Prophylactic and Therapeutic Hypothermia in Severe Traumatic Brain Injury

Prophylactic and Therapeutic Hypothermia in Severe Traumatic Brain Injury Purpose of Review This review aims to synthesize knowledge on the efficacy and safety of prophylactic hypothermia (PH— cooling started shortly after trauma) and therapeutic hypothermia (TH—cooling started to treat increased intracranial pressure (ICP)) in severe traumatic brain injury (TBI). Recent Findings Current evidence on the use of hypothermia in severe TBI is conflicting. Recent multicenter trials on the topic have demonstrated no improvement in functional outcome or mortality in patients treated with PH. Certain patient subgroups seem to benefit from this therapy, such as individuals undergoing craniotomy. TH appears to be ineffective as a stage 2 therapy, but evidence supports its use in stage 3 ICP management. Higher risks of complications occur with hypothermia, but they can be mitigated by using milder cooling, selective brain cooling, and gradual rewarming. Summary Short-term PH appears to be ineffective in improving outcome for severe TBI. However, PH may still be useful as a longer-duration therapy and in specific patient subgroups. In addition, optimal rate of rewarming and ideal target temperature need to be established. TH as a stage 3 ICP control therapy has only shown benefit in small trials. Higher-quality studies that shed light on these questions are required. . . http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Trauma Reports Springer Journals

Prophylactic and Therapeutic Hypothermia in Severe Traumatic Brain Injury

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Traumatic Surgery; Surgery; Emergency Medicine; Intensive / Critical Care Medicine; Rehabilitation
eISSN
2198-6096
D.O.I.
10.1007/s40719-018-0121-7
Publisher site
See Article on Publisher Site

Abstract

Purpose of Review This review aims to synthesize knowledge on the efficacy and safety of prophylactic hypothermia (PH— cooling started shortly after trauma) and therapeutic hypothermia (TH—cooling started to treat increased intracranial pressure (ICP)) in severe traumatic brain injury (TBI). Recent Findings Current evidence on the use of hypothermia in severe TBI is conflicting. Recent multicenter trials on the topic have demonstrated no improvement in functional outcome or mortality in patients treated with PH. Certain patient subgroups seem to benefit from this therapy, such as individuals undergoing craniotomy. TH appears to be ineffective as a stage 2 therapy, but evidence supports its use in stage 3 ICP management. Higher risks of complications occur with hypothermia, but they can be mitigated by using milder cooling, selective brain cooling, and gradual rewarming. Summary Short-term PH appears to be ineffective in improving outcome for severe TBI. However, PH may still be useful as a longer-duration therapy and in specific patient subgroups. In addition, optimal rate of rewarming and ideal target temperature need to be established. TH as a stage 3 ICP control therapy has only shown benefit in small trials. Higher-quality studies that shed light on these questions are required. . .

Journal

Current Trauma ReportsSpringer Journals

Published: Mar 10, 2018

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