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Intervention Review

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

  1. Manoj Saxena1,*,
  2. Peter JD Andrews2,
  3. Andrew Cheng3

Editorial Group: Cochrane Injuries Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 13 APR 2008

DOI: 10.1002/14651858.CD006811.pub2


How to Cite

Saxena M, Andrews PJD, Cheng A. Modest cooling therapies (35ºC to 37.5ºC) for traumatic brain injury. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006811. DOI: 10.1002/14651858.CD006811.pub2.

Author Information

  1. 1

    St George Hospital, Intensive Care, Sydney, NSW, Australia

  2. 2

    Lead Clinician, Critical Care Services, Western General Hospital, LUHD, Intensive Care & Pain Medicine, University of Edinburgh, Edinburgh, UK

  3. 3

    Sydney West Area Health Service, Anaesthesia, Sydney, NSW, Australia

*Manoj Saxena, Intensive Care, St George Hospital, Gray St, Kogarah, Sydney, NSW, 2217, Australia. m.saxena@unsw.edu.au.

Publication History

  1. Publication Status: New
  2. Published Online: 16 JUL 2008

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This is not the most recent version of the article. View current version (19 AUG 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

A recent retrospective study suggested that after traumatic brain injury, patients with a raised body temperature have an unfavourable outcome compared to patients that have a normal body temperature.

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

We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 3), MEDLINE (1950 to 2008), EMBASE (1980 to 2008), the National Research Register, Zetoc and the Current Controlled Trials MetaRegister of controlled trials. We also contacted investigators, pharmaceutical companies and the manufacturers of cooling equipment. The searches were conducted August to September 2007 and updated in April 2008.

Selection criteria

All completed randomised, controlled or placebo-controlled trials published or unpublished, where modest cooling therapies were applied in the first week after traumatic brain injury.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 searched for relevant trials.

Main results

We were unable to find any randomised, placebo-controlled trials of modest cooling therapies after traumatic brain injury.

Authors' conclusions

There is no evidence that interventions aimed at reducing body temperature to between 35 ºC and 37.5 ºC in the first week after TBI improves patient outcomes. Trials designed to explore the effect of these interventions on patient-centred outcomes are needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

There is no evidence to support the use of therapies that aim to reduce body temperature to between 35 ºC and 37.5 ºC in patients who have suffered a traumatic brain injury

Traumatic brain injury (an injury to the brain that occurs as a result of a direct impact, such as may occur after road traffic accidents and falls) is a major cause of death and long-term disability worldwide. There is some evidence from animal experiments that reducing body temperature after brain injury may improve the outcome. There is also some evidence in humans to suggest that people with a normal body temperature after traumatic brain injury may have a better outcome than those with a higher temperature. 

The authors of this Cochrane review looked for evidence that reducing body temperature to between 35 ºC and 37.5 ºC would benefit patients after traumatic brain injury. We looked for studies on the use of physical or chemical cooling therapy on patients with a traumatic brain injury. Physical cooling techniques include cooling blankets, use of ice, fans or other devices. Chemical cooling techniques include drugs used to reduce fever, like paracetamol (acetaminophen).

We did not find any randomised controlled trials or controlled clinical trials that we could include in this review. Such studies represent the best form of evidence to determine whether a particular therapy works, because they limit the errors that may be introduced into a study. Based on present evidence, we cannot recommend the use of interventions that reduce body temperature to between 35 ºC and 37.5 ºC after traumatic brain injury because there is no satisfactory research that shows this therapy to be effective and safe.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

中度降溫(35∼37.5度)對創傷後腦傷的影響

最近有篇回顧性的研究指出,創傷後的腦傷,高體溫和正常體溫相比,高體溫的預後較差。

目標

本研究在評估腦創傷後的第一週,使用中度降溫的療效(用任何方式使體溫維持在35∼37.5度,包括藥物,物理治療等)。

搜尋策略

搜尋Cochrane資料庫中,Injuries Group's Specialised Register及Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 3), MEDLINE (1950 to 2008), EMBASE (1980 to 2008),國家研究登記,Zetoc 和目前對照試驗整合登錄. 同時也連絡研發人員,藥商,和製造冷卻裝置的公司。檢索進行期間為2007年8∼9月,並在2008年4月更新。

選擇標準

蒐集所有已完成的隨機對照試驗或安慰劑對照試驗,探討創傷後腦損傷第一週使用中度降溫的療效,包括已發表的和尚未發表的研究。

資料收集與分析

兩位作者分別從相關的研究試驗中做搜尋。

主要結論

無法找到任何關於創傷造成腦傷後第一週使用中度降溫的隨機安慰劑對照試驗。

作者結論

目前沒有證據顯示,創傷後腦傷在第一週使用中度降溫能使預後更好。之後還需要更多的研究,用病人為中心的方式探討這種處置的預後及效果。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

創傷造成的腦傷(定義是因車禍或墜落,而造成直接的腦創傷),是全世界造成死亡和永久殘廢的重要原因。動物實驗指出,降低體溫能讓這類病人有較好的預後。在人體研究中,也有一些證據發現創傷後腦損傷病人其維持正常體溫和高體溫相比,正常體溫的預後較好。這篇Cochrane review的作者做了系統性的回顧,找尋中度降溫(維持體溫在35–37.5度)的實証醫學證據,探討是否能使預後更好。其中包括物理治療(低溫毯, 冰塊, 風扇等); 或化學降溫 (退燒藥,例如普拿疼)。我們沒有找到任何關於這篇回顧的隨機對照試驗或對照臨床試驗。這類的研究代表最佳形式的證據以確定特定療法是否具有作用,因為它們限制了可能在研究中的偏差。依照現有的證據,我們無法對腦創傷後的中度降溫,做任何實証醫學上的建議,因為目前沒有足夠的統計學資料,證明這樣的治療是安全且有效的。