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Mild Hypothermia for Severely Head-injured Patients with Low Intracranial Pressure (ICP).

Decreasing metabolic demands in patients following head injury may help in lowering intracranial pressure (ICP). Hypothermia is one method thought to decrease metabolic demands. Past studies have suggested an improved outcome in patients with increased ICP treated with hypothermia. Researchers in Japan studied the response to hypothermia in 16 severely head-injured patients with Glasgow Coma Scale scores of 8 or less and ICPs less than 20 mm Hg.[1] All were studied after receiving "traditional" therapies including fluid restriction, hyperventilation, and high-dose barbiturates. Patients were randomly assigned to receive mild hypothermia (with intracranial temperature lowered to 34 [degrees] C) or remain normothermic (with intracranial temperature at 37 [degrees] C). Both groups included a variety of etiologies, such as subarachnoid hemorrhage, subdural, epidural, or intracerebral hematomas. Surgical interventions for evacuation of hematoma were also variable. After 5 days of intervention, hypothermic patients were slowly rewarmed over 3 days. Cerebrospinal fluid (CSF) excitatory amino acids and cytokines were analyzed. Researchers found no difference in CSF substrates between the two groups.

Complications associated with head injury and hypothermia were monitored; the only difference was a significantly higher incidence of diabetes insipidus with hypernatremia in the hypothermic group (p [is less than] .01). Mild hypothermia did not provide any advantage over normothermia in this patient population.

Although this study utilized a tight intervention protocol and randomization, the sample size was small and heterogeneous. Certainly the "standard" interventions used in this study are also controversial. As with many head injury studies, interventions that improve outcome remain elusive.


[1.] Shiozaki T, Kato A, Taneda M et al: Little benefit from mild hypothermia therapy for severely head-injured patients with low intracranial pressure. J Neurosurg 1999; 91: 185-191.
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Author:Fowler, Susan
Publication:Journal of Neuroscience Nursing
Article Type:Brief Article
Date:Dec 1, 1999
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