title: A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan.
abstract: OBJECTIVE
  The criteria for the use of mild hypothermia (34 degrees C) in severely head injured patients have not been standardized. A prospective randomized controlled trial was conducted to determine whether mild hypothermia is essential in the treatment of severely head injured patients with low intracranial pressure (ICP).
  
  
  METHODS
  At 11 medical centers, 91 severely head injured patients with an admission Glasgow Coma Scale score of 8 or less in whom ICP could be maintained below 25 mm Hg by conventional therapies were divided randomly into two groups: the mild hypothermia group (HT group, 45 patients) and the normothermia group (NT group, 46 patients). Patients in the HT group were exposed to mild hypothermia (34 degrees C) for 48 hours, followed by rewarming at 1 degrees C per day for 3 days, whereas patients in the NT group were exposed to normothermia (37 degrees C) for 5 days. The two groups were similar with respect to prognostic factors, and there was no difference in clinical outcome at 3 months postinjury. During treatment, there was a significantly greater use of neuromuscular blocking agents in the HT group (p = 0.011). During the initial 2 weeks postinjury, the incidences of pneumonia, meningitis, leukocytopenia, thrombocytopenia, hypernatremia, hypokalemia, and hyperamylasemia were significantly higher in the HT than in the NT group (p < 0.05).
  
  
  CONCLUSIONS
  Mild hypothermia should not be used for the treatment of severely head injured patients with low ICP because this therapy conveys no advantage over normothermia in such patients.
authors.affiliation: Department of Traumatology, Osaka University Medical School, Kinki University School of Medicine, Japan. shiozaki@hp-emerg.med.osaka-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Shiozaki
authors.forename: T
authors.initials: T
authors.lastname: Hayakata
authors.forename: M
authors.initials: M
authors.lastname: Taneda
authors.forename: Y
authors.initials: Y
authors.lastname: Nakajima
authors.forename: N
authors.initials: N
authors.lastname: Hashiguchi
authors.forename: S
authors.initials: S
authors.lastname: Fujimi
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamori
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Shimazu
authors.forename: H
authors.initials: H
authors.lastname: Sugimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D017211:Treatment Failure