title: Noninvasive selective brain cooling by head and neck cooling is protective in severe traumatic brain injury.
abstract: Therapeutic hypothermia is a promising treatment for patients with severe traumatic brain injury (TBI). We present here the results of a study in which noninvasive selective brain cooling (SBC) was achieved using a head cap and neckband. Ninety patients with severe TBI were divided into a normothermia control group (n=45) and a SBC group (n=45), whose brain temperature was maintained at 33-35 degrees C for 3 days using a combination of head and neck cooling. At 24, 48 and 72h after injury, the mean intracranial pressure (ICP) values of the patients who underwent SBC were lower than those of the normothermia controls (19.14+/-2.33, 19.72+/-1.73 and 17.29+/-2.07 mmHg, versus 23.41+/-2.51, 20.97+/-1.86, and 20.13+/-1.87 mmHg, respectively, P<0.01). There was a significant difference in the neurological recovery of the two groups at the 6-month follow-up after TBI. Good neurological outcome (Glasgow Outcome Scale score of 4 to 5) rates 6 months after injury were 68.9% for the SBC group, and 46.7% for the control group (P<0.05). There were no complications resulting in severe sequelae. In conclusion, the noninvasive SBC described here is a safe method of administering therapeutic hypothermia, which can reduce ICP and improve prognosis without severe complications in patients with severe TBI.
authors.affiliation: Brain Center, Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou 310009, China.
authors.forename: Wusi
authors.initials: W
authors.lastname: Qiu
authors.forename: Hong
authors.initials: H
authors.lastname: Shen
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Weimin
authors.initials: W
authors.lastname: Wang
authors.forename: Weiguo
authors.initials: W
authors.lastname: Liu
authors.forename: Qizhou
authors.initials: Q
authors.lastname: Jiang
authors.forename: Ming
authors.initials: M
authors.lastname: Luo
authors.forename: Merriem
authors.initials: M
authors.lastname: Manou
mesh_terms: D000328:Adult; D000368:Aged; D001831:Body Temperature / Q000502:physiology; D001921:Brain / Q000502:physiology; D001930:Brain Injuries / Q000628:therapy*; D015984:Causality; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods* / Q000592:standards / Q000639:trends; D019586:Intracranial Hypertension / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome