Hypothermia therapy after traumatic brain injury in children.

Hypothermia therapy improves survival and the neurologic outcome in animal models of traumatic brain injury. However, the effect of hypothermia therapy on the neurologic outcome and mortality among children who have severe traumatic brain injury is unknown. In a multicenter, international trial, we randomly assigned children with severe traumatic brain injury to either hypothermia therapy (32.5 degrees C for 24 hours) initiated within 8 hours after injury or to normothermia (37.0 degrees C). The primary outcome was the proportion of children who had an unfavorable outcome (i.e., severe disability, persistent vegetative state, or death), as assessed on the basis of the Pediatric Cerebral Performance Category score at 6 months. A total of 225 children were randomly assigned to the hypothermia group or the normothermia group; the mean temperatures achieved in the two groups were 33.1+/-1.2 degrees C and 36.9+/-0.5 degrees C, respectively. At 6 months, 31% of the patients in the hypothermia group, as compared with 22% of the patients in the normothermia group, had an unfavorable outcome (relative risk, 1.41; 95% confidence interval [CI], 0.89 to 2.22; P=0.14). There were 23 deaths (21%) in the hypothermia group and 14 deaths (12%) in the normothermia group (relative risk, 1.40; 95% CI, 0.90 to 2.27; P=0.06). There was more hypotension (P=0.047) and more vasoactive agents were administered (P<0.001) in the hypothermia group during the rewarming period than in the normothermia group. Lengths of stay in the intensive care unit and in the hospital and other adverse events were similar in the two groups. In children with severe traumatic brain injury, hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality. (Current Controlled Trials number, ISRCTN77393684 [controlled-trials.com].).

Hutchison JS ，Ward RE ，Lacroix J ，Hébert PC ，Barnes MA ，Bohn DJ ，Dirks PB ，Doucette S ，Fergusson D ，Gottesman R ，Joffe AR ，Kirpalani HM ，Meyer PG ，Morris KP ，Moher D ，Singh RN ，Skippen PW ，Hypothermia Pediatric Head Injury Trial Investigators and the Canadian Critical Care Trials Group ... -  《-》

Lack of effect of induction of hypothermia after acute brain injury.

Clifton GL ，Miller ER ，Choi SC ，Levin HS ，McCauley S ，Smith KR Jr ，Muizelaar JP ，Wagner FC Jr ，Marion DW ，Luerssen TG ，Chesnut RM ，Schwartz M ... -  《-》

Hypothermia for children after severe brain injury does not work.

Lundberg GD 《-》

Treatment of traumatic brain injury with moderate hypothermia.

Marion DW ，Penrod LE ，Kelsey SF ，Obrist WD ，Kochanek PM ，Palmer AM ，Wisniewski SR ，DeKosky ST ... -  《-》

Effect of 35 degrees C hypothermia on intracranial pressure and clinical outcome in patients with severe traumatic brain injury.

Tokutomi T ，Miyagi T ，Takeuchi Y ，Karukaya T ，Katsuki H ，Shigemori M ... -  《-》