Characteristics of infection and leukocyte count in severely head-injured patients treated with mild hypothermia.
OBJECTIVE
This study was designed to characterize the infectious complications and kinetics of leukocyte count in severely head-injured patients treated with mild hypothermia.


METHODS
We retrospectively analyzed the incidence and severity of infectious complications as well as daily changes in leukocyte count in 41 severely head-injured patients treated with mild hypothermia (group H). They were retrospectively compared with 25 severely head-injured patients treated with high-dose barbiturates (group B) and to 25 other severely head-injured patients treated with no barbiturates (group N).


RESULTS
Initial intracranial pressure was significantly higher in group H than in the other groups. No significant differences existed in the incidence of pneumonia or meningitis among the three groups, whereas the incidence of bacteremia was significantly higher in group H than in the other two groups. Pneumonia was significantly more severe in group H than in the other groups. In six patients of group H, pneumonia spread fulminantly to become life threatening. Daily changes in total leukocyte count showed the same pattern, consisting of a peak, a nadir, and a second peak in all groups. Total leukocyte count was, however, significantly lower during the first 2 weeks in group H than in the other two groups. Lymphocyte and neutrophil counts were also lower in group H.


CONCLUSIONS
Infectious complications were more severe and leukocyte counts were lower in patients treated with mild hypothermia, who also had the highest initial intracranial pressures, than in patients treated with conventional therapies. Measures against increased susceptibility to infection and leukocyte suppression should be explored.
Ishikawa
K
K
Department of Traumatology, Osaka University Medical School, Japan.
Tanaka
H
H
Shiozaki
T
T
Takaoka
M
M
Ogura
H
H
Kishi
M
M
Shimazu
T
T
Sugimoto
H
H
D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D003428:Cross Infection / Q000097:blood* / Q000209:etiology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods; D007427:Intracranial Pressure; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives