Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
Br J Anaesth. 2013 Mar;110(3):357-67. doi: 10.1093/bja/aes500. Epub 2013 Jan 25.
This systematic review delineates the effect of primary therapeutic hypothermia (PTH) (initiated on presentation of the patient) on both mortality and neurological outcome in patients with traumatic brain injury. The safety profile of the therapy is also assessed. A systematic search of the following databases was performed: MEDLINE, EMBASE, Zetoc database of conference proceedings, the Cochrane Database of Systematic Reviews, and the clinicaltrials.gov website, up to July 28, 2011. Relevant journals were hand-searched for further articles and reference lists were checked against the retrieved results for additional resources. The retrieved results were filtered for randomized controlled trials in English where systemic hypothermia was applied for ≥ 12 h in the treatment arm and outcome was assessed at a minimum of 3 months. Randomized controlled trials were assessed for quality of evidence using the GRADE system. Eighteen randomized controlled trials (1851 patients) were identified. The overall relative risk of mortality with PTH when compared with controls was 0.84 [95% confidence interval (CI)=0.72-0.98] and of poor neurological outcome was 0.81 (95% CI=0.73-0.89). However, when only high-quality trials were analysed, the relative risks were 1.28 (95% CI=0.89-1.83) and 1.07 (95% CI=0.92-1.24), respectively. Hypothermia was associated with cerebrovascular disturbances on rewarming and possibly with pneumonia in adult patients. Given the quality of the data currently available, no benefit of PTH on mortality or neurological morbidity could be identified. The therapy should therefore only be used within the confines of well-designed clinical trials.
本系统评价描述了原发性治疗性低温（PTH）（在患者出现时开始）对创伤性脑损伤患者的死亡率和神经功能结局的影响。同时还评估了该疗法的安全性。系统检索了以下数据库：MEDLINE、EMBASE、Zetoc 会议论文数据库、Cochrane 系统评价数据库和 clinicaltrials.gov 网站，检索时间截至 2011 年 7 月 28 日。进一步的文章通过查阅相关期刊获得，并且根据检索结果检查了参考文献列表以获取其他资源。根据检索结果，筛选出了英文的随机对照试验，其中在治疗组中应用系统性低温≥12 小时，并且在至少 3 个月时评估结局。使用 GRADE 系统评估随机对照试验的证据质量。共确定了 18 项随机对照试验（1851 例患者）。与对照组相比，PTH 治疗组的死亡率相对风险为 0.84 [95%置信区间（CI）=0.72-0.98]，神经功能结局不良的相对风险为 0.81（95% CI=0.73-0.89）。然而，当仅分析高质量试验时，相对风险分别为 1.28（95% CI=0.89-1.83）和 1.07（95% CI=0.92-1.24）。复温时低温与脑血管紊乱有关，并且在成年患者中可能与肺炎有关。鉴于目前可用数据的质量，无法确定 PTH 对死亡率或神经发病率的有益作用。因此，该疗法应仅在精心设计的临床试验范围内使用。
