A meta-analysis of the effects of therapeutic hypothermia in
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Traumatic brain injury (TBI) is a great challenge to public health; more than 50 million people suffer from TBI every year worldwide. Therapeutic hypothermia (TH) can reduce ICP and, to some extent, play the role of a neuroprotective agent, thereby protecting the function of neurons, improving the prognosis of patients and achieving the goal of reducing mortality. To date, TH in patients with TBI remains controversial. However, in recent years, some studies have considered that TH, compared with the control condition, did not ameliorate outcomes among patients with severe TBI. Moreover, a large multicentre trial showed that TH played a negative role in the mortality rate and functional outcome. From this, we can see that the TH strategies remain controversial in patients with TBI. The aim of this meta-analysis is to use RCTs to update the evidence according to when and who administered TH to patients with TBI by analysing 6-month mortality rates, functional outcome, and pneumonia morbidity.

All studies included in this meta-analysis met the following criteria:
1. Type of research: Clinical randomised controlled trial
2. Population: Patients with TBI
3. Intervention: TH management
4. Control: Normothermia management or fever control
5. Research outcomes:
a) Primary outcomes: 6-month mortality, unfavourable functional outcome [Glasgow Outcome Scale (GOS) score 1–3: 1, death; 2, a vegetative state; 3, severe disability. Or Glasgow Outcome Scale-Extended (GOS-E) score 1–4: 1, death; 2, vegetative state; 3–4, severe disability]
b) Secondary outcome: Pneumonia morbidity.

Eligible studies were randomised controlled trials that investigated therapeutic hypothermia management versus normothermia management in patients with traumatic brain injury. We collected the individual data of the patients from each included study. Meta-analyses were performed for 6-month mortality, unfavourable functional outcome and pneumonia morbidity. The risk of bias was evaluated using the Cochrane Risk of Bias tool.

Twenty-three trials involving a total of 2796 patients were included. The randomised controlled trials with a high quality show significantly more mortality in the therapeutic hypothermia group [risk ratio (RR) 1.26, 95% confidence interval (CI) 1.04 to 1.53, p = 0.02]. Lower mortality in the therapeutic hypothermia group occurred when therapeutic hypothermia was received within 24 h (RR 0.83, 95% CI 0.71 to 0.96, p = 0.01), when hypothermia was received for treatment (RR 0.66, 95% CI 0.49 to 0.88, p = 0.006) or when hypothermia was combined with post-craniectomy measures (RR 0.69, 95% CI 0.48 to 1.00, p = 0.05). The risk of unfavourable functional outcome following therapeutic hypothermia management appeared to be significantly reduced (RR 0.78, 95% CI 0.67 to 0.91, p = 0.001). The meta-analysis suggested that there was a significant increase in the risk of pneumonia with therapeutic hypothermia management (RR 1.48, 95% CI 1.11 to 1.97, p = 0.007).

To Conclude it can be said that this meta-analysis demonstrated that therapeutic hypothermia did not reduce but might increase the mortality rate of patients with traumatic brain injury in some high-quality studies. However, traumatic brain injury patients with elevated intracranial hypertension could benefit from hypothermia in therapeutic management instead of prophylaxis when initiated within 24 h.

Source: https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2667-3
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