2009 Volume 31 Issue 2 Pages 91-98
The usefulness of brain hypothermia in patients with severe traumatic brain injury (TBI) was denied as a whole with Prospective Randomized Controlled Trials (PRCT) in the United States. In this study, recent situation of brain hypothermia as a treatment strategy of severe TBI was analyzed from the data of the Project 2004 (P2004) in the Japan Neurotrauma Data Bank (JNTDB). Also, the incidence and the outcome of brain hypothermia in P2004 were compared with those in the Project 1998 (P1998) to clarify whether there are any changes after the disappointing PRCT results.
A total of 1101 cases were registered in P2004. We analyzed all patients enrolled in this study including extradural evacuated mass lesion. The incidences of brain hypothermia and intensive normothermia in P2004 were 9.7% and 26.8%, respectively. Patient's average age was younger in the hypothermia group (40.5±22.2 y.o.) compared with the intensive normothermia (47.8±23.3 y.o.) and the non-controlled (52.8±24.6 y.o.) groups. Brain hypothermia was intended to induce in patients with low GCS and with papillary abnormality. However, critically ill patients were treated with intensive normothermia or conservatively. The rate of good outcome (GR/MD) on discharge in hypothermia patients was 21.5%, which was significantly worse compared with that in intensive normothermia (33.9%) and non-controlled (34.6%) patients, maybe due to low initial GCS. When comparison was made with P1998 in a subgroup age above 6 y.o. excluding extradural mass lesion and cardiopulmonary arrest on arrival, there was no significant improvement of outcome on discharge and reduction of mortality rate with hypothermia in P2004. Patients treated with intensive normothermia showed most favorable outcome and lowest mortality rate in P2004. Further studies are necessary to validate the usefulness of intensive normothermia in patients with severe TBI.
