2019 年 42 巻 2 号 p. 96-102
Objectives: The purpose of this study was to elucidate the recent trends in temperature management for severe traumatic brain injury (TBI) using the database of the Japan Neurotrauma Data Bank (JNTDB) Project 2015.
Methods: Data from JNTDB Project 2015, in which a total of 1,345 patients registered, were retrospectively reviewed. Patients were classified into three groups: hypothermia (targeted body temperature of < 35°C), intensive normothermia (35.5 – 38.0°C), and no temperature management. Clinical characteristics, radiological findings, methods of temperature management and the clinical course of each group were examined.
Results: Forty patients (3.0%) were categorized into the hypothermia group, 335 patients (24.9%) into the intensive normothermia group and 970 (72.1%) into the no temperature management group. The mean ages of the groups were 42.8 years, 53.5 years and 61.3 years respectively (p<0.0001). Traffic accidents were the most common cause of injury in the hypothermia group compared with the other groups (p=0.0002). In the hypothermia group, the Glasgow Coma Scale sum score tended to be lower (p=0.0565), pupillary abnormality and tachypnea were more frequent (p=0.0225 and p=0.0044 respectively) and systolic blood pressure was higher (p=0.002). Intracranial pressure (ICP) was more frequently monitored as 95% (p<0.0001) and initial ICP (21.2 mmHg) and maximum ICP (40.2 mmHg) tended to be higher (p=0.0782 and p=0.0929 respectively). Evacuated mass lesions according to the Traumatic Coma Data Bank CT classification was more commonly involved in the hypothermia group (p=0.0242). Cooling blankets were most frequently used for temperature management, followed by cooling pads and intravascular cooling systems. The time to reach the maximum ICP was significantly extended in the hypothermia group (p=0.0402). There were no differences in favorable outcome rates between the groups.
Conclusion: Hypothermia treatment was more commonly applied to younger traffic accident victims with evacuated mass lesions under ICP monitoring. This finding corresponded with the results of recent randomized clinical trials concerning hypothermia for TBI.
