Clinical Insights and Future Directions in Hypothermia for Severe Traumatic Brain Injury: A Narrative Review.
Hitoshi KobataPublished in: Journal of clinical medicine (2024)
Fever control is essential in patients with severe traumatic brain injury (TBI). The efficacy of therapeutic hypothermia (TH) in severe TBI has been investigated over the last few decades; however, in contrast to experimental studies showing benefits, no evidence of efficacy has been demonstrated in clinical practice. In this review, the mechanisms and history of hypothermia were briefly outlined, while the results of major randomized controlled trials (RCTs) and meta-analyses investigating TH for adult TBI were introduced and discussed. The retrieved meta-analyses showed conflicting results, with a limited number of studies indicating the benefits of TH. Some studies have shown the benefits of long-term TH compared with short-term TH. Although TH is effective at lowering elevated intracranial pressure (ICP), reduced ICP does not lead to favorable outcomes. Low-quality RCTs overestimated the benefits of TH, while high-quality RCTs showed no difference or worse outcomes with TH. RCTs assessing standardized TH quality demonstrated the benefits of TH. As TBI has heterogeneous and complicated pathologies, applying a uniform treatment may not be ideal. A meta-analysis of young patients who underwent early cooling and hematoma removal showed better TH results. TH should not be abandoned, and its optimal usage should be advocated on an individual basis.
Keyphrases
- severe traumatic brain injury
- meta analyses
- traumatic brain injury
- cardiac arrest
- systematic review
- randomized controlled trial
- end stage renal disease
- brain injury
- newly diagnosed
- case control
- chronic kidney disease
- peritoneal dialysis
- prognostic factors
- quality improvement
- magnetic resonance imaging
- adipose tissue
- type diabetes
- optic nerve
- middle aged
- study protocol
- insulin resistance
- single molecule
- smoking cessation
- drug induced
- combination therapy