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35°C Hypothermia Can Reduce Increased Intracranial Pressure as Well as 33°C Hypothermia in Patients with Severe Traumatic Brain Injury: 845

INTRODUCTION: For many years, we have used therapeutic hypothermia (48–72 hr) in patients with severe traumatic brain injury (Glasgow Coma Scale scores of 5 or less). In 2000, we altered the target temperature to 35°C from the former 33°C, as our findings suggested that cooling to 35°C is sufficient to control intracranial hypertension and that hypothermia below 35°C may predispose patients to persistent cumulative oxygen debt, which may be associated with an increased risk of complications. In this study, we attempted to clarify whether 35°C hypothermia has the same effect as 33°C hypothermia in reducing intracranial hypertension and whether it is associated with fewer complications and improved outcomes. METHODS: We compared intracranial pressure and biochemical parameters of the 30 patients treated with 35°C hypothermia (January 2000–June 2005) with those of the 31 patients treated with 33°C hypothermia (July 1994–December 1999). RESULTS: Patient characteristics were similar in the two groups. The mean intracranial pressure on Days 1 to 7 after injury were 15.3 9.6 to 20.1 9.0 mmHg in the 35°C hypothermia group and 14.9 10.2 to 20.7 12.7 mmHg in the 33°C hypothermia group (P 0.0669 to 0.9903). The incidence of intracranial hypertension ( 20 mmHg) on Days 1 to 7 was 18 to 39% and 18 to 37% of measurements in the 35°C and 33°C groups, respectively (P 0.1444–0.9930). Furthermore, our 35°C hypothermic patients exhibited a significant improvement in the decline of systemic oxygen consumption and serum potassium concentrations during hypothermia, and in the increment of C-reactive protein after rewarming. Although the mortality rate tended to be lower in the 35°C group (27 versus 48%, P 0.0801), there were no statistically significant differences in the incidence of systemic complications. CONCLUSION: The effects of 35°C hypothermia on intracranial hypertension are similar to those of 33°C hypothermia.