Hypothermia in traumatic brain injury for control of intracranial hypertension: Standalone therapeutic option or adjunct?

 

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Background: Traumatic brain injury (TBI) is a major cause of death and disability across the globe. Raised intracranial pressure (ICP) has been the major detrimental factor while dealing with management of head trauma. Hypothermia has been shown to reduce ICP. Hence, our study planned to see the effect of hypothermia (32–35°C) for ICP reduction after TBI. Methodology: In this prospective randomised controlled trial, adult patients with primary closed TBI with raised ICP >20 mmHg for ≥5 min after first line treatments and with no obvious reversible cause, ≤10 days from the initial head injury, with core temperature ≥36°C (at the time of randomisation) and with an abnormal computed tomography scan were randomised to either hypothermia (32–35°C) or normothermia group. Results: A total of 27 patients were randomised, 14 in hypothermia group and 13 in normothermia group. The mean age of the patients was 35.29 and 26.85 years, the mean ICP at the time of randomisation was 22.65 and 24.05 mmHg in hypothermia and control group, respectively. The Glasgow coma score at admission was 6.9 in the two groups. Of 13 patients in the hypothermia group, 4 patients were enrolled following decompressive craniectomy and raised ICP responded well to induction of hypothermia. In rest of the patients in hypothermia group, 5 were managed with hypothermia alone whereas 4 required decompressive surgery. Two patients in each group developed pneumonia. There were no coagulation abnormalities in either group. Mean duration of Intensive Care Unit and hospital stay was 10.15 days, 9.5 days and 19.5, 18.57 days in normothermia and hypothermia group, respectively. Conclusions: Hypothermia can be used safely as adjunct to other modalities for controlling ICP in severe head injury patients.