Abstract
The complications of mild hypothermia in 39 patients suffering from a severe head injury and with a Glasgow Coma Scale rating of less than 8 on admission were discussed, especially with respect to cardiopulmonary function, hemodynamic function, and infections of the respiratory system. The patients were treated using mild hypothermia, according to the protocol of our institute, to control intracranial pressure (ICP) and to prevent secondary neuronal damage. In these patirnts the following were continuously recorded : ICP, the saturation of jugular oxygen (SjO_2), and hemodynamic function using a thermodilution (Swan-Ganz) catheter. A patient's white blood cells (WBC) and c-reactive protein were checked each day as an indication of possible infection. The sputum and urine were cultured, and every two days a chest X-ray was taken to detect the possibility of pneumonia. Cerebral perfusion pressure (CPP) and ICP were decreased after the commencement of mild hypothermia. The value of SjO_2 suggested recovery from cerebral ischemia during, and after, the treatment with hypothermia. Systemic and pulmonary vascular resistance, the WBC and CPP were significantly increased during the mild hypothermia. Pathogenic organisms were isolated in 73.5% of the patients, and these included : Pseudomonas aeruginosa, meticillin resistant Staphylococcus aureus (MRSA), and Klebsiella pneumoniae. Our study suggests that mild hypothermia for the treatment of sever head injury is effective for controlling ICP and preventing cerebral ischemia, and that it is necessary to test for systemic complications such as hemodynamic suppression and for pneumonia.
