TY - JOUR
T1 - Optimal temperature for the management of severe traumatic brain injury
T2 - Effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism
AU - Tokutomi, Takashi
AU - Morimoto, Kazuya
AU - Miyagi, Tomoya
AU - Yamaguchi, Shintaro
AU - Ishikawa, Kazufumi
AU - Shigemori, Minoru
AU - Yamaura, Akira
AU - Valadka, Alex B.
AU - Muizelaar, J. Paul
PY - 2003/1/1
Y1 - 2003/1/1
N2 - OBJECTIVE: We studied the effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism in patients with severe traumatic brain injury to clarify the optimal temperature for hypothermia, with a view toward establishing the proper management techniques for such patients. METHODS: The study was performed in 31 patients with severe head injury (Glasgow Coma Scale score as high as 5). All patients were sedated, paralyzed, ventilated, and cooled to 33°C. Brain temperature, core temperature, intracranial pressure, cerebral perfusion pressure, jugular venous oxygen saturation, mixed venous oxygen saturation, cardiac output, oxygen delivery, oxygen consumption, and resting energy expenditure were monitored continuously. RESULTS: Intracranial pressure decreased significantly at brain temperatures below 37°C and decreased more sharply at temperatures 35 to 36°C, but no differences were observed at temperatures below 35°C. Cerebral perfusion pressure peaked at 35.0 to 35.9°C and decreased with further decreases in temperature. Jugular venous oxygen saturation and mixed venous oxygen saturation remained in the normal range during hypothermia. Resting energy expenditure and cardiac output decreased progressively with hypothermia. Oxygen delivery and oxygen consumption decreased to abnormally low levels at rectal temperatures below 35°C, and the correlation between them became less significant at less than 35°C than that when temperatures were 35°C or higher. Brain temperature was consistently higher than rectal temperature by 0.5 ± 0.3°C. CONCLUSION: These results suggest that, after traumatic brain injury, decreasing body temperature to 35 to 35.5°C can reduce intracranial hypertension while maintaining sufficient cerebral perfusion pressure without cardiac dysfunction or oxygen debt. Thus, 35 to 35.5°C seems to be the optimal temperature at which to treat patients with severe traumatic brain injury.
AB - OBJECTIVE: We studied the effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism in patients with severe traumatic brain injury to clarify the optimal temperature for hypothermia, with a view toward establishing the proper management techniques for such patients. METHODS: The study was performed in 31 patients with severe head injury (Glasgow Coma Scale score as high as 5). All patients were sedated, paralyzed, ventilated, and cooled to 33°C. Brain temperature, core temperature, intracranial pressure, cerebral perfusion pressure, jugular venous oxygen saturation, mixed venous oxygen saturation, cardiac output, oxygen delivery, oxygen consumption, and resting energy expenditure were monitored continuously. RESULTS: Intracranial pressure decreased significantly at brain temperatures below 37°C and decreased more sharply at temperatures 35 to 36°C, but no differences were observed at temperatures below 35°C. Cerebral perfusion pressure peaked at 35.0 to 35.9°C and decreased with further decreases in temperature. Jugular venous oxygen saturation and mixed venous oxygen saturation remained in the normal range during hypothermia. Resting energy expenditure and cardiac output decreased progressively with hypothermia. Oxygen delivery and oxygen consumption decreased to abnormally low levels at rectal temperatures below 35°C, and the correlation between them became less significant at less than 35°C than that when temperatures were 35°C or higher. Brain temperature was consistently higher than rectal temperature by 0.5 ± 0.3°C. CONCLUSION: These results suggest that, after traumatic brain injury, decreasing body temperature to 35 to 35.5°C can reduce intracranial hypertension while maintaining sufficient cerebral perfusion pressure without cardiac dysfunction or oxygen debt. Thus, 35 to 35.5°C seems to be the optimal temperature at which to treat patients with severe traumatic brain injury.
KW - Hemodynamics
KW - Hypothermia pressure
KW - Metabolism
KW - Traumatic brain injury
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U2 - 10.1097/00006123-200301000-00013
DO - 10.1097/00006123-200301000-00013
M3 - Article
C2 - 12493106
AN - SCOPUS:0037236483
SN - 0148-396X
VL - 52
SP - 102
EP - 112
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -