Modest cooling therapies (35ºC to 37.5ºC) for traumatic brain injury

BACKGROUND: Animal models of traumatic brain injury suggest that induced normothermia (36.5 or 37 ºC), compared to induced hyperthermia (39 ºC), improves histopathological and neurobehavioural outcomes. Observational clinical studies of patients with TBI suggest an association between raised body temperature and unfavourable outcome, although this relationship is inconsistent.

OBJECTIVES: To assess the effects of modest cooling therapies (defined as any drug or physical therapy aimed at maintaining body temperature between 35 ºC and 37.5 ºC) when applied to patients in the first week after traumatic brain injury.

SEARCH METHODS: The most recent search was run on 23(rd) September 2013. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library (CENTRAL), MEDLINE (OvidSP), Embase (OvidSP), ISI WOS: SCI-EXPANDED (1970) & CPCI-S (1990), PubMed and trials registries together with reference checking.

SELECTION CRITERIA: All completed randomised, controlled and placebo-controlled trials published or unpublished, where modest cooling therapies were applied in the first week after traumatic brain injury.

DATA COLLECTION AND ANALYSIS: Two authors independently applied the selection criteria to relevant trials.

MAIN RESULTS: We were unable to find any randomised controlled trials of modest cooling therapies after traumatic brain injury.

AUTHORS' CONCLUSIONS: In order to further explore the preliminary findings provided by animal models and observational clinical studies that suggests there may be a beneficial effect of modest cooling for TBI, randomised trials designed to explore the effect of these interventions on patient-centred outcomes are needed.