FEASIBILITY OF THE TITRATION METHOD OF MILD HYPOTHERMIA IN SEVERELY HEAD-INJURED PATIENTS WITH INTRACRANIAL HYPERTENSION

OBJECTIVE: Clinical strategy to maximize effectiveness and to minimize adverse influences remains to be determined for mild hypothermia ther apy for traumatic brain injury. This study was conducted to evaluate t he clinical feasibility of the titration method of mild hypothermia in severely head-injured patients in whom a reduction in intracranial pr essure was regarded as the target effect. METHODS: Nine consecutive pa tients with severe head injury were studied. Patient age ranged betwee n 18 and 66 years, Glasgow Coma Scale scores were equal to or less tha n 8, and intracranial pressures were equal to or greater than 20 mm Hg despite removal of intracranial hematoma and drugs, including glycero l and thiopental. During a maximum of 6 days of hypothermia therapy, j ugular venous blood or cerebrospinal fluid temperature was titrated to reduce intracranial pressure to less than 20 mm Hg by means of repeat ed intragastric cooling with our nasoduodenal tube and surface cooling . The feasibility and the effects on systemic complications of this ti tration method of mild hypothermia were evaluated. RESULTS: Intracrani al pressure variably decreased from before to 3 hours after the beginn ing of all procedures of cooling. The mean intracranial pressure signi ficantly decreased from 24 to 15 mm Hg with cooling, while temperature reduced an average of 2.0 degrees C. Four patients had systemic infec tion complications. Increased C-reactive protein and decreased platele t count were observed in all patients during hypothermia. The incidenc e of good recovery and moderate disability according to the Glasgow Ou tcome Scale was seven of nine patients. CONCLUSION: The titration meth od of mild hypothermia to control intracranial hypertension in severel y head-injured patients is clinically feasible. However, the method fa iled to reduce the incidence of infectious and hematological complicat ions.