Systematic Review Exploring the Effect of Therapeutic Hypothermia on Patients with Intracranial Hypertension

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2022 Jul 20

PMID 35855124

Authors

Kamlesh Thakur

Haneet Kaur

Manju Dhandapani

Teenu Xavier

Ganesan Srinivasan

Laskmanan Gopichandran

Sivashanmugam Dhandapani

Affiliations

Soon will be listed here.

Abstract

Background: Intracranial hypertension is found in patients with various neurological and neurosurgical conditions such as subarachnoid hemorrhage (more than 50% of the patients have intracranial pressure > 20 mmHg at some point during their hospital stay), traumatic brain injury, and stroke. Various modalities are used to control intracranial hypertension, therapeutic hypothermia is one of them. This systematic review aims to assess the efficacy of therapeutic hypothermia in controlling intracranial hypertension in an adult patient.

Methods: A systematic review of the literature published between one patient 1990 and 2020 was conducted. Four databases were searched including CINAHL, PubMed, the Cochrane Library, and EMBASE using keywords traumatic brain injury, intracranial pressure, randomized and controlled trials, and the effect of therapeutic hypothermia on intracranial hypertension.

Results: All of the studies included in this review were randomized controlled trials. Most of the studies provided their sample demographics. Sample sizes ranged from 14 to 501. Of the 12 studies, five of them were from the United Kingdom, three of them were from China, two from North America, one from India, and one from Japan.

Conclusion: Treating intracranial hypertension with therapeutic hypothermia may be beneficial according to a few studies but it is also associated with many adverse effects. Both the groups suffered from adverse events which were higher in the hypothermic group. However, these adverse events can be managed in any health-care setting. To treat the patients with therapeutic hypothermia, one (the managing team) should be competent enough to manage the adverse effects.

References

Shiozaki T, Sugimoto H, Taneda M, Yoshida H, Iwai A, Yoshioka T . Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg. 1993; 79(3):363-8. DOI: 10.3171/jns.1993.79.3.0363. View

Alotaibi N, Wang J, Pasarikovski C, Guha D, Al-Mufti F, Mamdani M . Management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage: time for a consensus?. Neurosurg Focus. 2017; 43(5):E13. DOI: 10.3171/2017.7.FOCUS17426. View

Lee H, Chuang H, Cho D, Cheng K, Lin P, Chen C . Applying cerebral hypothermia and brain oxygen monitoring in treating severe traumatic brain injury. World Neurosurg. 2011; 74(6):654-60. DOI: 10.1016/j.wneu.2010.06.019. View

Clifton G, Valadka A, Zygun D, Coffey C, Drever P, Fourwinds S . Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol. 2010; 10(2):131-9. PMC: 3628679. DOI: 10.1016/S1474-4422(10)70300-8. View

Soleimanpour H, Rahmani F, Ej Golzari S, Safari S . Main complications of mild induced hypothermia after cardiac arrest: a review article. J Cardiovasc Thorac Res. 2014; 6(1):1-8. PMC: 3992725. DOI: 10.5681/jcvtr.2014.001. View

Andrews P, Sinclair H, Rodriguez A, Harris B, Battison C, Rhodes J . Hypothermia for Intracranial Hypertension after Traumatic Brain Injury. N Engl J Med. 2015; 373(25):2403-12. DOI: 10.1056/NEJMoa1507581. View

Karakis I, Nuccio A, Amadio J, Fountain Jr A . The Monro-Kellie Doctrine in Action: Posterior Reversible Leukoencephalopathy Syndrome Caused by Intracranial Hypotension from Lumboperitoneal Shunt Placement. World Neurosurg. 2016; 98:868.e11-868.e15. DOI: 10.1016/j.wneu.2016.12.046. View

Todd M, Hindman B, Clarke W, Torner J . Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med. 2005; 352(2):135-45. DOI: 10.1056/NEJMoa040975. View

Dhandapani S, Sharma K . Is "en-bloc" excision, an option for select large vascular meningiomas?. Surg Neurol Int. 2013; 4:102. PMC: 3766328. DOI: 10.4103/2152-7806.116307. View

10.

Dhandapani S, Aggarwal A, Srinivasan A, Meena R, Gaudihalli S, Singh H . Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation?. Surg Neurol Int. 2015; 6(Suppl 21):S543-8. PMC: 4653325. DOI: 10.4103/2152-7806.168067. View

11.

Blair E, ESMOND W, Attar S, Cowley R . THE EFFECT OF HYPOTHERMIA ON LUNG FUNCTION. Ann Surg. 1964; 160:814-23. PMC: 1408827. DOI: 10.1097/00000658-196411000-00006. View

12.

Kapoor A, Dhandapani S, Gaudihalli S, Dhandapani M, Singh H, Mukherjee K . Serum albumin level in spontaneous subarachnoid haemorrhage: More than a mere nutritional marker!. Br J Neurosurg. 2017; 32(1):47-52. DOI: 10.1080/02688697.2017.1344615. View

13.

Dhandapani S, Sarda A, Kapoor A, Salunke P, Mathuriya S, Mukherjee K . Validation of a New Clinico-Radiological Grading for Compound Head Injury: Implications on the Prognosis and the Need for Surgical Intervention. World Neurosurg. 2015; 84(5):1244-50. DOI: 10.1016/j.wneu.2015.05.058. View

14.

Rangel-Castilla L, Rangel-Castillo L, Gopinath S, Robertson C . Management of intracranial hypertension. Neurol Clin. 2008; 26(2):521-41, x. PMC: 2452989. DOI: 10.1016/j.ncl.2008.02.003. View

15.

Andrews P, Rodriguez A, Suter P, Battison C, Rhodes J, Puddu I . Mortality Risk Stratification After Traumatic Brain Injury and Hazard of Death With Titrated Hypothermia in the Eurotherm3235Trial. Crit Care Med. 2017; 45(5):883-890. PMC: 5389587. DOI: 10.1097/CCM.0000000000002376. View

16.

Li L, You C, Chaudhary B . Intraoperative mild hypothermia for postoperative neurological deficits in people with intracranial aneurysm. Cochrane Database Syst Rev. 2016; 3:CD008445. PMC: 6599874. DOI: 10.1002/14651858.CD008445.pub3. View

17.

Dundee J, KING R . Clinical aspects of induced hypothermia; methods of production and indications for its use. Br J Anaesth. 1959; 31(3):106-33. DOI: 10.1093/bja/31.3.106. View

18.

. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346(8):549-56. DOI: 10.1056/NEJMoa012689. View

19.

Harris B, Andrews P, Murray G, Forbes J, Moseley O . Systematic review of head cooling in adults after traumatic brain injury and stroke. Health Technol Assess. 2012; 16(45):1-175. PMC: 4781040. DOI: 10.3310/hta16450. View

20.

Rim H, Ahn J, Kim J, Oh J, Song J, Chang I . Therapeutic Hypothermia for Increased Intracranial Pressure after Decompressive Craniectomy: A Single Center Experience. Korean J Neurotrauma. 2016; 12(2):55-60. PMC: 5110919. DOI: 10.13004/kjnt.2016.12.2.55. View