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

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  • 1 Departments of Traumatology and Neurosurgery, Osaka University Medical School, Osaka, Japan
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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.

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Contributor Notes

Address reprint requests to: Tadahiko Shiozaki, MD., Department of Traumatology, Osaka University Medical School, 2–2 Yamada oka, Suita-shi, Osaka 565, Japan.
  • 1.

    Astrup J, , Sørensen PM, & Sørensen HR: Inhibition of cerebral oxygen and glucose consumption in the dog by hypothermia, pentobarbital, and lidocaine. Anesthesiology 55:263268, 1981 Astrup J, Sørensen PM, Sørensen HR: Inhibition of cerebral oxygen and glucose consumption in the dog by hypothermia, pentobarbital, and lidocaine. Anesthesiology 55:263–268, 1981

    • Search Google Scholar
    • Export Citation
  • 2.

    Berntman L, , Welsh FA, & Harp JR: Cerebral protective effect of low-grade hypothermia. Anesthesiology 55:495498, 1981 Berntman L, Welsh FA, Harp JR: Cerebral protective effect of low-grade hypothermia. Anesthesiology 55:495–498, 1981

    • Search Google Scholar
    • Export Citation
  • 3.

    Bohn DJ, , Biggar WD, & Smith CR, et al: Influence of hypothermia, barbiturate therapy, and intracranial pressure monitoring on morbidity and mortality after near-drowning. Crit Care Med 14:529534, 1986 Bohn DJ, Biggar WD, Smith CR, et al: Influence of hypothermia, barbiturate therapy, and intracranial pressure monitoring on morbidity and mortality after near-drowning. Crit Care Med 14:529–534, 1986

    • Search Google Scholar
    • Export Citation
  • 4.

    Boutros A, , Hoyt J, & Menezes A, et al: Management of Reye's syndrome: a rational approach to a complex problem. Crit Care Med 5:234238, 1977 Boutros A, Hoyt J, Menezes A, et al: Management of Reye's syndrome: a rational approach to a complex problem. Crit Care Med 5:234–238, 1977

    • Search Google Scholar
    • Export Citation
  • 5.

    Busto R, , Dietrich WD, & Globus MYT, et al: Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 7:729738, 1987 Busto R, Dietrich WD, Globus MYT, et al: Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 7:729–738, 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Chopp M, , Knight R, & Tidwell CD, et al: The metabolic effects of mild hypothermia on global cerebral ischemia and recirculation in the cat: comparison to normothermia and hypothermia. J Cereb Blood Flow Metab 9:141148, 1989 Chopp M, Knight R, Tidwell CD, et al: The metabolic effects of mild hypothermia on global cerebral ischemia and recirculation in the cat: comparison to normothermia and hypothermia. J Cereb Blood Flow Metab 9:141–148, 1989

    • Search Google Scholar
    • Export Citation
  • 7.

    Clifton GL, , Jiang JY, & Lyeth BG, et al: Marked protection by moderate hypothermia after experimental traumatic brain injury. J Cereb Blood Flow Metab 11:114121, 1991 Clifton GL, Jiang JY, Lyeth BG, et al: Marked protection by moderate hypothermia after experimental traumatic brain injury. J Cereb Blood Flow Metab 11:114–121, 1991

    • Search Google Scholar
    • Export Citation
  • 8.

    Cold GE: Cerebral blood flow in acute head injury. The regulation of cerebral blood flow and metabolism during the acute phase of head injury, and its significance for therapy. Acta Neurochir Suppl 49:164, 1990 Cold GE: Cerebral blood flow in acute head injury. The regulation of cerebral blood flow and metabolism during the acute phase of head injury, and its significance for therapy. Acta Neurochir Suppl 49:1–64, 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Dearden NM: Management of raised intracranial pressure after severe head injury. Br J Hosp Med 36:94103, 1986 Dearden NM: Management of raised intracranial pressure after severe head injury. Br J Hosp Med 36:94–103, 1986

    • Search Google Scholar
    • Export Citation
  • 10.

    Farrar JK: Hydrogen clearance technique, in Wood JH (ed): Cerebral Blood Flow: Physiologic and Clinical Aspects. New York: McGraw-Hill, 1987, pp 275287 Farrar JK: Hydrogen clearance technique, in Wood JH (ed): Cerebral Blood Flow: Physiologic and Clinical Aspects. New York: McGraw-Hill, 1987, pp 275–287

    • Search Google Scholar
    • Export Citation
  • 11.

    Frewen TC, , Sumabat WO, & Han VK, et al: Effects of hyperventilation, hypothermia, and altered blood viscosity on cerebral blood flow, cross-brain oxygen extraction, and cerebral metabolic rate for oxygen in cats. Crit Care Med 17:912916, 1989 Frewen TC, Sumabat WO, Han VK, et al: Effects of hyperventilation, hypothermia, and altered blood viscosity on cerebral blood flow, cross-brain oxygen extraction, and cerebral metabolic rate for oxygen in cats. Crit Care Med 17:912–916, 1989

    • Search Google Scholar
    • Export Citation
  • 12.

    Frewen TC, , Swedlow DB, & Watcha M, et al: Outcome in severe Reye syndrome with early pentobarbital coma and hypothermia. J Pediatr 100:663665, 1982 Frewen TC, Swedlow DB, Watcha M, et al: Outcome in severe Reye syndrome with early pentobarbital coma and hypothermia. J Pediatr 100:663–665, 1982

    • Search Google Scholar
    • Export Citation
  • 13.

    Gobiet W, , Grote W, & Bock WJ: The relation between intracranial pressure, mean arterial pressure and cerebral blood flow in patients with severe head injury. Acta Neurochir 32:1324, 1975 Gobiet W, Grote W, Bock WJ: The relation between intracranial pressure, mean arterial pressure and cerebral blood flow in patients with severe head injury. Acta Neurochir 32:13–24, 1975

    • Search Google Scholar
    • Export Citation
  • 14.

    Gotoh H, , Meyer JS, & Tomita M: Hydrogen method for determining cerebral blood flow in man. Arch Neurol 15:549559, 1966 Gotoh H, Meyer JS, Tomita M: Hydrogen method for determining cerebral blood flow in man. Arch Neurol 15:549–559, 1966

    • Search Google Scholar
    • Export Citation
  • 15.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 16.

    Leonov Y, , Sterz F, & Safar P, et al: Mild cerebral hypothermia during and after cardiac arrest improves neurologic outcome in dogs. J Cereb Blood Flow Metab 10:5770, 1990 Leonov Y, Sterz F, Safar P, et al: Mild cerebral hypothermia during and after cardiac arrest improves neurologic outcome in dogs. J Cereb Blood Flow Metab 10:57–70, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    van der Linden J, , Ekroth R, & Lincoln C, et al: Is cerebral blood flow/metabolic mismatch during rewarming a risk factor after profound hypothermic procedures in small children? Eur J Cardiothorac Surg 3:209215, 1989 van der Linden J, Ekroth R, Lincoln C, et al: Is cerebral blood flow/metabolic mismatch during rewarming a risk factor after profound hypothermic procedures in small children? Eur J Cardiothorac Surg 3:209–215, 1989

    • Search Google Scholar
    • Export Citation
  • 18.

    Marshall LF, , Smith RW, & Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part II: Acute and chronic barbiturate administration in the management of head injury. J Neurosurg 50:2630, 1979 Marshall LF, Smith RW, Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part II: Acute and chronic barbiturate administration in the management of head injury. J Neurosurg 50:26–30, 1979

    • Search Google Scholar
    • Export Citation
  • 19.

    Michenfelder JD, & Theye RA: The effects of anesthesia and hypothermia on canine cerebral ATP and lactate during anoxia produced by decapitation. Anesthesiology 33:430439, 1970 Michenfelder JD, Theye RA: The effects of anesthesia and hypothermia on canine cerebral ATP and lactate during anoxia produced by decapitation. Anesthesiology 33:430–439, 1970

    • Search Google Scholar
    • Export Citation
  • 20.

    Miller JD, , Butterworth JF, & Gudeman SK, et al: Further experience in the management of severe head injury. J Neurosurg 54:289299, 1981 Miller JD, Butterworth JF, Gudeman SK, et al: Further experience in the management of severe head injury. J Neurosurg 54:289–299, 1981

    • Search Google Scholar
    • Export Citation
  • 21.

    Minamisawa H, , Smith ML, & Siesjö BK: The effects of mild hyperthermia and hypothermia on brain damage following 5, 10, and 15 minutes of forebrain ischemia. Ann Neurol 28:2633, 1990 Minamisawa H, Smith ML, Siesjö BK: The effects of mild hyperthermia and hypothermia on brain damage following 5, 10, and 15 minutes of forebrain ischemia. Ann Neurol 28:26–33, 1990

    • Search Google Scholar
    • Export Citation
  • 22.

    Narayan RK, , Kishore PRS, & Becker DP, et al: Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 56:650659, 1982 Narayan RK, Kishore PRS, Becker DP, et al: Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 56:650–659, 1982

    • Search Google Scholar
    • Export Citation
  • 23.

    Nordby HK, & Nesbakken R: The effect of high dose barbiturate decompression after severe head injury. A controlled clinical trial. Acta Neurochir 72:157166, 1984 Nordby HK, Nesbakken R: The effect of high dose barbiturate decompression after severe head injury. A controlled clinical trial. Acta Neurochir 72:157–166, 1984

    • Search Google Scholar
    • Export Citation
  • 24.

    Nordström CH, , Messeter K, & Sundbärg G, et al: Cerebral blood flow, vasoreactivity, and oxygen consumption during barbiturate therapy in severe traumatic brain lesions. J Neurosurg 68:424431, 1988 Nordström CH, Messeter K, Sundbärg G, et al: Cerebral blood flow, vasoreactivity, and oxygen consumption during barbiturate therapy in severe traumatic brain lesions. J Neurosurg 68:424–431, 1988

    • Search Google Scholar
    • Export Citation
  • 25.

    Obrist WD, , Langfitt TW, & Jaggi JL, et al: Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61:241253, 1984 Obrist WD, Langfitt TW, Jaggi JL, et al: Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61:241–253, 1984

    • Search Google Scholar
    • Export Citation
  • 26.

    Rea GL, & Rockswold GL: Barbiturate therapy in uncontrolled intracranial hypertension. Neurosurgery 12:401404, 1983 Rea GL, Rockswold GL: Barbiturate therapy in uncontrolled intracranial hypertension. Neurosurgery 12:401–404, 1983

    • Search Google Scholar
    • Export Citation
  • 27.

    Reuler JB: Hypothermia: pathophysiology, clinical settings, and management. Ann Intern Med 89:519527, 1978 Reuler JB: Hypothermia: pathophysiology, clinical settings, and management. Ann Intern Med 89:519–527, 1978

    • Search Google Scholar
    • Export Citation
  • 28.

    Rosomoff HL: Cerebral edema and brain swelling. Acta Anaesthesiol Scand Suppl 29:7597, 1968 Rosomoff HL: Cerebral edema and brain swelling. Acta Anaesthesiol Scand Suppl 29:75–97, 1968

    • Search Google Scholar
    • Export Citation
  • 29.

    Rosomoff HL, & Holaday DA: Cerebral blood flow and cerebral oxygen consumption during hypothermia. Am J Physiol 179:8588, 1954 Rosomoff HL, Holaday DA: Cerebral blood flow and cerebral oxygen consumption during hypothermia. Am J Physiol 179:85–88, 1954

    • Search Google Scholar
    • Export Citation
  • 30.

    Shapiro HM, , Wyte SR, & Loeser J: Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension. J Neurosurg 40:90100, 1974 Shapiro HM, Wyte SR, Loeser J: Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension. J Neurosurg 40:90–100, 1974

    • Search Google Scholar
    • Export Citation
  • 31.

    Steen PA, , Soule EH, & Michenfelder JD: Detrimental effect of prolonged hypothermia in cats and monkeys with and without regional cerebral ischemia. Stroke 10:522529, 1979 Steen PA, Soule EH, Michenfelder JD: Detrimental effect of prolonged hypothermia in cats and monkeys with and without regional cerebral ischemia. Stroke 10:522–529, 1979

    • Search Google Scholar
    • Export Citation
  • 32.

    Sterz F, , Safar P, & Tisherman S, et al: Mild hypothermia cardiopulmonary resuscitation improves outcome after prolonged cardiac arrest in dogs. Crit Care Med 19:379389, 1991 Sterz F, Safar P, Tisherman S, et al: Mild hypothermia cardiopulmonary resuscitation improves outcome after prolonged cardiac arrest in dogs. Crit Care Med 19:379–389, 1991

    • Search Google Scholar
    • Export Citation
  • 33.

    Ward JD, , Becker DP, & Miller JD, et al: Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg 62:383388, 1985 Ward JD, Becker DP, Miller JD, et al: Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg 62:383–388, 1985

    • Search Google Scholar
    • Export Citation

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