Active cooling in traumatic brain-injured patients: a questionable therapy?

Area of Science:

• Neuroscience
• Critical Care Medicine
• Trauma Surgery

Background:

• Hypothermia offers neuroprotection in global brain ischemia.
• Its efficacy in focal ischemia, like severe traumatic brain injury (TBI), remains controversial.
• Previous studies on hypothermia for TBI have yielded mixed results, often limited by low trial quality.

Purpose of the Study:

• To review current knowledge on active cooling in TBI patients.
• To explore reasons for the lack of demonstrated benefit in TBI outcomes.
• To discuss potential mechanisms hindering hypothermia's effectiveness in TBI.

Main Methods:

• Review of existing literature on hypothermia and TBI.
• Analysis of factors potentially limiting therapeutic effects.
• Consideration of evidence from high-quality randomized controlled trials.

Main Results:

• High-quality trials indicate a potential increase in mortality for TBI patients treated with active cooling.
• Concerns exist regarding compromised penumbra zone circulation under hypothermia.
• Increased risk of bleeding and vasoconstrictor use are potential adverse effects.

Conclusions:

• Active cooling may not be beneficial for TBI outcomes and could be harmful.
• Further research is needed to understand the complex effects of hypothermia in TBI.
• Pharmacological reduction of high fever is suggested as a safer alternative.