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Therapeutic Whole-Body Hypothermia Reduces Death in Severe Traumatic Brain Injury if the Cooling Index Is Sufficiently High: Meta-Analyses of the Effect of Single Cooling Parameters and Their Integrated Measure.
Olah, Emoke; Poto, Laszlo; Hegyi, Peter; Szabo, Imre; Hartmann, Petra; Solymar, Margit; Petervari, Erika; Balasko, Marta; Habon, Tamas; Rumbus, Zoltan; Tenk, Judit; Rostas, Ildiko; Weinberg, Jordan; Romanovsky, Andrej A; Garami, Andras.
Afiliación
  • Olah E; 1 Institute for Translational Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Poto L; 2 Institute of Bioanalysis, Medical School, University of Pecs , Pecs, Hungary .
  • Hegyi P; 1 Institute for Translational Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Szabo I; 3 Division of Gastroenterology, First Department of Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Hartmann P; 4 Momentum Gastroenterology Multidisciplinary Research Group, Hungarian Academy of Sciences - University of Szeged , Szeged, Hungary .
  • Solymar M; 3 Division of Gastroenterology, First Department of Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Petervari E; 5 Institute of Surgical Research, University of Szeged , Szeged, Hungary .
  • Balasko M; 1 Institute for Translational Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Habon T; 1 Institute for Translational Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Rumbus Z; 1 Institute for Translational Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Tenk J; 6 Department of Cardiology and Angiology, First Department of Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Rostas I; 1 Institute for Translational Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Weinberg J; 1 Institute for Translational Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Romanovsky AA; 1 Institute for Translational Medicine, Medical School, University of Pecs , Pecs, Hungary .
  • Garami A; 7 Trauma Research, St. Joseph's Hospital and Medical Center , Phoenix, Arizona.
J Neurotrauma ; 35(20): 2407-2417, 2018 10 15.
Article en En | MEDLINE | ID: mdl-29681213
Therapeutic hypothermia was investigated repeatedly as a tool to improve the outcome of severe traumatic brain injury (TBI), but previous clinical trials and meta-analyses found contradictory results. We aimed to determine the effectiveness of therapeutic whole-body hypothermia on the deaths of adult patients with severe TBI by using a novel approach of meta-analysis. We searched the PubMed, EMBASE, and Cochrane Library databases from inception to February 2017. The identified human studies were evaluated regarding statistical, clinical, and methodological designs to ensure interstudy homogeneity. We extracted data on TBI severity, body temperature, death, and cooling parameters; then we calculated the cooling index, an integrated measure of therapeutic hypothermia. Forest plot of all identified studies showed no difference in the outcome of TBI between cooled and not cooled patients, but interstudy heterogeneity was high. On the contrary, by meta-analysis of randomized clinical trials that were homogenous with regard to statistical, clinical designs, and precisely reported the cooling protocol, we showed decreased odds ratio for death in therapeutic hypothermia compared with no cooling. As independent factors, milder and longer cooling, and rewarming at <0.25°C/h were associated with better outcome. Therapeutic hypothermia was beneficial only if the cooling index (measure of combination of cooling parameters) was sufficiently high. We conclude that high methodological and statistical interstudy heterogeneity could underlie the contradictory results obtained in previous studies. By analyzing methodologically homogenous studies, we show that cooling improves the outcome of severe TBI, and this beneficial effect depends on certain cooling parameters and on their integrated measure, the cooling index.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Lesiones Traumáticas del Encéfalo / Hipotermia Inducida Tipo de estudio: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: J Neurotrauma Asunto de la revista: NEUROLOGIA / TRAUMATOLOGIA Año: 2018 Tipo del documento: Article País de afiliación: Hungria Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Lesiones Traumáticas del Encéfalo / Hipotermia Inducida Tipo de estudio: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: J Neurotrauma Asunto de la revista: NEUROLOGIA / TRAUMATOLOGIA Año: 2018 Tipo del documento: Article País de afiliación: Hungria Pais de publicación: Estados Unidos