alexa Considering the use of induced hypothermia in a pediatric patient with traumatic brain injury: a critical appraisal of two meta-analyses.
Anesthesiology

Anesthesiology

Journal of Anesthesia & Clinical Research

Author(s): Shafi NI, Mariscalco MM

Abstract Share this page

Abstract OBJECTIVE: To review whether induced hypothermia after traumatic brain injury affects morbidity and mortality based on the results of two meta-analyses. DESIGN: Critical appraisals of McIntyre et al: Prolonged therapeutic hypothermia after traumatic brain injury in adults: A systematic review. JAMA 2003; 289:2992-2999, and Henderson et al: Hypothermia in the management of traumatic brain injury: A systematic review and meta-analysis. Intensive Care Med 2003; 29:1637-1644. FINDINGS: Both meta-analyses included trials of adult patients with severe traumatic brain injury randomized to induced hypothermia or normothermia and evaluated risk of death and poor neurologic outcomes. McIntyre et al. found the overall relative risk of mortality with induced hypothermia to be 0.81 (95\% confidence interval 0.69-0.96). By designing a priori analyses, these authors also found that the relative risk of death was reduced in patients cooled for >48 hrs, and the risk of poor neurologic outcome was reduced with all durations of cooling, cooling to 32-33 degrees C, and rewarming in <24 hrs. In contrast, Henderson et al. found that induced hypothermia did not change the odds of death after traumatic brain injury (odds ratio 0.81; 95\% confidence interval 0.59-1.13) and that normothermic controls had an odds ratio of 0.42 (95\% confidence interval 0.25-0.70) for developing intercurrent pneumonia. Both analyses found trials to be heterogeneous with respect to neurologic outcome. CONCLUSIONS: The discrepancies in the results of these contemporaneous meta-analyses may stem, in part, from differences in their trial selection strategies as well as from sources of trial heterogeneity. Nevertheless, McIntyre et al. uncovered the equivalent of a dose-dependent reduction in the risk of death with induced hypothermia, supporting further study of this neuroprotective strategy. Although these meta-analyses included trials containing adult patients, a phase II trial of induced hypothermia in pediatric traumatic brain injury has established its feasibility and safety in infants and children. As in adult patients, induced hypothermia for traumatic brain injury in children can be considered an optional therapy for refractory intracranial hypertension but should not be regarded as standard of care. This article was published in Pediatr Crit Care Med and referenced in Journal of Anesthesia & Clinical Research

Relevant Expert PPTs

Relevant Speaker PPTs

Recommended Conferences

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

agrifoodaquavet@omicsonline.com

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

clinical_biochem@omicsonline.com

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

business@omicsonline.com

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

chemicaleng_chemistry@omicsonline.com

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

environmentalsci@omicsonline.com

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

engineering@omicsonline.com

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

generalsci_healthcare@omicsonline.com

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

genetics_molbio@omicsonline.com

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

immuno_microbio@omicsonline.com

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

omics@omicsonline.com

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

materialsci@omicsonline.com

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

mathematics_physics@omicsonline.com

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

medical@omicsonline.com

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

neuro_psychology@omicsonline.com

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

pharma@omicsonline.com

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

social_politicalsci@omicsonline.com

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version