Research Reports - Therapeutic hypothermia for traumatic brain injury in adult and pediatric patients

Crit Care Med. 2017 Apr;45(4):575-583. doi: 10.1097/CCM.0000000000002205.

Crompton EM(1), Lubomirova I, Cotlarciuc I, Han TS, Sharma SD, Sharma P.

OBJECTIVE: Therapeutic hypothermia has been used to attenuate the effects of
traumatic brain injuries. However, the required degree of hypothermia, length of
its use, and its timing are uncertain. We undertook a comprehensive meta-analysis
to quantify benefits of hypothermia therapy for traumatic brain injuries in
adults and children by analyzing mortality rates, neurologic outcomes, and
adverse effects.
DATA SOURCES: Electronic databases PubMed, Google Scholar, Web of Science,
Cochrane Central Register of Controlled Trials, and and manual
searches of studies were conducted for relevant publications up until February
STUDY SELECTION: Forty-one studies in adults (n = 3,109; age range, 18-81 yr) and
eight studies in children (n = 454; age range, 3 mo to 18 yr) met eligibility
DATA EXTRACTION: Baseline patient characteristics, enrollment time, methodology
of cooling, target temperature, duration of hypothermia, and rewarming protocols
were extracted.
DATA SYNTHESIS: Risk ratios with 95% CIs were calculated. Compared with adults
who were kept normothermic, those who underwent therapeutic hypothermia were
associated with 18% reduction in mortality (risk ratio, 0.82; 95% CI, 0.70-0.96;
p = 0.01) and a 35% improvement in neurologic outcome (risk ratio, 1.35; 95% CI,
1.18-1.54; p < 0.00001). The optimal management strategy for adult patients
included cooling patients to a minimum of 33°C for 72 hours, followed by
spontaneous, natural rewarming. In contrast, adverse outcomes were observed in
children who underwent hypothermic treatment with a 66% increase in mortality
(risk ratio, 1.66; 95% CI, 1.06-2.59; p = 0.03) and a marginal deterioration of
neurologic outcome (risk ratio, 0.90; 95% CI, 0.80-1.01; p = 0.06).
CONCLUSIONS: Therapeutic hypothermia is likely a beneficial treatment following
traumatic brain injuries in adults but cannot be recommended in children. 

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