Therapeutic Hypothermia: Its Potential and Questionable Role in Traumatic Brain Injury

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Therapeutic Hypothermia: Its Potential and Questionable Role in Traumatic Brain Injury

Authors
  • RL, Tieng Kong1
Type
Published Article
Journal
Asploro Journal of Biomedical and Clinical Case Reports
Publisher
Asploro Open Access Publications
Publication Date
Sep 30, 2019
Volume
2
Issue
2
Pages
84–86
Identifiers
DOI: 10.36502/2019/asjbccr.6166
Source
MyScienceWork
Keywords
License
Green

Abstract

From the acute management of cardiac arrest and stroke to traumatic brain injury, the implementation of hypothermia therapy since the past two decades has progressed from various guidelines committees' consideration of minimal benefit to mixed favorable outcomes being obtained from numerous randomized controlled trials [1]. As far as cases of traumatic brain injury are concerned, there were evidences of positive benefit in terms of mortality rates and neurological outcomes. According to a systematic analysis by Peterson et al. (2008), the relative risks (RR) of mortality (95% confidence interval) in comparison with control treatment groups were lower in subgroups of hypothermic procedures which utilized a cooling duration of over 48 hours (RR = 0.51), delivered at a temperature range of 33 degrees Celsius and above that was defined as milder than below 33 degrees Celsius (RR = 0.77), and when the patient was rewarmed passively (RR = 0.49). Overall, patients' positive outcomes were more significantly demonstrated over long-term follow-up of at least 1 year. Needless to say, these condition variables and results are an indication or suggestive that a stable maintenance of hypothermia therapy delivered over the mild intensity range, i.e. 33 degrees Celsius and above, produces near to optimal results that are more evidenced over the long term as opposed to substantially strong cooling. Such methodology could help guide treatment standard protocol that can simultaneously increase favorable neurological outcomes and reduce the risk of occurrence of pneumonia and heart rate complications due to milder cooling temperature being introduced as well as a gradual pace of passive rewarming method. This also allows for a broader and more flexible duration window of adjustment and recovery for the brain and peripheral systems while they are still being subjected to potential post-injury effect(s). Building on the concept of stability and mild intensity cooling, a method of less invasive and indirect delivery of hypothermia therapy yet permitting a greater amount of physical surface area of exposure, through placement of patient in low environmental temperature recovery units may be worth considering. No doubt, there is a broad range of interrelated physiological aspects and processes which are subjected to constant modulatory strategies by temperature dynamics, e.g. immune system directed inflammation, increased intracranial pressure, etc., and such associations increase the

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