Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases

Ji-Yao Jiang Department of Neurosurgery, Chang Zheng Hospital, Shanghai Neurosurgical Institute, Shanghai, People's Republic of China

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Ming-Kun Yu Department of Neurosurgery, Chang Zheng Hospital, Shanghai Neurosurgical Institute, Shanghai, People's Republic of China

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Cheng Zhu Department of Neurosurgery, Chang Zheng Hospital, Shanghai Neurosurgical Institute, Shanghai, People's Republic of China

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Object. The goal of this study was to investigate the protective effects of long-term (3–14 days) mild hypothermia therapy (33–35°C) on outcome in 87 patients with severe traumatic brain injury (TBI) (Glasgow Coma Scale score ≤ 8).

Methods. In 43 patients assigned to a mild hypothermia group, body temperatures were cooled to 33 to 35°C a mean of 15 hours after injury and kept at 33 to 35°C for 3 to 14 days. Rewarming commenced when the individual patient's intracranial pressure (ICP) returned to the normal level. Body temperatures in 44 patients assigned to a normothermia group were maintained at 37 to 38°C. Each patient's outcome was evaluated 1 year later by using the Glasgow Outcome Scale. One year after TBI, the mortality rate was 25.58% (11 of 43 patients) and the rate of favorable outcome (good recovery or moderate disability) was 46.51% (20 of 43 patients) in the mild hypothermia group. In the normothermia group, the mortality rate was 45.45% (20 of 44 patients) and the rate of favorable outcome was 27.27% (12 of 44 patients) (p < 0.05). Induced mild hypothermia also markedly reduced ICP (p < 0.01) and inhibited hyperglycemia (p < 0.05). The rates of complication were not significantly different between the two groups.

Conclusions. The data produced by this study demonstrate that long-term mild hypothermia therapy significantly improves outcomes in patients with severe TBI.

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