Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients*

@article{Crompton2017MetaAnalysisOT,
  title={Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients*},
  author={Ellie Crompton and Irina Lubomirova and Ioana Cotlarciuc and Thang Sieu Han and Sapna Sharma and Pankaj Sharma},
  journal={Critical Care Medicine},
  year={2017},
  volume={45},
  pages={575–583}
}
Objective: Therapeutic hypothermia has been used to attenuate the effects of traumatic brain injuries. However, the required degree of hypothermia, length of its use, and its timing are uncertain. We undertook a comprehensive meta-analysis to quantify benefits of hypothermia therapy for traumatic brain injuries in adults and children by analyzing mortality rates, neurologic outcomes, and adverse effects. Data Sources: Electronic databases PubMed, Google Scholar, Web of Science, Cochrane Central… 
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References

SHOWING 1-10 OF 92 REFERENCES
Hypothermia treatment for traumatic brain injury: a systematic review and meta-analysis.
TLDR
An updated meta-analysis of the effects of hypothermia therapy on mortality, favorable neurologic outcome, and associated adverse effects in adults with traumatic brain injury (TBI) for use by BTF/AANS task force supports previous findings that hypothermic therapy constitutes a beneficial treatment of TBI in specific circumstances.
Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review.
TLDR
Therapeutic hypothermia may reduce the risks of mortality and poor neurologic outcome in adults with TBI, but the evidence is not yet sufficient to recommend routine use of therapeutic Hypothermia for TBI outside of research settings.
Moderate hypothermia treatment in adult patients with severe traumatic brain injury: A meta-analysis
TLDR
MHT may be effective in reducing death and unfavourable clinical neurological outcomes, but this finding is not statistically significant, except for decreasing the mortality in Asian patients.
Is therapeutic hypothermia beneficial for pediatric patients with traumatic brain injury? A meta-analysis
TLDR
Hypothermia may slightly increase the risk of mortality in children with traumatic brain injury and the ratio of cardiac arrhythmia after this hypothermia therapy is slightly higher than that in normothermia groups.
Discrete cerebral hypothermia in the management of traumatic brain injury: a randomized controlled trial.
TLDR
The cooling cap was not effective in establishing a statistically significant cranial-bladder temperature gradient or in reaching the target intracranial temperature in the majority of patients.
Hypothermia for Traumatic Brain Injury in Children—A Phase II Randomized Controlled Trial*
TLDR
Early therapeutic hypothermia in children with severe traumatic brain injury does not improve outcome and should not be used outside a clinical trial.
Phase II Clinical Trial of Moderate Hypothermia after Severe Traumatic Brain Injury in Children
TLDR
Moderate hypothermia after severe TBI in children was found to be safe relative to standard management and NORM in children of all ages and in children with delay of initiation of treatment up to 24 hours, and functional outcome tended to improve from the 3- to 6-month cognitive assessment in HYPO compared with NORM.
Lack of effect of induction of hypothermia after acute brain injury.
TLDR
Treatment with hypothermia, with the body temperature reaching 33 degrees C within eight hours after injury, is not effective in improving outcomes in patients with severe brain injury.
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