Quote:
Originally Posted by swatsurgeon
save your money...cooling helps kids not adults with TBI.......
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Maybe, maybe not.....haven't seen anything definite either way on this. Seems to be a mixed bag. I can say that we are not doing this at two of the shops I've worked at.
Thanks.
Wook
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J Neurotrauma. 2008 Jan;25(1):62-71.
Hypothermia treatment for traumatic brain injury: a systematic review and meta-analysis.
Peterson K, Carson S, Carney N.
Source
Oregon Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon 97239, USA.
peterski@ohsu.edu
Abstract
In this study, we conducted an updated meta-analysis of the effects of hypothermia therapy on mortality, favorable neurologic outcome, and associated adverse effects in adults with traumatic brain injury (TBI) for use by Brain Trauma Foundation (BTF)/American Association of Neurological Surgeons (AANS) task force to develop evidence-based treatment guidelines. Our data sources relied on handsearches of four previous good-quality systematic reviews, which all conducted electronic searches of primarily MEDLINE (OVID), EMBASE, and Cochrane Library. An independent, supplemental electronic search of MEDLINE was undertaken as well (last searched June 2007). Only English-language publications of randomized controlled trials of therapeutic hypothermia in adults with TBI were selected for analysis. Two reviewers independently abstracted data on trial design, patient population, hypothermia and cointervention protocols, patient outcomes, and aspects of methodological quality. Pooled relative risks (RR) and associated 95% confidence intervals (CIs) were calculated for each outcome using random-effects models. In the current study, only 13 trials met eligibility criteria, with a total of 1339 randomized patients. Sensitivity analyses revealed that outcomes were influenced by variations in methodological quality. Consequently, main analyses were conducted based on eight trials that demonstrated the lowest potential for bias (n = 781). Reductions in risk of mortality were greatest (RR 0.51; 95% CI 0.33, 0.79) and favorable neurologic outcomes much more common (RR 1.91; 95% CI 1.28, 2.85) when hypothermia was maintained for more than 48 h. However, this evidence comes with the suggestion that the potential benefits of hypothermia may likely be offset by a significant increase in risk of pneumonia (RR 2.37; 95% CI 1.37, 4.10). In sum, the present study's updated meta-analysis supports previous findings that hypothermic therapy constitutes a beneficial treatment of TBI in specific circumstances. Accordingly, the BTF/AANS guidelines task force has issued a Level III recommendation for optional and cautious use of hypothermia for adults with TBI.
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Neurotherapeutics. Author manuscript; available in PMC 2011 January 1.
Published in final edited form as:
Neurotherapeutics. 2010 January; 7(1): 43.
doi: 10.1016/j.nurt.2009.10.015
PMCID: PMC2819078
NIHMSID: NIHMS169689
Copyright notice and Disclaimer
THE EVIDENCE FOR HYPOTHERMIA AS A NEUROPROTECTANT IN TRAUMATIC BRAIN INJURY
W. Dalton Dietrich, Ph.D. and Helen M. Bramlett, Ph.D.
Department of Neurological Surgery The Miami Project to Cure Paralysis University of Miami Miller School of Medicine Miami, FL
Correspondence to: W. Dalton Dietrich, III, Ph.D., Professor of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Suite 2-30, Miami, FL 33136-1060, Telephone: (305) 243-2297, Fax: (305) 243-3207, Email:
ddietrich@miami.edu
The purpose of this article is to review published experimental and clinical evidence for the benefits of modest hypothermia in the treatment of traumatic brain injury (TBI). Therapeutic hypothermia has been reported to improve outcome in several animal models of CNS injury and has been successfully translated to specific patient populations. A Pub Med search for hypothermia and TBI was conducted and important papers reviewed on the subject. Summarized research was conducted at major academic institutions throughout the world. Experimental studies have emphasized that hypothermia can affect multiple pathophysiological mechanisms felt to participate in the detrimental consequences of TBI. Published data from several relevant clinical trials on the use of hypothermia in severely injured TBI patients is also included. The consequences of mild to moderate levels of hypothermia introduced by different strategies to the head injured patient for variable periods of time are discussed. Both experimental and clinical data support the beneficial effects of modest hypothermia following TBI in specific patient populations. In addition to single institution studies, positive findings from multicenter TBI trials are now required before this experimental treatment is considered standard of care.
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January 5, 2010 — The early induction of hypothermia did not improve outcomes in patients with diffuse severe traumatic brain injury enrolled in the National Acute Brain Injury Study Hypothermia II (NABIS: H II).
However, results of a subgroup analysis suggested that hypothermia may have benefits in patients with surgically removed hematomas.
"We see little basis for further testing of early hypothermia induction as a neuroprotectant in diffuse brain injury," conclude Guy L. Clifton, MD, of the Department of Neurosurgery, The University of Texas Medical School at Houston, and colleagues. "However, the role of early hypothermia treatment of patients with evacuated hematomas deserves further testing," they wrote.
"This study provides proof positive that therapies affect patients with diffuse injury and hematoma in different ways," Dr. Clifton added in an interview with Medscape Medical News.
The results were published online December 20 in The Lancet Neurology.
Andrew I. R. Maas, MD, PhD, chairman of the Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium, told Medscape Medical News, "The results support the concept that a simple one size fits all approach in traumatic brain injury is inappropriate."
Dr. Maas, who was not involved in the study, coauthored an accompanying commentary with Nino Stocchetti, MD, of Milan University, Italy.
Dr. Maas said he does not think the results reported in this study "will or should have a direct effect on ongoing trials of hypothermia in traumatic brain injury. The numbers are simply too small to permit any definitive conclusions."
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