ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 23 of 39
УЖМБС 2017, 2(6): 111–115
Clinical Medicine

Comparative Evaluation of Therapeutic Hypothermia Effectiveness in the Intensive Care of Brain Severe Injury

Tsarev A.

Сurrent article presents the results of neurological outcomes studying in 24 patients aged 20 to 66 years with severe TBI. The purpose of the study was to examine neurological outcomes in patients with severe TBI using therapeutic hypothermia in the intensive care in comparison with the control group. Materials and methods. Patients divided into 2 groups were examined: I (n=12) – patients with standard intensive care complex, according to the “Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition, 2016” in the treatment of the ICU; II group (n=12) – with the therapeutic hypothermia "Blanketrol II" (CSZ) with the use of non-invasive technology to achieve the target core body temperature of 34.50C. Induction of therapeutic hypothermia was performed by intravenous drip as fast as possible infusion of 40C with a saline at a dose of 30 ml/kg, followed by maintenance of therapeutic hypothermia with the hypotherm "Blanketrol-II" through blankets with circulating cold water. In the induction phase, an analgesia and pharmacological prevention of cold shiver development was performed. Induction, maintenance of therapeutic hypothermia, and warming of patients, the body core temperature was continuously measured by means of an esophageal temperature sensor connected to the "Blanketrol-II". Criteria for the inclusion of patients in the study: the first 24 hours from the moment of receiving severe TBI (both with the carrying out without an operative neurosurgical intervention), the initial level of neurological deficit, which was assessed on the Glasgow Coma Scale (GCS), in the range of 5-7 points. Exclusion criteria were: age ≤18 years, neurological status on the GCS ≥8 and ≤4 points at the time of the study, pregnancy, refractory arterial hypotension using high doses of vasopressors. Patients of both groups were mechanically ventilated. Results. Early recovery of consciousness (the first 5 days) in 16.7% in group I and 41.7% in the group II was detected (p>0.05). The dynamics of neurologic recovery on day 10 after TBI was significantly better in the group II on the GCS: 12.5±1.70 compared with 11.16±1.86 in the group I (p<0.05). Similar dynamics was revealed at the time of discharge of patients on the GCS: 11.75±2.08 and 13.33±1.92 points in the first and second groups, respectively (p<0.05). At discharge neurologic recovery at the level of Сerebral Performance Categories (CPC) 1-2 was observed in 58.3%, and at the level of CPC 3-4 in 41.7% of patients in both groups. In the analysis of poor outcomes, in the group with the use of therapeutic hypothermia, there was a tendency to reduce the severity of the neurological damage, in comparison with the control group of patients. Thus, the most unfavorable outcome of severe TBI of CPC-4 in the first group developed in 33.3% of patients, while in the second group it was 8.3%. Mean values of outcomes on the scale of the CPC at the time of discharge from the hospital were 2.58±1.11 in group I and 2.16±0.9 in the group II (p>0.05). Limitations of this study are a small sample of patients and heterogeneity of traumatic brain injury, which requires additional studies. Thus, the results of the study showed a better dynamics of neurologic recovery when used in a complex of intensive care for severe TBI therapeutic hypothermia.

Keywords: brain injury, therapeutic hypothermia, neurological outcomes, intensive care

Full text: PDF (Rus) 197K

  1. Carney N, Totten AM, O’Reilly C, Ullman JS, Gregory WJ, Hawryluk GWJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Brain Trauma Foundation. Neurosurgery. 2017; 80 (1): 6-15.
  2. Crompton EM, Lubomirova I, Cotlarcius I, Han TS, Sharma SD, Sharma P. Meta-analysis of therapeutic hypothermia for traumatic brain injury in adult and pediatric patients. Crit Care Med. 2017; 45: 575-83. 10.1097/CCM.0000000000002205
  3. Kochanek PM, Jackson TC. The brain and hypothermia – from Aristotle to Target Temperature Management. Crit Care Med. 2017; 45: 305-10.
  4. Lundbye JB (Ed.) Therapeutic Hypothermia after Cardiac Arrest. Clinical Application and Management. Heidelberg-NewYork-London: Springer; 2012.
  5. Nielsen N, Wetterslev J, Cronberg T, Erlinged D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, et al. Target temperature management at 330C versus 360C after cardiac arrest. NEJM. 2013; 369: 2197-206.
  6. Peterson K, Carson S, Cairney N. Hypothermia treatment for traumatic brain injury: A systematic review and meta-analysis. Journal of Neurotrauma. 2008; 26: 62-71.
  7. Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet. 2008; 371: 1955-65.
  8. White MG, Luca LE, Nonner D, Saleh O, Hu B, Barrett EF, Barrett JN. Cellular mechanisms of neuronal damage from hyperthermia. Prog Brain Res. 2007; 162: 347–71.