Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury

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✓ Recent experimental studies have demonstrated that mild hypothermia at about 34°C can be effective in the control of intracranial hypertension. A randomized controlled study of mild hypothermia was carried out in 33 severely head-injured patients. All patients fulfilled the following criteria: 1) persistent intracranial pressure (ICP) greater than 20 mm Hg despite fluid restriction, hyperventilation, and high-dose barbiturate therapy; 2) an ICP lower than the mean arterial blood pressure; and 3) a Glasgow Coma Scale score of 8 or less. The patients were divided into two groups: one received mild hypothermia (16 patients) and one served as a control group (17 patients).

Mild hypothermia significantly reduced the ICP and increased the cerebral perfusion pressure. Eight patients (50%) in the hypothermia group and three (18%) in the control group survived (p < 0.05), while five (31%) in the hypothermia group and 12 (71%) in the control group died of uncontrollable intracranial hypertension (p < 0.05). In five patients in the hypothermia group, cerebral blood flow was measured by the hydrogen clearance method and arteriojugular venous oxygen difference was evaluated before and during mild hypothermia. Mild hypothermia significantly decreased the cerebral blood flow, arteriojugular venous oxygen difference, and cerebral metabolic rate of oxygen (p < 0.01). The results of this preliminary investigation suggest that mild hypothermia is a safe and effective method to control traumatic intracranial hypertension and to improve mortality and morbidity rates.

Article Information

Address reprint requests to: Tadahiko Shiozaki, MD., Department of Traumatology, Osaka University Medical School, 2–2 Yamada oka, Suita-shi, Osaka 565, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph showing the Glasgow Coma Scale scores on admission in the group with induced mild hypothermia (16 patients) and the control group (17 patients). There were no statistical differences between the groups.

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    Graph showing the type of lesion displayed by admission computerized tomography. The category “hematoma” includes epidural, subdural, and/or intracranial hematoma.

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    Graphs showing changes in intracranial pressure (ICP) and cerebral perfusion pressure (CPP) during normothermia (37°C) and mild hypothermia (34°C) in 16 patients. Each pair of circles represents measurements in one patient. In 12 patients (open circles), ICP declined and CPP rose with mild hypothermia; four patients (closed circles) showed no ICP or CPP response to mild hypothermia.

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    Graphs showing changes in cerebral blood flow (CBF), arteriojugular venous oxygen difference (AVDO2), and cerebral metabolic rate of oxygen (CMRO2) in five patients in the group with induced mild hypothermia during normothermia (37°C) and mild hypothermia (34°C).

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