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Traumatic Brain Injury: Clinical Studies

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Therapeutic Hypothermia

Part of the book series: Molecular and Cellular Biology of Critical Care Medicine ((MCCM,volume 4))

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Abstract

The treatment of traumatic brain injury (TBI) using hypothermia was first described by Temple Fay in 1943 (1). In the 1950s, Sedzimir noted “better than expected” outcomes in several patients with TBI after lowering their body temperatures to between 27° and 30°C for 1 to 5 days (2). Reports of contemporaneous research suggest that this pioneering use of hypothermia was based on the premise that TBI causes a hypermetabolic state, and that an increase in cerebral blood flow in response to the increased metabolic demand is responsible for the brain swelling associated with TBI. In uninjured dogs, for example, Rosomoff found that both cerebral blood flow and the cerebral metabolic rate for oxygen fell 6.7% for every 1°C reduction in body temperature between 35° and 25°C (3, 4). Stone and co-workers reported that cooling to 30°C in a primate model produced a 50% reduction in the cerebral metabolic rate for oxygen and a significantly lower rate of adenosine triphosphate depletion (5). According to Lundberg in 1959, hypothermia was as effective as osmotic diuretics for reducing elevated intracranial pressure (ICP) and had a more prolonged ICP-reducing effect than hyperventilation (6). James and colleagues found that hypothermia lowered the ICP in 20 of 40 patients with severe TBI; the ICP reduction averaged 51% (7).

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References

  1. Fay T. Observations on generalized refrigeration in cases of severe cerebral trauma. Assoc Res Nerv Ment Dis Proc 1943; 24:611–619.

    Google Scholar 

  2. Sedzimir CB. Therapeutic hypothermia in cases of head injury. J Neurosurg 1959; 16:407–414.

    PubMed  CAS  Google Scholar 

  3. Rosomoff HL, Holaday DA. Cerebral blood flow and cerebral oxygen consumption during hypothermia. Am J Physiol 1954; 179:85–88.

    PubMed  CAS  Google Scholar 

  4. Rosomoff HL. Relationship of metabolism to hypothermia. Res Publ Assoc 1966; 41:116–126.

    CAS  Google Scholar 

  5. Stone HH, Donnelly C, Frobese AS. The effect of lowered body temperature on the cerebral hemodynamics and metabolism of man. Surg Gynecol Obstet 1956; 103:313–322.

    PubMed  Google Scholar 

  6. Lundberg N, Kjallquist A, Bien C. Reduction of increased intracranial pressure by hyperventilation. Acta Psychiatr Scand 1959; 34:4–64.

    Google Scholar 

  7. James HE, Langfitt TW, Kumar VS, Ghostine SY. Treatment of intracranial hypertension. Analysis of 105 continuous recordings of intracranial pressure. Acta Neurochir (Wien) 1977; 36:189–200.

    Article  CAS  Google Scholar 

  8. Clifton GL, Jiang JY, Lyeth BG, et al. Marked protection by moderate hypothermia after experimental traumatic brain injury. J Cereb Blood Flow Metab 1991; 11:114–121.

    PubMed  CAS  Google Scholar 

  9. Busto R, Globus MYT, Dietrich WD, et al. Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke 1989; 7:904–910.

    Google Scholar 

  10. DeKosky ST, Miller PD, Styren S, O’Malley M, Marion DW. Interleukin-1B elevation in CSF following head injury in humans is attenuated by hypothermia. J Neurotrauma 1994; 11:106.

    Google Scholar 

  11. Chatzipanteli K, Alonso OF, Kraydieh S, Dietrich WD. Importance of posttraumatic hypothermia and hyperthermia on the inflammatory response after fluid percussion brain injury: biochemical and immunocytochemical studies. J Cereb Blood Flow Metab 2000; 20:531–42.

    Article  PubMed  CAS  Google Scholar 

  12. Kawai N, Nakamura T, Okauchi M, Nagao S. Effects of hypothermia on intracranial pressure and brain edema formation: studies in a rat acute subdural hematoma model. J Neurotrauma 2000; 17:193–202.

    PubMed  CAS  Google Scholar 

  13. Busto R, Dietrich WD, Globus MY, et.al. Postischemic moderate hypothermia inhibits CA1 hippocampal ischemic neuronal injury. J Cereb Blood Flow Metab 1989; 9:S266.

    Google Scholar 

  14. Dietrich WD, Alonso O, Busto R, et al. Post-traumatic brain hypothermia reduces histopathological damage following concussive brain injury in the rat. Ada Neuropathol 1994; 87:250–258.

    CAS  Google Scholar 

  15. Kramer RS, Sanders AP, Lesage AM. The effect of profound hypothermia on preservation of cerebral ATP content during circulatory arrest. J Thorac Cardiovasc Surg 1968; 56:699–709.

    PubMed  CAS  Google Scholar 

  16. Dixon CE, Markgraf CG, Angileri F, et al. Protective effects of moderate hypothermia on behavioral deficits but not necrotic cavitation following cortical impact injury in the rat. J Neurotrauma. 1998; 15:95–103.

    PubMed  CAS  Google Scholar 

  17. Marion DW, Obrist WD, Carlier PM, Penrod LE, Darby JM. The use of moderate therapeutic hypothermia for patients with severe head injuries: A preliminary report. J Neurosurg 1993; 79:354–362.

    PubMed  CAS  Google Scholar 

  18. Clifton GL, Allen S, Barrodale P et al. A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma 1993; 10:263–271.

    PubMed  CAS  Google Scholar 

  19. Shiozaki T, Sugimoto H, Taneda M, et al. Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg 1993; 79:363–368.

    PubMed  CAS  Google Scholar 

  20. Marion DW, Penrod LE, Kelsey SF, et al. Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 1997; 336:540–546.

    Article  PubMed  CAS  Google Scholar 

  21. Jiang J, Yu M, Zhu C. Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg 2000; 93:546–549.

    PubMed  CAS  Google Scholar 

  22. Signorini DF, Alderson P. Therapeutic hypothermia for head injury. Cochrane Database Syst Rev 2000; CD001048.

    Google Scholar 

  23. Clifton GL, Miller ER, Choi SC, et al. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001; 344:556–563.

    Article  PubMed  CAS  Google Scholar 

  24. Zhi D, Zhang S, and Lin X. Study on the therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury. Surg Neurol. 2003; 59:381–385.

    Article  PubMed  Google Scholar 

  25. Harris OA, Colford JM, Jr., Good MC, Matz PG. The role of hypothermia in the management of severe brain injury: a meta-analysis. Arch Neurol 2002; 59:1077–1083.

    Article  PubMed  Google Scholar 

  26. Shiozaki T, Hayakata T, Taneda M, et al. A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan. J Neurosurg 2001; 94:50–54.

    PubMed  CAS  Google Scholar 

  27. Clifton GL, Miller ER, Choi SC, et al. Hypothermia on admission in patients with severe brain injury. J Neurotrauma 2002; 19:293–301.

    Article  PubMed  Google Scholar 

  28. Yamamoto T, Mori K, Maeda M. Assessment of prognostic factors in severe traumatic brain injury patients treated by mild therapeutic cerebral hypothermia therapy. Neurol Res 2002; 24:789–795.

    Article  PubMed  Google Scholar 

  29. Clifton GL, Choi SC, Miller ER, et al. Intercenter variance in clinical trials of head trauma—experience of the National Acute Brain Injury Study: Hypothermia. J Neurosurg 2001; 95:751–755.

    PubMed  CAS  Google Scholar 

  30. Gentilello LM, Jurkovich GJ, Stark MS, Hassantash SA, O’Keefe GE. Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg 1997; 226:439–447.

    Article  PubMed  CAS  Google Scholar 

  31. Soukup J, Zauner A, Doppenberg EM, et al. Relationship between brain temperature, brain chemistry and oxygen delivery after severe human head injury: the effect of mild hypothermia. Neurol Res 2002; 24:161–168.

    Article  PubMed  CAS  Google Scholar 

  32. Tokutomi T, Morimoto K, Miyagi T, et al. Optimal temperature for the management of severe traumatic brain injury: effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. Neurosurg 2003; 52:102–112.

    Article  Google Scholar 

  33. Gupta AK, Al Rawi PG, Hutchinson PJ, Kirkpatrick PJ. Effect of hypothermia on brain tissue oxygenation in patients with severe head injury. Br J Anaesth 2002; 88:188–192.

    Article  PubMed  CAS  Google Scholar 

  34. Dietrich WD, Alonso O, Halley M, Busto R. Delayed posttraumatic brain hyperthermia worsens outcome after fluid percussion brain injury: A light and electron microscopic study in rats. Neurosurg 1996; 38:533–541.

    Article  CAS  Google Scholar 

  35. Baena RC, Busto R, Dietrich WD, Globus MY, Ginsberg MD. Hyperthermia delayed by 24 hours aggravates neuronal damage in rat hippocampus following global ischemia. Neurologyl 1997; 48:768–773.

    CAS  Google Scholar 

  36. Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke 2000; 31:410–414.

    PubMed  CAS  Google Scholar 

  37. Schwarz S, Hafner K, Aschoff A, Schwab S. Incidence and prognostic significance of fever following intracerebral hemorrhage. Neurology 2000; 54:354–361.

    PubMed  CAS  Google Scholar 

  38. Oliveira-Filho J, Ezzeddine MA, Segal AZ, et al. Fever in subarachnoid hemorrhage: relationship to vasospasm and outcome. Neurology 2001; 56:1299–1304.

    PubMed  CAS  Google Scholar 

  39. Kilpatrick MM, Lowry DW, Firlik AD, Yonas H, Marion DW. Uncontrolled hyperthermia in the neurosurgical intensive care unit. Neurosurg 2000; 47:850–856.

    Article  CAS  Google Scholar 

  40. Henker RA, Brown SD, Marion DW. Comparison of brain temperature with bladder and rectal temperatures in adults with severe head injury. Neurosurg 1998; 42:1071–1075.

    Article  CAS  Google Scholar 

  41. Markgraf CG, Clifton GL, Moody MR. Treatment window for hypothermia in brain injury. J Neurosurg 2001; 95:979–983.

    PubMed  CAS  Google Scholar 

  42. Marion DW, White MJ. Treatment of experimental brain injury with moderate hypothermia and 21-aminosteroids. J Neurotrauma 1996; 13:139–147.

    Article  PubMed  CAS  Google Scholar 

  43. Diringer MN. Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 2004; 32:559–564.

    Article  PubMed  Google Scholar 

  44. Bayir H, Clark RS, Kochanek PM. Promising strategies to minimize secondary brain injury after head trauma. Crit Care Med 2003; 31: S112–S117.

    Article  PubMed  CAS  Google Scholar 

  45. Yan HQ, Yu J, Kline AE, et al. Evaluation of combined fibroblast growth factor-2 and moderate hypothermia therapy in traumatically brain injured rats. Brain Res 2000; 887:134–143.

    Article  PubMed  CAS  Google Scholar 

  46. Li PA, He QP, Siesjo BK. Effects of intracarotid arterial injection of cyclosporin A and spontaneous hypothermia on brain damage incurred after a long period of global ischemia. Brain Res 2001; 890:306–313.

    Article  PubMed  CAS  Google Scholar 

  47. Kline AE, Bolinger BD, Kochanek PM, et al. Acute systemic administration of interleukin-10 suppresses the beneficial effects of moderate hypothermia following traumatic brain injury in rats. Brain Res 2002; 937:22–31.

    Article  PubMed  CAS  Google Scholar 

  48. Metz C, Holzschuh M, Bein T, et al. Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects. J Neurosurg 1996; 85:533–541.

    Article  PubMed  CAS  Google Scholar 

  49. Nara I, Shiogai T, Hara M, Saito I. Comparative effects of hypothermia, barbiturate, and osmotherapy for cerebral oxygen metabolism, intracranial pressure, and cerebral perfusion pressure in patients with severe head injury. Acta Neurochir Suppl (Wien) 1998; 71:22–26.

    CAS  Google Scholar 

  50. Tateishi A, Soejima Y, Taira Y, et al. Feasibility of the titration method of mild hypothermia in severely head-injured patients with intracranial hypertension. Neurosurg 1998; 42:1065–1069.

    Article  CAS  Google Scholar 

  51. Takahashi I, Kitahara T, Endo M, Ohwada T. Clinical analysis of hypothermia in children with severe head injury. No Shinkei Geka 2000; 28:983–989.

    PubMed  CAS  Google Scholar 

  52. Biswas AK, Bruce DA, Sklar FH, Bokovoy JL, Sommerauer JF. Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension. Crit Care Med 2002; 30:2742–2751.

    Article  PubMed  Google Scholar 

  53. Gal R, Cundrle I, Zimova I, Smrcka M. Mild hypothermia therapy for patients with severe brain injury. Clin Neurol Neurosurg 2002; 104:318–321.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. The Brain Trauma Foundation, New York, New York, USA

    Donald W. Marion MD

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  1. Donald W. Marion MD
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Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Samuel A. Tisherman MD

  2. Emergency Medicine, Medical University of Vienna, 1090, Vienna, Austria

    Fritz Sterz MD

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Marion, D.W. (2005). Traumatic Brain Injury: Clinical Studies. In: Tisherman, S.A., Sterz, F. (eds) Therapeutic Hypothermia. Molecular and Cellular Biology of Critical Care Medicine, vol 4. Springer, Boston, MA. https://doi.org/10.1007/0-387-25403-X_6

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  • DOI: https://doi.org/10.1007/0-387-25403-X_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-25402-9

  • Online ISBN: 978-0-387-25403-6

  • eBook Packages: MedicineMedicine (R0)

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