Hypothermia in Treatment of Traumatic Brain Injury
Alistair Nichol explains the use of hypothermia in the treatment of traumatic brain injury (TBI).
TBI is a major cause of mortality and long-term morbidity. It leads to terrible outcomes and is a major cause of health burden across the globe.
Prophylactic hypothermia presents a promising treatment to address this hidden epidemic. The pathophysiology of TBI is exceedingly complex.
Evidently, one drug will likely not be the answer. This leads Alistair to discuss hypothermia as a treatment for TBI, which has huge potential benefit.
As Alistair explains, it acts in many different places, in many ways, across many time periods. Could this be the ‘drug’ to give?
The questions then become, when should you give it, how should you give it and how low should you aim?
Alistair recommends inducing hypothermia as early as humanly possible.
In the case of TBI, this means at the roadside if practical. How low should you go?
Given the effect of hypothermia on coagulation, and the propensity for trauma patients to bleed, this is a tricky question. Alistair states that 32 degrees is ideal however this leads to further haematological complications.
To that end, 35 degrees is a sensible aim, to then go lower once bleeding has been excluded in the Emergency Department.
How do you do it? Ice is unfavourable, given the difficulty of controlling the temperature and the adverse effects including ice burns. Alistair also warns against the use of ice cold saline due to the effects of positive fluid balances in TBI patients.
Alistair explains the current methods, such as surface cooling pads and intravascular cooling catheters. It is not a risk-free treatment. Risk of infection rises due to effects on cellular processes. Propofol-related Infusion Syndrome (PRIS) is also being increasingly recognised as an adverse outcome.
Finally, the re-warming following hypothermia is risky. Alistair explains the complex process of re-warming.
Alistair concludes by explaining the current trials underway and the potential future for this treatment.
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