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01-06-2015 | Editorial

An injured brain needs cooling down: no

Authors: Mathieu van der Jagt, Iain Haitsma

Published in: Intensive Care Medicine | Issue 6/2015

Excerpt

There is no conclusive evidence that therapeutic hypothermia for traumatic brain injury (TBI), stroke or central nervous system (CNS) infections improves outcomes [1]. Robust evidence is even unavailable for fever control in the acute phase after these types of brain injury (excluding comatose patients after cardiac arrest for whom fever control does result in improved outcomes), and authors of practice guidelines have therefore been reluctant to recommend fever control [2‐4]. The only way to prove that fever is causally linked to poor outcomes is to perform prospective randomized controlled studies that show improved outcomes with fever control versus no fever control, but such studies have not been done in TBI, stroke or CNS infections. …

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Le Roux P, Menon DK, Citerio G, Vespa P, Bader MK, Brophy G, Diringer MN, Stocchetti N, Videtta W, Armonda R, Badjatia N, Bösel J, Chesnut R, Chou S, Claassen J, Czosnyka M, De Georgia M, Figaji A, Fugate J, Helbok R, Horowitz D, Hutchinson P, Kumar M, McNett M, Naidech A, Oddo M, Olson D, O’Phelan K, Provencio JJ, Puppo C, Riker R, Roberson C, Schmidt M, Taccone F (2014) The international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: a list of recommendations and additional conclusions. A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care. Neurocrit Care 21(2):282–296CrossRef

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Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Åneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H, Trial Investigators TTM (2013) Targeted temperature management at 33 versus 36 °C after cardiac arrest. N Engl J Med 369:2197–2206PubMedCrossRef

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 (2001) Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 344:556–563PubMedCrossRef

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Hypothermia after cardiac arrest study group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556CrossRef

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Clifton GL, Valadka A, Zygun D, Coffey CS, Drever P, Fourwinds S, Janis LS, Wilde E, Taylor P, Harshman K, Conley A, Puccio A, Levin HS, McCauley SR, Bucholz RD, Smith KR, Schmidt JH, Scott JN, Yonas H, Okonkwo DO (2011) Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol 10:131–139PubMedCentralPubMedCrossRef

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Andrews PJ, Sinclair HL, Battison CG, Polderman KH, Citerio G, Mascia L, Harris BA, Murray GD, Stocchetti N, Menon DK, Shakur H, De Backer D, Eurotherm3235Trial collaborators (2011) European Society of Intensive Care Medicine study of therapeutic hypothermia (32–35 °C) for intracranial pressure reduction after traumatic brain injury (the Eurotherm3235Trial). Trials 12:8PubMedCentralPubMedCrossRef

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Australian and New Zealand Intensive Care Research Centre (2015) POLAR-RCT. https://clinicaltrials.gov/ct2/show/NCT00987688

13.

Maze R, Le May MR, Froeschl M, Hazra SK, Wells PS, Osborne C, Labinaz M, Hibbert B, So DY, CArdiovascular Percutaneous Intervention TriAL (CAPITAL) investigators (2014) Endovascular cooling catheter related thrombosis in patients undergoing therapeutic hypothermia for out of hospital cardiac arrest. Resuscitation 85:1354–1358PubMedCrossRef

14.

Hoedemaekers CW, Ezzahti M, Gerritsen A, Van der Hoeven JG (2007) Comparison of cooling methods to induce and maintain normo- and hypothermia in intensive care unit patients: a prospective intervention study. Crit Care 11:R91PubMedCentralPubMedCrossRef

15.

Covaciu L, Weis J, Bengtsson C, Allers M, Lunderquist A, Ahlstrom H, Rubertsson S (2011) Brain temperature in volunteers subjected to intranasal cooling. Intensive Care Med 37:1277–1284PubMedCrossRef

Title: An injured brain needs cooling down: no
Authors: Mathieu van der Jagt
Iain Haitsma
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 6/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3844-8

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