Comparative Effectiveness of Different Targeted Temperature Management Modalities for Adult Patients with Traumatic...

Traumatic brain injury (TBI) poses a significant global health burden, yet treatment options remain limited. Several analyses have demonstrated that targeted temperature management (TTM) is superior to normothermia in improving outcomes for patients with TBI. However, the optimal strategy for implementing targeted temperature management in critically ill patients with TBI remains unclear. This study aimed to evaluate and rank different TTM approaches in patients with TBI using a network meta-analysis with meta-regression of randomized controlled trials (RCTs).

We performed a Bayesian network meta-analysis using a hierarchical model with Monte Carlo simulation to integrate both direct and indirect evidence. RCTs comparing TTM with normothermia in patients with TBI were included. Primary outcomes were mortality and poor functional recovery. Relative risks (RRs) and 95% credible intervals (CrIs) were reported. The surface under the cumulative ranking curve and forest plots were used to rank and visualize treatment effects.

A total of 30 RCTs involving 3498 participants were included. Surface cooling (RR: 0.54; 95% CrI: 0.43-0.69) and cranial cooling (RR: 0.61; 95% CrI: 0.36-0.98) significantly reduced mortality compared with intravenous or gastric cooling. Moreover, surface cooling (RR: 0.69; 95% CrI: 0.62-0.77) and cranial cooling (RR: 0.44; 95% CrI: 0.29-0.65) were related to better functional outcomes compared with intravenous or gastric cooling. These findings remained robust in the subgroup of patients with severe TBI.

In adults with TBI, targeted temperature management delivered via surface or cranial cooling reduces mortality and improves functional recovery compared with other cooling methods. Large-scale randomized controlled trials are warranted to further validate our results and to investigate the impact of different target temperature settings on patient outcomes.