Analysis of rebound intracranial pressure occurring during rewarming after therapeutic hypothermia in traumatic brain injury patients
To investigate the risk factors associated with rebound intracranial pressure (ICP), a phenomenon that occurs when brain swelling reprogresses rapidly during rewarming in patients who have undergone therapeutic hypothermia for traumatic brain injury (TBI). This study analyzed 42 patients who underwe...
Gespeichert in:
| Veröffentlicht in: | Clinical neurology and neurosurgery 2023-07, Vol.230, p.107755-107755, Article 107755 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 107755 |
|---|---|
| container_issue | |
| container_start_page | 107755 |
| container_title | Clinical neurology and neurosurgery |
| container_volume | 230 |
| creator | Yoon, Sun Geon Choi, Kyunghak Kyung, Kyu-Hyouck Kim, Min Soo |
| description | To investigate the risk factors associated with rebound intracranial pressure (ICP), a phenomenon that occurs when brain swelling reprogresses rapidly during rewarming in patients who have undergone therapeutic hypothermia for traumatic brain injury (TBI).
This study analyzed 42 patients who underwent therapeutic hypothermia among 172 patients with severe TBI admitted to a single regional trauma center between January 2017 and December 2020. Forty-two patients were classified into 34.5 °C (mild) and 33 °C (moderate) hypothermia groups according to the therapeutic hypothermia protocol for TBI. Rewarming was initiated post-hypothermia, wherein ICP was maintained at ≤ 20 mmHg and cerebral perfusion pressure was maintained at ≥ 50 mmHg for ≥ 24 h. In the rewarming protocol, the target core temperature was increased to 36.5 °C at 0.1 °C/h.
Of the 42 patients who underwent therapeutic hypothermia, 27 did not survive: 9 in the mild and 18 in the moderate hypothermia groups. The moderate hypothermia group had a significantly higher mortality rate than the mild hypothermia group (p = 0.013). Rebound ICP occurred in 9 of 25 patients: 2 in the mild and 7 in the moderate hypothermia groups. In the risk factor analysis of rebound ICP, only the degree of hypothermia was statistically significant, and rebound ICP was observed more frequently in the moderate than in the mild hypothermia group (p = 0.025).
In patients who underwent rewarming after therapeutic hypothermia, rebound ICP presented a higher risk at 33 °C than at 34.5 °C. Therefore, more careful rewarming is needed in patients receiving therapeutic hypothermia at 33 °C.
•Rebound intracranial pressure (ICP) is one of the fatal complications of rewarming of therapeutic hypothermia with TBI.•Rebound ICP showed a higher risk at core temperature of 33 °C than at 34.5 °C.•The lower the core temperature, the more careful rewarming is recommended. |
| doi_str_mv | 10.1016/j.clineuro.2023.107755 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2816768211</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0303846723001713</els_id><sourcerecordid>2816768211</sourcerecordid><originalsourceid>FETCH-LOGICAL-c343t-aec7dbd905897e0f2dfe898333de9fa391382ceaebff997f2b00db99f4e413a93</originalsourceid><addsrcrecordid>eNqFkctuFDEQRS0EIkPgFyJLbNj04MdM294RReEhRWIDa8ttl4lb_aLcBs0H8N-4mYQFG1blKp-6Jd1LyBVne854-7bf-yFNUHDeCyZkHSp1PD4hO66VaFrT6qdkxySTjT606oK8yLlnjEnZ6ufkQirBlFR8R35dT2445ZTpHClCN5cp0DSt6Dy6KbmBLgg5FwQ6e18Q0_SNhvKnIPx0OG4vF1dAut4DugXKmjy9Py3z1o_JVTla9croto8OXe3T1Bc80aWOYFrzS_IsuiHDq4d6Sb6-v_1y87G5-_zh0831XePlQa6NA69CFww7aqOARREiaKOllAFMdNJwqYUHB12MxqgoOsZCZ0w8wIFLZ-QleXPWXXD-XiCvdkzZwzC4CeaSrdC8Va0WnFf09T9oPxesZm2UEIrJY8sq1Z4pj3POCNEumEaHJ8uZ3YKyvX0Mym5B2XNQdfHqQb50I4S_a4_JVODdGYDqx48EaLOvXnkICcGvNszpfzd-A9HZrDE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2822703560</pqid></control><display><type>article</type><title>Analysis of rebound intracranial pressure occurring during rewarming after therapeutic hypothermia in traumatic brain injury patients</title><source>Elsevier ScienceDirect Journals</source><creator>Yoon, Sun Geon ; Choi, Kyunghak ; Kyung, Kyu-Hyouck ; Kim, Min Soo</creator><creatorcontrib>Yoon, Sun Geon ; Choi, Kyunghak ; Kyung, Kyu-Hyouck ; Kim, Min Soo</creatorcontrib><description>To investigate the risk factors associated with rebound intracranial pressure (ICP), a phenomenon that occurs when brain swelling reprogresses rapidly during rewarming in patients who have undergone therapeutic hypothermia for traumatic brain injury (TBI).
This study analyzed 42 patients who underwent therapeutic hypothermia among 172 patients with severe TBI admitted to a single regional trauma center between January 2017 and December 2020. Forty-two patients were classified into 34.5 °C (mild) and 33 °C (moderate) hypothermia groups according to the therapeutic hypothermia protocol for TBI. Rewarming was initiated post-hypothermia, wherein ICP was maintained at ≤ 20 mmHg and cerebral perfusion pressure was maintained at ≥ 50 mmHg for ≥ 24 h. In the rewarming protocol, the target core temperature was increased to 36.5 °C at 0.1 °C/h.
Of the 42 patients who underwent therapeutic hypothermia, 27 did not survive: 9 in the mild and 18 in the moderate hypothermia groups. The moderate hypothermia group had a significantly higher mortality rate than the mild hypothermia group (p = 0.013). Rebound ICP occurred in 9 of 25 patients: 2 in the mild and 7 in the moderate hypothermia groups. In the risk factor analysis of rebound ICP, only the degree of hypothermia was statistically significant, and rebound ICP was observed more frequently in the moderate than in the mild hypothermia group (p = 0.025).
In patients who underwent rewarming after therapeutic hypothermia, rebound ICP presented a higher risk at 33 °C than at 34.5 °C. Therefore, more careful rewarming is needed in patients receiving therapeutic hypothermia at 33 °C.
•Rebound intracranial pressure (ICP) is one of the fatal complications of rewarming of therapeutic hypothermia with TBI.•Rebound ICP showed a higher risk at core temperature of 33 °C than at 34.5 °C.•The lower the core temperature, the more careful rewarming is recommended.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2023.107755</identifier><identifier>PMID: 37207371</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Body temperature ; Brain death ; Brain injuries ; Coma ; Cytokines ; Drugs ; Edema ; Factor analysis ; Fatalities ; Hypothermia ; Induced ; Intracranial pressure ; Neurology ; Rewarming ; Risk factors ; Statistical analysis ; Trauma ; Traumatic ; Traumatic brain injury</subject><ispartof>Clinical neurology and neurosurgery, 2023-07, Vol.230, p.107755-107755, Article 107755</ispartof><rights>2023 Elsevier B.V.</rights><rights>Copyright © 2023 Elsevier B.V. All rights reserved.</rights><rights>2023. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c343t-aec7dbd905897e0f2dfe898333de9fa391382ceaebff997f2b00db99f4e413a93</cites><orcidid>0000-0002-8901-7241 ; 0000-0002-1013-936X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0303846723001713$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37207371$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yoon, Sun Geon</creatorcontrib><creatorcontrib>Choi, Kyunghak</creatorcontrib><creatorcontrib>Kyung, Kyu-Hyouck</creatorcontrib><creatorcontrib>Kim, Min Soo</creatorcontrib><title>Analysis of rebound intracranial pressure occurring during rewarming after therapeutic hypothermia in traumatic brain injury patients</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>To investigate the risk factors associated with rebound intracranial pressure (ICP), a phenomenon that occurs when brain swelling reprogresses rapidly during rewarming in patients who have undergone therapeutic hypothermia for traumatic brain injury (TBI).
This study analyzed 42 patients who underwent therapeutic hypothermia among 172 patients with severe TBI admitted to a single regional trauma center between January 2017 and December 2020. Forty-two patients were classified into 34.5 °C (mild) and 33 °C (moderate) hypothermia groups according to the therapeutic hypothermia protocol for TBI. Rewarming was initiated post-hypothermia, wherein ICP was maintained at ≤ 20 mmHg and cerebral perfusion pressure was maintained at ≥ 50 mmHg for ≥ 24 h. In the rewarming protocol, the target core temperature was increased to 36.5 °C at 0.1 °C/h.
Of the 42 patients who underwent therapeutic hypothermia, 27 did not survive: 9 in the mild and 18 in the moderate hypothermia groups. The moderate hypothermia group had a significantly higher mortality rate than the mild hypothermia group (p = 0.013). Rebound ICP occurred in 9 of 25 patients: 2 in the mild and 7 in the moderate hypothermia groups. In the risk factor analysis of rebound ICP, only the degree of hypothermia was statistically significant, and rebound ICP was observed more frequently in the moderate than in the mild hypothermia group (p = 0.025).
In patients who underwent rewarming after therapeutic hypothermia, rebound ICP presented a higher risk at 33 °C than at 34.5 °C. Therefore, more careful rewarming is needed in patients receiving therapeutic hypothermia at 33 °C.
•Rebound intracranial pressure (ICP) is one of the fatal complications of rewarming of therapeutic hypothermia with TBI.•Rebound ICP showed a higher risk at core temperature of 33 °C than at 34.5 °C.•The lower the core temperature, the more careful rewarming is recommended.</description><subject>Body temperature</subject><subject>Brain death</subject><subject>Brain injuries</subject><subject>Coma</subject><subject>Cytokines</subject><subject>Drugs</subject><subject>Edema</subject><subject>Factor analysis</subject><subject>Fatalities</subject><subject>Hypothermia</subject><subject>Induced</subject><subject>Intracranial pressure</subject><subject>Neurology</subject><subject>Rewarming</subject><subject>Risk factors</subject><subject>Statistical analysis</subject><subject>Trauma</subject><subject>Traumatic</subject><subject>Traumatic brain injury</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkctuFDEQRS0EIkPgFyJLbNj04MdM294RReEhRWIDa8ttl4lb_aLcBs0H8N-4mYQFG1blKp-6Jd1LyBVne854-7bf-yFNUHDeCyZkHSp1PD4hO66VaFrT6qdkxySTjT606oK8yLlnjEnZ6ufkQirBlFR8R35dT2445ZTpHClCN5cp0DSt6Dy6KbmBLgg5FwQ6e18Q0_SNhvKnIPx0OG4vF1dAut4DugXKmjy9Py3z1o_JVTla9croto8OXe3T1Bc80aWOYFrzS_IsuiHDq4d6Sb6-v_1y87G5-_zh0831XePlQa6NA69CFww7aqOARREiaKOllAFMdNJwqYUHB12MxqgoOsZCZ0w8wIFLZ-QleXPWXXD-XiCvdkzZwzC4CeaSrdC8Va0WnFf09T9oPxesZm2UEIrJY8sq1Z4pj3POCNEumEaHJ8uZ3YKyvX0Mym5B2XNQdfHqQb50I4S_a4_JVODdGYDqx48EaLOvXnkICcGvNszpfzd-A9HZrDE</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Yoon, Sun Geon</creator><creator>Choi, Kyunghak</creator><creator>Kyung, Kyu-Hyouck</creator><creator>Kim, Min Soo</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8901-7241</orcidid><orcidid>https://orcid.org/0000-0002-1013-936X</orcidid></search><sort><creationdate>202307</creationdate><title>Analysis of rebound intracranial pressure occurring during rewarming after therapeutic hypothermia in traumatic brain injury patients</title><author>Yoon, Sun Geon ; Choi, Kyunghak ; Kyung, Kyu-Hyouck ; Kim, Min Soo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c343t-aec7dbd905897e0f2dfe898333de9fa391382ceaebff997f2b00db99f4e413a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Body temperature</topic><topic>Brain death</topic><topic>Brain injuries</topic><topic>Coma</topic><topic>Cytokines</topic><topic>Drugs</topic><topic>Edema</topic><topic>Factor analysis</topic><topic>Fatalities</topic><topic>Hypothermia</topic><topic>Induced</topic><topic>Intracranial pressure</topic><topic>Neurology</topic><topic>Rewarming</topic><topic>Risk factors</topic><topic>Statistical analysis</topic><topic>Trauma</topic><topic>Traumatic</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yoon, Sun Geon</creatorcontrib><creatorcontrib>Choi, Kyunghak</creatorcontrib><creatorcontrib>Kyung, Kyu-Hyouck</creatorcontrib><creatorcontrib>Kim, Min Soo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurology and neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yoon, Sun Geon</au><au>Choi, Kyunghak</au><au>Kyung, Kyu-Hyouck</au><au>Kim, Min Soo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of rebound intracranial pressure occurring during rewarming after therapeutic hypothermia in traumatic brain injury patients</atitle><jtitle>Clinical neurology and neurosurgery</jtitle><addtitle>Clin Neurol Neurosurg</addtitle><date>2023-07</date><risdate>2023</risdate><volume>230</volume><spage>107755</spage><epage>107755</epage><pages>107755-107755</pages><artnum>107755</artnum><issn>0303-8467</issn><eissn>1872-6968</eissn><abstract>To investigate the risk factors associated with rebound intracranial pressure (ICP), a phenomenon that occurs when brain swelling reprogresses rapidly during rewarming in patients who have undergone therapeutic hypothermia for traumatic brain injury (TBI).
This study analyzed 42 patients who underwent therapeutic hypothermia among 172 patients with severe TBI admitted to a single regional trauma center between January 2017 and December 2020. Forty-two patients were classified into 34.5 °C (mild) and 33 °C (moderate) hypothermia groups according to the therapeutic hypothermia protocol for TBI. Rewarming was initiated post-hypothermia, wherein ICP was maintained at ≤ 20 mmHg and cerebral perfusion pressure was maintained at ≥ 50 mmHg for ≥ 24 h. In the rewarming protocol, the target core temperature was increased to 36.5 °C at 0.1 °C/h.
Of the 42 patients who underwent therapeutic hypothermia, 27 did not survive: 9 in the mild and 18 in the moderate hypothermia groups. The moderate hypothermia group had a significantly higher mortality rate than the mild hypothermia group (p = 0.013). Rebound ICP occurred in 9 of 25 patients: 2 in the mild and 7 in the moderate hypothermia groups. In the risk factor analysis of rebound ICP, only the degree of hypothermia was statistically significant, and rebound ICP was observed more frequently in the moderate than in the mild hypothermia group (p = 0.025).
In patients who underwent rewarming after therapeutic hypothermia, rebound ICP presented a higher risk at 33 °C than at 34.5 °C. Therefore, more careful rewarming is needed in patients receiving therapeutic hypothermia at 33 °C.
•Rebound intracranial pressure (ICP) is one of the fatal complications of rewarming of therapeutic hypothermia with TBI.•Rebound ICP showed a higher risk at core temperature of 33 °C than at 34.5 °C.•The lower the core temperature, the more careful rewarming is recommended.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>37207371</pmid><doi>10.1016/j.clineuro.2023.107755</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-8901-7241</orcidid><orcidid>https://orcid.org/0000-0002-1013-936X</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0303-8467 |
| ispartof | Clinical neurology and neurosurgery, 2023-07, Vol.230, p.107755-107755, Article 107755 |
| issn | 0303-8467 1872-6968 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2816768211 |
| source | Elsevier ScienceDirect Journals |
| subjects | Body temperature Brain death Brain injuries Coma Cytokines Drugs Edema Factor analysis Fatalities Hypothermia Induced Intracranial pressure Neurology Rewarming Risk factors Statistical analysis Trauma Traumatic Traumatic brain injury |
| title | Analysis of rebound intracranial pressure occurring during rewarming after therapeutic hypothermia in traumatic brain injury patients |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-30T22%3A29%3A39IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Analysis%20of%20rebound%20intracranial%20pressure%20occurring%20during%20rewarming%20after%20therapeutic%20hypothermia%20in%20traumatic%20brain%20injury%20patients&rft.jtitle=Clinical%20neurology%20and%20neurosurgery&rft.au=Yoon,%20Sun%20Geon&rft.date=2023-07&rft.volume=230&rft.spage=107755&rft.epage=107755&rft.pages=107755-107755&rft.artnum=107755&rft.issn=0303-8467&rft.eissn=1872-6968&rft_id=info:doi/10.1016/j.clineuro.2023.107755&rft_dat=%3Cproquest_cross%3E2816768211%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2822703560&rft_id=info:pmid/37207371&rft_els_id=S0303846723001713&rfr_iscdi=true |