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Neurocritical Care
Published in: Neurocritical Care 2/2015

01-04-2015 | Original Article

Therapeutic Intravascular Normothermia Reduces The Burden of Metabolic Crisis

Authors: Mohamad Chmayssani, Nathan R. Stein, David L. McArthur, Paul M. Vespa

Published in: Neurocritical Care | Issue 2/2015

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Abstract

Background

We aim to investigate whether therapeutic-induced normothermia (TIN) ≤37.5 °C, by means of intravascular cooling devices is more efficacious than standard medical therapy (MED) in alleviating metabolic crisis (MC) acutely following traumatic brain injury (TBI).

Methods

We retrospectively analyzed data from 62 patients with severe TBI, GCS ≤ 8. We divided the cohort into two groups. (1) Patients who had temperature controlled via standard medical therapies (n = 52), (2) TIN group (n = 10). For each group, we analyzed the percent time spent in normothermia, and in MC. Furthermore, we focused the investigation on pre-TIN versus post-TIN comparing temp, intracranial pressure (ICP), sedation, and MC before and after intravascular cooling.

Results

TIN patients had a better temperature control than MED group (60.72 ± 19.53 vs 69.75 ± 24.98 %, p < 0.001) and spent shorter time in MC (22.60 ± 20.45 vs 32.17 ± 27.25 %, p < 0.001). Temperature control was associated with reduced incidence of MC in TIN (OR 0.51, CI 0.38–0.67, p < 0.001, p < 0.001) but not in MED (OR 0.97, CI 0.87–1.1, p = 0.63). Within TIN group analysis, following TIN both temperature and incidence of MC improved from 37.62 ± 0.34 versus 36.69 ± 0.90 °C (p < 0.005) and 41.95 ± 27.74 % before to 8.35 ± 9.78 % (p = 0.005) after, respectively. ICP was well controlled both before and after intravascular cooling (13.07 vs 15.83 mmHg, p = 0.20).

Conclusion

Therapeutic normothermia, using intravascular cooling, results in a reduction in the burden of MC. This differential effect occurs despite equivalent control of ICP in both TIN and MED treatments. These results demonstrate proof of concept of normothermia, when applied in a controlled manner, being neuroprotective.
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Metadata
Title
Therapeutic Intravascular Normothermia Reduces The Burden of Metabolic Crisis
Authors
Mohamad Chmayssani
Nathan R. Stein
David L. McArthur
Paul M. Vespa
Publication date
01-04-2015
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2015
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-014-0076-7

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