Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy.
OBJECTIVE
We investigated the effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy (TBI).


METHODS
Eighty patients with severe TBI after unilateral craniotomy were randomized into a therapeutic hypothermia group with the brain temperature maintained at 33 degrees C to 35 degrees C for 4 days, and a normothermia control group in the intensive care unit. Vital signs, intracranial pressure, serum superoxide dismutase level, Glasgow Outcome Scale scores, and complications were prospectively analyzed.


RESULTS
The mean intracranial pressure values of the therapeutic hypothermia group at 24, 48, and 72 hours after injury were much lower than those of the control group (23.49 +/- 2.38, 24.68 +/- 1.71, and 22.51 +/- 2.44 vs 25.87 +/- 2.18, 25.90 +/- 1.86, and 24.57 +/- 3.95 mm Hg; P = .000, .000, and .003, respectively). The mean serum superoxide dismutase levels of the therapeutic hypothermia group at days 3 and 7 were much higher than those of the control group at the same time point (533.0 +/- 103.4 and 600.5 +/- 82.9 vs 458.7 +/- 68.1 and 497.0 +/- 57.3 mug/L, respectively; P = .000). The percentage of favorable neurologic outcome 1 year after injury was 70.0% and 47.5%, respectively (P = .041). Complications, including pulmonary infections (57.5% in the therapeutic hypothermia group vs 32.5% in the control group; P = .025) were managed without severe sequelae.


CONCLUSIONS
Therapeutic mild hypothermia provides a promising way in the intensive care unit for patients with severe TBI after craniotomy.
Qiu
Wusi
W
Department of Neurosurgery, Hangzhou Second Hospital, School of Medicine, Hangzhou Normal College, Hangzhou 310012, China. shihai954@163.com
Zhang
Ying
Y
Sheng
Hong
H
Zhang
Jianmin
J
Wang
Weiming
W
Liu
Weiguo
W
Chen
Keyong
K
Zhou
Junfu
J
Xu
Zefeng
Z
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000601:surgery / Q000628:therapy*; D003399:Craniotomy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D019586:Intracranial Hypertension / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D013482:Superoxide Dismutase / Q000378:metabolism; D016019:Survival Analysis; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy*
D013482:Superoxide Dismutase