo cual determina una disminución de la PIC 8,9 . Smrcka M. y cols., en un estudio de 72 pacientes con TEC grave (Glasgow < 8), demostró que el empleo de hipotermia moderada logró disminuir la PIC, tanto en las lesiones cerebrales primarias como en los casos con hematomas extracerebrales 16 . Una reciente revisión Cochrane analizó 21 trabajos, que incluyeron 1.587 pacientes con TEC aleatorizados a hipotermia moderada o tratamiento convencional 17 .…”

Section: Discussionunclassified

Hipotermia intravascular prolongada en un paciente con hipertensión endocraneana refractaria

et al. 2012

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“…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%

“…Many studies noted hemodynamic changes associated with hypothermia: bradycardia in 7 trials 8,17,19,25,26,28,32 and hypotension in 3 trials. 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.…”

Section: Prophylactic Hypothermia For Traumatic Brain Injurymentioning

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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The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury

Cited by 46 publications

References 6 publications

Use of Magnesium in Traumatic Brain Injury

Use of Magnesium in Traumatic Brain Injury

Hipotermia intravascular prolongada en un paciente con hipertensión endocraneana refractaria

Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review

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