Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
Crit Care. 2010;14(1):204. doi: 10.1186/cc8220. Epub 2010 Feb 15.
Traumatic brain injury remains a major cause of death and severe disability throughout the world. Traumatic brain injury leads to 1,000,000 hospital admissions per annum throughout the European Union. It causes the majority of the 50,000 deaths from road traffic accidents and leaves 10,000 patients severely handicapped: three quarters of these victims are young people. Therapeutic hypothermia has been shown to improve outcome after cardiac arrest, and consequently the European Resuscitation Council and American Heart Association guidelines recommend the use of hypothermia in these patients. Hypothermia is also thought to improve neurological outcome after neonatal birth asphyxia. Cardiac arrest and neonatal asphyxia patient populations present to health care services rapidly and without posing a diagnostic dilemma; therefore, therapeutic systemic hypothermia may be implemented relatively quickly. As a result, hypothermia in these two populations is similar to the laboratory models wherein systemic therapeutic hypothermia is commenced very soon after the injury and has shown so much promise. The need for resuscitation and computerised tomography imaging to confirm the diagnosis in patients with traumatic brain injury is a factor that delays intervention with temperature reduction strategies. Treatments in traumatic brain injury have traditionally focussed on restoring and maintaining adequate brain perfusion, surgically evacuating large haematomas where necessary, and preventing or promptly treating oedema. Brain swelling can be monitored by measuring intracranial pressure (ICP), and in most centres ICP is used to guide treatments and to monitor their success. There is an absence of evidence for the five commonly used treatments for raised ICP and all are potential 'double-edged swords' with significant disadvantages. The use of hypothermia in patients with traumatic brain injury may have beneficial effects in both ICP reduction and possible neuro-protection. This review will focus on the bench-to-bedside evidence that has supported the development of the Eurotherm3235Trial protocol.
外伤性脑损伤仍然是全世界范围内导致死亡和严重残疾的主要原因。外伤性脑损伤导致欧盟每年有 100 万人因该病住院。它导致了 5 万例道路交通死亡事故中的大多数，使 1 万名患者严重残疾：其中四分之三的受害者是年轻人。治疗性低温已被证明可改善心搏骤停后的预后，因此欧洲复苏理事会和美国心脏协会指南建议在这些患者中使用低温。低温也被认为可改善新生儿窒息后的神经预后。心搏骤停和新生儿窒息患者迅速到达医疗保健服务机构，且不存在诊断难题；因此，可相对较快地实施全身系统低温治疗。因此，这些患者人群与实验室模型相似，在这些模型中，全身治疗性低温在损伤后很快开始实施，并且显示出很大的希望。在创伤性脑损伤患者中，需要复苏和计算机断层成像来确认诊断，这是延迟降低体温策略干预的一个因素。在创伤性脑损伤中的治疗传统上侧重于恢复和维持足够的脑灌注，必要时手术清除大血肿，并预防或及时治疗水肿。脑肿胀可以通过测量颅内压 (ICP) 来监测，并且在大多数中心，ICP 用于指导治疗并监测其效果。对于升高的 ICP 的五种常用治疗方法，缺乏证据，而且所有这些方法都是潜在的“双刃剑”，存在重大缺点。在创伤性脑损伤患者中使用低温可能对降低 ICP 和可能的神经保护都有有益作用。本综述将重点介绍支持 Eurotherm3235 试验方案制定的从实验室到临床的证据。
