title: Hypothermia for Increased Intracranial Pressure: Is It Dead?
abstract: Mild to moderate therapeutic hypothermia (HT) has been used to alleviate intracranial hypertension in traumatic brain injury (TBI). Its main contribution is thought to be via reduction in cerebral metabolic requirement leading both to favorable oxygen/metabolic delivery-demand ratios as well as a reduction of cerebral blood volume resulting in decreased ICP. Nevertheless, HT is a clinically complex, labor-intensive procedure with numerous potential adverse effects. Furthermore, randomized controlled trials suggest either no effect or harm. These facts challenge the role of HT in TBI. We address this challenge by posing three questions that relate to the overarching value of controlling ICP, the effectiveness of HT in reducing ICP, and the benefit-risk ratio of the intervention. We conclude that HT should not be used as an "early" intervention unless as a part of a clinical trial, although it may still have a role in patients with refractory intracranial hypertension.
authors.affiliation: Departments of Neurology, Baylor College of Medicine, McNair Campus 7200 Cambridge St., 9th Floor, MS: NB302, Houston, TX, 77030, USA. lazaridi@bcm.edu.|Division of Neurocritical Care, Baylor College of Medicine, Houston, TX, USA. lazaridi@bcm.edu.
authors.forename: Christos
authors.initials: C
authors.lastname: Lazaridis
authors.affiliation: Departments of, Neurosurgery, Baylor College of Medicine, Baylor Plaza, Houston, TX, 77030, USA.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Robertson
mesh_terms: D000818:Animals; D001930:Brain Injuries / Q000503:physiopathology; D006801:Humans; D007036:Hypothermia, Induced; D019586:Intracranial Hypertension / Q000503:physiopathology / Q000628:therapy*; D007427:Intracranial Pressure; D064926:Neurophysiological Monitoring
keywords: Hypothermia; Intracranial pressure; Neuromonitoring; Traumatic brain injury