Korean J Neurotrauma.  2016 Oct;12(2):55-60. 10.13004/kjnt.2016.12.2.55.

Therapeutic Hypothermia for Increased Intracranial Pressure after Decompressive Craniectomy: A Single Center Experience

• Rim HT
• Ahn JH
• Kim JH
• Oh JK
• Song JH
• Chang IB

• KMID: 2356773
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.55

Abstract

OBJECTIVE
Therapeutic hypothermia (TH) and decompressive craniectomy are neuroprotective interventions following severe brain swelling. The precise benefits, risks, and clinical outcomes in brain swelling after TH are still being investigated. We aimed to investigate the effects of TH in severe brain injury after decompressive craniectomy.
METHODS
We reviewed the cases of 24 patients who underwent decompressive craniectomy with intracranial pressure (ICP) monitor insertion in one medical center between January 2012 and May 2016. All patients had an ICP greater than 15 mmHg and a Glasgow Coma Scale score of less than 7 at the time of intervention. TH was induced in half of the patients (n=12) directly after surgery; the remaining 12 patients remained normothermic. The ICP, vital signs, complications, and functional outcomes were reviewed and compared between the patient groups.
RESULTS
The mean ICP in the TH group was significantly lower than in the normothermia group. Complications during the 3 days after surgery were not different between the groups, with the exception of hypokalemia in the TH group. Mortality in the intensive care unit (ICU) was higher in the normothermia group, but the functional outcomes 3 months after surgery were not different between the TH and normothermia groups.
CONCLUSION
TH after decompressive craniectomy was effective for lowering ICP in patients with severe brain swelling. TH also reduced mortality in the ICU, but it had no benefit in functional outcomes.

Keyword

Decompressive craniectomy; Intracranial pressure; Hypothermia, induced

MeSH Terms

Brain Edema
Brain Injuries
Decompressive Craniectomy*
Glasgow Coma Scale
Humans
Hypokalemia
Hypothermia, Induced*
Intensive Care Units
Intracranial Pressure*
Mortality
Vital Signs

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