Optimal temperature for the management of severe traumatic brain injury: Effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism

Takashi Tokutomi, Kazuya Morimoto, Tomoya Miyagi, Shintaro Yamaguchi, Kazufumi Ishikawa, Minoru Shigemori, Akira Yamaura, Alex B. Valadka, J. Paul Muizelaar

Research output: Contribution to journalArticle

127 Citations (Scopus)

Abstract

OBJECTIVE: We studied the effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism in patients with severe traumatic brain injury to clarify the optimal temperature for hypothermia, with a view toward establishing the proper management techniques for such patients. METHODS: The study was performed in 31 patients with severe head injury (Glasgow Coma Scale score as high as 5). All patients were sedated, paralyzed, ventilated, and cooled to 33°C. Brain temperature, core temperature, intracranial pressure, cerebral perfusion pressure, jugular venous oxygen saturation, mixed venous oxygen saturation, cardiac output, oxygen delivery, oxygen consumption, and resting energy expenditure were monitored continuously. RESULTS: Intracranial pressure decreased significantly at brain temperatures below 37°C and decreased more sharply at temperatures 35 to 36°C, but no differences were observed at temperatures below 35°C. Cerebral perfusion pressure peaked at 35.0 to 35.9°C and decreased with further decreases in temperature. Jugular venous oxygen saturation and mixed venous oxygen saturation remained in the normal range during hypothermia. Resting energy expenditure and cardiac output decreased progressively with hypothermia. Oxygen delivery and oxygen consumption decreased to abnormally low levels at rectal temperatures below 35°C, and the correlation between them became less significant at less than 35°C than that when temperatures were 35°C or higher. Brain temperature was consistently higher than rectal temperature by 0.5 ± 0.3°C. CONCLUSION: These results suggest that, after traumatic brain injury, decreasing body temperature to 35 to 35.5°C can reduce intracranial hypertension while maintaining sufficient cerebral perfusion pressure without cardiac dysfunction or oxygen debt. Thus, 35 to 35.5°C seems to be the optimal temperature at which to treat patients with severe traumatic brain injury.

Original languageEnglish (US)
Pages (from-to)102-112
Number of pages11
JournalNeurosurgery
Volume52
Issue number1
DOIs
StatePublished - Jan 1 2003

Fingerprint

Intracranial Pressure
Hypothermia
Hemodynamics
Temperature
Cerebrovascular Circulation
Oxygen
Oxygen Consumption
Cardiac Output
Energy Metabolism
Traumatic Brain Injury
Brain
Neck
Glasgow Coma Scale
Intracranial Hypertension
Body Temperature
Craniocerebral Trauma
Reference Values

Keywords

  • Hemodynamics
  • Hypothermia pressure
  • Metabolism
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Optimal temperature for the management of severe traumatic brain injury : Effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. / Tokutomi, Takashi; Morimoto, Kazuya; Miyagi, Tomoya; Yamaguchi, Shintaro; Ishikawa, Kazufumi; Shigemori, Minoru; Yamaura, Akira; Valadka, Alex B.; Muizelaar, J. Paul.

In: Neurosurgery, Vol. 52, No. 1, 01.01.2003, p. 102-112.

Research output: Contribution to journalArticle

Tokutomi, Takashi ; Morimoto, Kazuya ; Miyagi, Tomoya ; Yamaguchi, Shintaro ; Ishikawa, Kazufumi ; Shigemori, Minoru ; Yamaura, Akira ; Valadka, Alex B. ; Muizelaar, J. Paul. / Optimal temperature for the management of severe traumatic brain injury : Effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. In: Neurosurgery. 2003 ; Vol. 52, No. 1. pp. 102-112.
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AU - Tokutomi, Takashi

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AU - Yamaguchi, Shintaro

AU - Ishikawa, Kazufumi

AU - Shigemori, Minoru

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AB - OBJECTIVE: We studied the effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism in patients with severe traumatic brain injury to clarify the optimal temperature for hypothermia, with a view toward establishing the proper management techniques for such patients. METHODS: The study was performed in 31 patients with severe head injury (Glasgow Coma Scale score as high as 5). All patients were sedated, paralyzed, ventilated, and cooled to 33°C. Brain temperature, core temperature, intracranial pressure, cerebral perfusion pressure, jugular venous oxygen saturation, mixed venous oxygen saturation, cardiac output, oxygen delivery, oxygen consumption, and resting energy expenditure were monitored continuously. RESULTS: Intracranial pressure decreased significantly at brain temperatures below 37°C and decreased more sharply at temperatures 35 to 36°C, but no differences were observed at temperatures below 35°C. Cerebral perfusion pressure peaked at 35.0 to 35.9°C and decreased with further decreases in temperature. Jugular venous oxygen saturation and mixed venous oxygen saturation remained in the normal range during hypothermia. Resting energy expenditure and cardiac output decreased progressively with hypothermia. Oxygen delivery and oxygen consumption decreased to abnormally low levels at rectal temperatures below 35°C, and the correlation between them became less significant at less than 35°C than that when temperatures were 35°C or higher. Brain temperature was consistently higher than rectal temperature by 0.5 ± 0.3°C. CONCLUSION: These results suggest that, after traumatic brain injury, decreasing body temperature to 35 to 35.5°C can reduce intracranial hypertension while maintaining sufficient cerebral perfusion pressure without cardiac dysfunction or oxygen debt. Thus, 35 to 35.5°C seems to be the optimal temperature at which to treat patients with severe traumatic brain injury.

KW - Hemodynamics

KW - Hypothermia pressure

KW - Metabolism

KW - Traumatic brain injury

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