Therapeutic hypothermia and traumatic brain injury.

ABSTRACT

PURPOSE OF REVIEW Therapeutic hypothermia after traumatic brain injury (TBI)? For the last 10 years, no topic has been more popular and more controversial among neurointensivists. This article reviews the most current findings (experimental, clinical, adult and pediatric TBI), as well as the clinical management of therapeutic hypothermia. RECENT FINDINGS: Despite ample experimental evidence, the clinical utility of therapeutic hypothermia has still to be conclusively demonstrated in terms of reduced mortality or improved functional recovery after TBI (even in pediatric TBI). Current findings support that hypothermia should be initiated as soon as possible, for at least 48 h duration, and that outcome is worse when barbiturates are part of ICU management. Currently, available cooling techniques, including prehospital cooling protocols, expand and improve clinical management of therapeutic hypothermia. SUMMARY: Taking into consideration all results from clinical hypothermia TBI studies discussion has to be focused around the possibility that a better outcome could be achieved if protocols for therapeutic hypothermia are reviewed. It is possible that the negative effects of the cooling and the rewarming procedure currently overshadow the neuroprotective effects.