Kawakita Kenya, Shishido Hajime, Kuroda Yasuhiro
Emergency Medical Center, Kagawa University Hospital, Miki 761-0793, Japan.
Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University, Miki 760-0793, Japan.
J Clin Med. 2024 Apr 8;13(7):2144. doi: 10.3390/jcm13072144.
Therapeutic hypothermia (TH) for severe traumatic brain injury has seen restricted application due to the outcomes of randomized controlled trials (RCTs) conducted since 2000. In contrast with earlier RCTs, recent trials have implemented active normothermia management in control groups, ensuring comparable intensities of non-temperature-related therapeutic interventions, such as neurointensive care. This change in approach may be a contributing factor to the inability to establish the efficacy of TH. Currently, an active temperature management method using temperature control devices is termed "targeted temperature management (TTM)". One of the goals of TTM for severe traumatic brain injury is the regulation of increased intracranial pressure, employing TTM as a methodology for intracranial pressure management. Additionally, fever in traumatic brain injury has been acknowledged as contributing to poor prognosis, underscoring the importance of proactively preventing fever. TTM is also employed for the preemptive prevention of fever in severe traumatic brain injury. As an integral component of current neurointensive care, it is crucial to precisely delineate the targets of TTM and to potentially apply them in the treatment of severe traumatic brain injury.
自2000年以来开展的随机对照试验(RCT)结果表明,治疗性低温(TH)在重型颅脑损伤中的应用受到限制。与早期的RCT不同,近期的试验在对照组中实施了积极的体温正常管理,确保了非温度相关治疗干预措施(如神经重症监护)的强度相当。这种方法的改变可能是无法确定TH疗效的一个促成因素。目前,使用温度控制设备的主动体温管理方法被称为“目标温度管理(TTM)”。重型颅脑损伤TTM的目标之一是调节颅内压升高,将TTM作为一种颅内压管理方法。此外,颅脑损伤后的发热被认为会导致预后不良,这凸显了积极预防发热的重要性。TTM也用于重型颅脑损伤发热的预防性预防。作为当前神经重症监护的一个组成部分,精确界定TTM的目标并将其潜在地应用于重型颅脑损伤的治疗至关重要。