This is a multicentre, randomised controlled trial of therapeutic hypothermia versus normothermia in 77 children with severe TBI .In this study there were no statistically significant differences in mortality or functional outcomes between the two intervention groups, but the mortality was higher in the hypothermia group than it was in the normothermia group 15% vs 5%( p=0·15). ...after this study .... should we still use hypothermia in TBI to treat intracranial hypertension refractory to other therapies?
This is very interesting to read. For improving outcome of head injury, I am sure that we must use multimodal approach. I still think that hypothermia is promising, perhaps combined with other treatment strategies:
Optimising cerebral perfusion pressure by using transcranial Doppler early in the emergency department before intracranial pressure monitoring is available.
Using tools for cerebral perfusion pressure optimisation as PRx index, brain tissue oxygen tension and cerebral microdialysis.
Using those tools for optimising glucemia and hemoglobin.
And of course continuous EEG monitoring.
Using more prolonged duration of hypothermia. In my unit, the duration of the storm following head injury is far more than 48h. We use 4 to 5 days of hypothermia (in combination with adjustments of CPP using trancranial Doppler and SjvO2) our clinical impression is that hypothermia patients are doing better.
I must precise that until now, we cannot always monitor intracranial pressure. And of course we do not have the advanced monitoring I mentioned.
Wainting for more comments to get new idea and learn.
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