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Published on: March 3, 2021
Protective effect of moderate hypothermia on severe traumatic brain injury in children
1Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China.
Insights
Moderate hypothermia safely reduced intracranial pressure and protected neurons in children with severe traumatic brain injury (TBI). This neuroprotective effect was observed by lower biomarker levels and reduced mortality in the hypothermia group.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Trauma Surgery
Background:
- Severe traumatic brain injury (TBI) in children presents significant management challenges.
- Elevated intracranial pressure (ICP) and neuronal damage are critical concerns following pediatric TBI.
- Neuroprotective strategies are essential to improve outcomes in severe pediatric TBI.
Purpose of the Study:
- To evaluate the safety and neuroprotective efficacy of moderate hypothermia in children with severe TBI.
- To compare the effects of moderate hypothermia versus normothermia on ICP and specific biomarkers.
- To assess the impact of hypothermia on mortality and physiological parameters.
Main Methods:
- A randomized controlled trial involving 22 children with severe TBI.
- Treatment groups: moderate hypothermia (34.5°C for 72h) and normothermia (38.0°C).
- Measured ICP, cerebrospinal fluid levels of NSE, S-100, CK-BB, pH, electrolytes, and heart rate.
Main Results:
- Moderate hypothermia significantly reduced ICP compared to normothermia at all time points (p < 0.01).
- Biomarkers of neuronal injury (NSE, S-100, CK-BB) were significantly lower in the hypothermia group (p < 0.01).
- The hypothermia group showed a trend towards lower mortality (8.3% vs. 20%) and maintained normal pH and electrolyte balance.
Conclusions:
- Moderate hypothermia is a safe and effective neuroprotective strategy for severe pediatric TBI.
- Maintaining intracranial temperature at 34.5°C for 72 hours reduces ICP and neuronal damage.
- Hypothermia therapy demonstrates potential to improve outcomes and reduce mortality in this patient population.
Abstract:
This study investigated the safety and neuroprotective effect of moderate hypothermia in children with severe traumatic brain injury (TBI). Twenty-two children suffering from TBI were randomly divided into groups treated with moderate hypothermia (intracranial temperature of 34.5 +/- 0.2 degrees C, maintained for 72 h, n = 12) or normothermia (intracranial temperature of 38.0 +/- 0.5, n = 10). The cerebrospinal fluid levels of neuron-specific enolase (NSE), S-100, brain-specific creatine kinase (CK-BB), and intracranial pressure (ICP) levels were used to assess the protective effects. The variations in pH and electrolyte balance were also examined. The results indicated that the peak ICP level in the normothermia group (26.30 +/- 1.08 mm Hg) was reached 48 h after TBI. The ICP level in the moderate hypothermia group was lower than in the control group at every time point examined (p < 0.01). Furthermore, at 24, 48, and 72 h, the NSE, S-100, and CK-BB levels in the moderate hypothermia group were also lower than that of the normothermia group (p < 0.01). In the moderate hypothermia group, the pH and electrolyte balance at the end of the monitoring period were normal, but the heart rates were lower (p < 0.05). There were a total of three deaths (13.6%) in this study: one in the moderate hypothermia group (8.3%) and two in the normothermia group (20%). In conclusion, moderate hypothermia provided neuronal protection for children with severe TBI, and maintaining the intracranial temperature at 34.5 degrees C for 72 h was safe in this clinical setting.
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