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In case of hypothermia, the core temperature of the body is cooled between 33 and 35 ° C. It is followed by a gradual warming. At normothermia, it is 37 ° C / anitalvdb, stock.adobe.com
Melbourne / Paris Once again, a multicenter study concludes that hypothermia after traumatic brain injury (TBI) is without benefit (JAMA2018; doi: 10,1001 / jama.2018.17075). For writers around Jamie Cooper and Alistair Nichol of Monash University in Melbourne, the strategy has failed. This opinion is shared by an expert from the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI). Cooper had presented the data yesterday at the congress of the European Society of Critical Care Medicine (ESICM) in Paris.
About 50 to 60 million people around the world suffer one each year traumatic brain injury (TBI) and more than half of the world's population will suffer from at least one TBI during its lifetime.
Experts have long debated the benefits of brain cooling in the intensive care unit after a TBI. The theory: insufficient cooling or cooling reduces the inflammation of the brain and the resulting damage. The POLAR study of 466 patients can not confirm this theory. She concludes that early and prophylactic hypothermia does not improve the general clinical neurologic outcome of patients with severe brain-brain trauma.
In hypothermia, doctors started an average of 1.8 hours after the injury and slowly warmed up after about 22.5 hours. The benign results measured by Glasgow's outcome scale occurred after 6 months in 117 patients (48.8%) of the hypothermic group and 111 (49.1%) of the control group. Relative risk was not significantly different in both groups (RR = 0.99 [95 % CI, 0,82-1,19]; p = 0.94). Pneumonia and intracranial hemorrhage were more common during the first 10 days following hypothermia: pneumonia rates were 55.0% vs. 51.3% and the rates of increase were Intracranial hemorrhage was 18.1% versus 15.4%.
In other words, the translation of an experimentally highly effective principle into the clinic did not work again. Andreas Unterberg, University Hospital Heidelberg
This is the 4th large multicenter randomized study on hypertension after severe traumatic brain-brain injury, which gives a negative result, says Andreas Unterberg, representative of neuromedicine in the DIVI presidium. This is all the more regrettable as many experimental studies conducted in different models have shown clear neuroprotective effects of hypothermia. In other words, the translation of an experimentally extremely effective principle into the clinic has not worked again, says the director of the Department of Neurosurgery at the Heidelberg University Hospital. German law sheet,
on the subject
German Law Sheet
aerzteblatt.de
In Germany, hypothermia is only used sporadically during skull-brain trauma. Unterberg is convinced of this and points out that induced hypothermia requires a considerable amount of personnel and equipment. In addition, this could lead to serious side effects. According to the neurosurgeon, the only effective and evidence-based neuroprotective approach to severe brain-to-brain injury is decompressive craniectomy for intracranial refractory pressure.
Cambridge A craniectomy to relieve the increase in intracranial pressure reduced the death rate of patients with severe brain-brain trauma compared to continued drug therapy in a randomized study by half. However, according to the New England Journal of Medicine (2016, doi: 10.1056 / NEJMoa1605215), many of the surviving patients left the clinic (…)
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