Initial experiences of intentional normothermia maintained by an intravascular cooling system for severe traumatic brain injury

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  • Nakao Junzo
    Department of Neurosurgery, Tsukuba Medical Center Hospital Department of Neurosurgery, Faculty of medicine, University of Tsukuba
  • Nakai Yasunobu
    Department of Neurosurgery, Tsukuba Medical Center Hospital
  • Ikeda Go
    Department of Neurosurgery, Tsukuba Medical Center Hospital
  • Nishihira Takahito
    Department of Neurosurgery, Tsukuba Medical Center Hospital
  • Onuma Kuniyuki
    Department of Neurosurgery, Tsukuba Medical Center Hospital
  • Takada Maya
    Department of Neurosurgery, Tsukuba Medical Center Hospital
  • Ishikawa Eiichi
    Department of Neurosurgery, Faculty of medicine, University of Tsukuba
  • Uemura Kazuya
    Department of Neurosurgery, Tsukuba Medical Center Hospital
  • Matsumura Akira
    Department of Neurosurgery, Faculty of medicine, University of Tsukuba

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Other Title
  • 血管内冷却システムを使用した重症頭部外傷に対する積極的平温療法の初期経験
  • ケッカン ナイ レイキャク システム オ シヨウ シタ ジュウショウ トウブ ガイショウ ニ タイスル セッキョクテキ ヘイオン リョウホウ ノ ショキ ケイケン

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Abstract

<p>  Acute hyperthermia after severe traumatic brain injury (sTBI) can lead to secondary brain damage and a significantly poor outcome for patients. We report the efficacy and problems of a novel intravascular cooling system, the Thermogard XP/ COOL LINE® catheter, for temperature control in cases of acute hyperthermia after sTBI. The participants were 7 patients who underwent intentional normothermia therapy for acute hyperthermia after sTBI at our hospital from June 2016 to December 2016. All patients underwent decompressive craniectomy within 24 hours of the sTBI. All cases exhibited fever with temperatures above 38℃ within 72 hours of the injury. Five cases were controlled by a Thermogard XP/ COOL LINE® catheter (CL group) and 2 cases were controlled by a surface cooling water cooling blanket (BL group). The time taken to reach the target temperature in the CL group was significantly faster than that in the BL group (151.2±48.6 [37‒211] vs. 765.0±75.0 [690‒840] minutes: P＜0.05). Furthermore, temperatures in the CL group were stable during normothermia therapy. The Glasgow Outcome Scale (GOS) showed no significant difference between the CL and BL groups (2.8±0.7 vs. 3.5±0.5). It should be noted that the Thermogard XP/ COOL LINE® catheter involves a risk of deep vein thrombosis and catheter‒related infection. Nevertheless, our study suggests that the new intravascular cooling system is a useful device to rapidly control and stabilize body temperature. Further study is required to confirm the efficacy of this intravascular cooling system in controlling acute hyperthermia after sTBI.</p>

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