Acute Crit Care.  2022 Nov;37(4):483-490. 10.4266/acc.2022.01291.

Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention

• Jo KW

• KMID: 2540136
• DOI: http://doi.org/10.4266/acc.2022.01291

Abstract

Traumatic brain injury (TBI) is a critical cause of disability and death worldwide. Many studies have been conducted aimed at achieving favorable neurologic outcomes by reducing secondary brain injury in TBI patients. However, ground-breaking outcomes are still insufficient so far. Because mild-to-moderate hypothermia (32°C–35°C) has been confirmed to help neurological recovery for recovered patients after circulatory arrest, it has been recognized as a major neuroprotective treatment plan for TBI patients. Thereafter, many clinical studies about the effect of therapeutic hypothermia (TH) on severe TBI have been conducted. However, efficacy and safety have not been demonstrated in many large-scale randomized controlled studies. Rather, some studies have demonstrated an increase in mortality rate due to complications such as pneumonia, so it is not highly recommended for severe TBI patients. Recently, some studies have shown results suggesting TH may help reperfusion/ischemic injury prevention after surgery in the case of mass lesions, such as acute subdural hematoma, and it has also been shown to be effective in intracranial pressure control. In conclusion, TH is still at the center of neuroprotective therapeutic studies regarding TBI. If proper measures can be taken to mitigate the many adverse events that may occur during the course of treatment, more positive efficacy can be confirmed. In this review, we look into adverse events that may occur during the process of the induction, maintenance, and rewarming of targeted temperature management and consider ways to prevent and address them.

Keyword

intracranial pressure; ischemia; reperfusion; targeted temperature management; therapeutic hypothermia; traumatic brain injury

Figure

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  Figure 1. Shivering management [19,27]. Continuous electroencephalogram monitoring may be considered for early detection of nonconvulsive status epilepticus for Stages 2 and 3.

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  Figure 2. Different management plans according to alpha-stat and pH-stat. ICP: intracranial pressure.

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