Anestesia e Pesquisa Clínica
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Traumatic Brain Injury: Treatment with Mild Prolonged Hypothermia

Alaa M Atia and Khaled A Abdel-Rahman

Introduction: Hypothermia has been used as a method of brain protection in patients with traumatic brain injury (TBI) for many years. The protective effects of hypothermia are related to the inhibition of the excitatory amino acids (EAA) release including glutamate. The hypothermic decline of the cerebral metabolic rate of oxygen is also another mechanism of brain protection because it maintains the aerobic metabolism of the brain. Aim of the work: To study the effect of mild hypothermia on the outcome and complications in severe head trauma. Patients and methods: Ninety four patients (16-60 years old) with severe head trauma (Glasgow coma scale ≤ 8) were classified into hypothermic group (n=47) and normothermic group (n=47). The jugular venous bulb oxygen saturation, the jugular venous lactate, the Glasgow outcome scale at hospital discharge (GOS-HD), the length of ICU stay and other variables were measured and recorded. Results: Mild hypothermia improved the jugular venous bulb oxygen saturation, decreased the jugular venous lactate, with no effect on (GOS-HD). Conclusion: Prophylactic mild hypothermia lacks any effect on the outcome in patients with TBI, although there is improvement in the cerebral oxygenation and decrease the oxygen extraction and prevention of the anaerobic metabolism by decreasing the level of serum lactate. A subgroup of patients with intracranial hematoma may benefit from this type of treatment.