Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy

Abstract Purpose We investigated the effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy (TBI). Methods Eighty patients with severe TBI after unilateral craniotomy were randomized into a therapeutic hypothermia group with the brain temperature maintained at 33°C to 35°C for 4 days, and a normothermia control group in the intensive care unit. Vital signs, intracranial pressure, serum superoxide dismutase level, Glasgow Outcome Scale scores, and complications were prospectively analyzed. Results The mean intracranial pressure values of the therapeutic hypothermia group at 24, 48, and 72 hours after injury were much lower than those of the control group (23.49 ± 2.38, 24.68 ± 1.71, and 22.51 ± 2.44 vs 25.87 ± 2.18, 25.90 ± 1.86, and 24.57 ± 3.95 mm Hg; P = .000, .000, and .003, respectively). The mean serum superoxide dismutase levels of the therapeutic hypothermia group at days 3 and 7 were much higher than those of the control group at the same time point (533.0 ± 103.4 and 600.5 ± 82.9 vs 458.7 ± 68.1 and 497.0 ± 57.3 μ g/L, respectively; P = .000). The percentage of favorable neurologic outcome 1 year after injury was 70.0% and 47.5%, respectively ( P = .041). Complications, including pulmonary infections (57.5% in the therapeutic hypothermia group vs 32.5% in the control group; P = .025) were managed without severe sequelae. Conclusions Therapeutic mild hypothermia provides a promising way in the intensive care unit for patients with severe TBI after craniotomy.