‘Cool and quiet’ therapy for malignant hyperthermia following severe traumatic brain injury: A preliminary clinical approach

Liu,Yu-He; Shang,Zhen-De; Chen,Chao; Lu,Nan; Liu,Qi-Feng; Liu,Ming; Yan,Jing

doi:10.3892/etm.2014.2130

‘Cool and quiet’ therapy for malignant hyperthermia following severe traumatic brain injury: A preliminary clinical approach

Authors:
- Yu-He Liu
- Zhen-De Shang
- Chao Chen
- Nan Lu
- Qi-Feng Liu
- Ming Liu
- Jing Yan
View Affiliations

Affiliations: Department of Neurosurgery, The 88th Hospital of PLA, Taian, Shandong 271000, P.R. China
Published online on: December 15, 2014 https://doi.org/10.3892/etm.2014.2130
Pages: 464-468

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Malignant hyperthermia increases mortality and disability in patients with brain trauma. A clinical treatment for malignant hyperthermia following severe traumatic brain injury, termed ‘cool and quiet’ therapy by the authors of the current study, was investigated. Between June 2003 and June 2013, 110 consecutive patients with malignant hyperthermia following severe traumatic brain injury were treated using mild hypothermia (35‑36˚C) associated with small doses of sedative and muscle relaxant. Physiological parameters and intracranial pressure were monitored, and the patients slowly rewarmed following the maintenance of mild hypothermia for 3-12 days. Consecutive patients who had undergone normothermia therapy were retrospectively analyzed as the control. In the mild hypothermia group, the recovery rate was 54.5%, the mortality rate was 22.7%, and the severe and mild disability rates were 11.8 and 10.9%, respectively. The mortality rate of the patients, particularly that of patients with a Glasgow Coma Scale (GCS) score of between 3 and 5 differed significantly between the hypothermia group and the normothermia group (P<0.05). The mortality of patients with a GCS score of between 6 and 8 was not significantly different between the two groups (P> 0.05). The therapy using mild hypothermia with a combination of sedative and muscle relaxant was beneficial in decreasing the mortality of patients with malignant hyperthermia following severe traumatic brain injury, particularly in patients with a GCS score within the range 3‑5 on admission. The therapy was found to be safe, effective and convenient. However, rigorous clinical trials are required to provide evidence of the effectiveness of ‘cool and quiet’ therapy for hyperthermia.

View Figures

View References

1	Li J and Jiang JY: Chinese Head Trauma Data Bank: effect of hyperthermia on the outcome of acute head trauma patients. J Neurotrauma. 29:96–100. 2012. View Article : Google Scholar :
2	Ginsberg MD and Busto R: Combating hyperthermia in acute stroke: a significant clinical concern. Stroke. 29:529–534. 1998. View Article : Google Scholar : PubMed/NCBI
3	Wang CX, Stroink A, Casto JM and Kattner K: Hyperthermia exacerbates ischaemic brain injury. Int J Stroke. 4:274–284. 2009. View Article : Google Scholar : PubMed/NCBI
4	Cairns CJ and Andrews PJ: Management of hyperthermia in traumatic brain injury. Curr Opin Crit Care. 8:106–110. 2002. View Article : Google Scholar : PubMed/NCBI
5	Childs C, Wieloch T, Lecky F, Machin G, Harris B and Stocchetti N: Report of a consensus meeting on human brain temperature after severe traumatic brain injury: its measurement and management during pyrexia. Front Neurol. 1:1462010. View Article : Google Scholar
6	Jiang JY, Gao GY, Li WP, et al: Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma. 19:869–874. 2002. View Article : Google Scholar : PubMed/NCBI
7	Natale JE, Joseph JG, Helfaer MA and Shaffner DH: Early hyperthermia after traumatic brain injury in children: risk factors, influence on length of stay, and effect on short-term neurologic status. Crit Care Med. 28:2608–2615. 2000. View Article : Google Scholar : PubMed/NCBI
8	Tokutomi T, Morimoto K, Miyagi T, et al: Optimal temperature for the management of severe traumatic brain injury: effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. Neurosurgery. 52:102–112. 2003.
9	Stiefel MF, Spiotta A, Gracias VH, et al: Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg. 103:805–811. 2005. View Article : Google Scholar : PubMed/NCBI
10	Dietrich WD and Bramlett HM: The evidence for hypothermia as a neuroprotectant in traumatic brain injury. Neurotherapeutics. 7:43–50. 2010. View Article : Google Scholar : PubMed/NCBI
11	Yokobori S, Frantzen J, Bullock R, Gajavelli S, Burks S, Bramlett H and Dietrich WD: The use of hypothermia therapy in traumatic ischemic/reperfusional brain injury: review of the literatures. Ther Hypothermia Temp Manag. 1:185–192. 2011. View Article : Google Scholar : PubMed/NCBI
12	Globus MY, Alonso O, Dietrich WD, Busto R and Ginsberg MD: Glutamate release and free radical production following brain injury: effects of posttraumatic hypothermia. J Neurochem. 65:1704–1711. 1995. View Article : Google Scholar : PubMed/NCBI
13	Maeda T, Katayama Y, Kawamata T and Yamamoto T: Mechanisms of excitatory amino acid release in contused brain tissue: effects of hypothermia and in situ administration of Co²⁺ on extracellular levels of glutamate. J Neurotrauma. 15:655–664. 1998. View Article : Google Scholar : PubMed/NCBI
14	Mori K, Maeda M, Miyazaki M and Iwase H: Effects of mild (33 degrees C) and moderate (29 degrees C) hypothermia on cerebral blood flow and metabolism, lactate, and extracellular glutamate in experimental head injury. Neurol Res. 20:719–726. 1998.PubMed/NCBI
15	Mitani A, Kadoya F and Kataoka K: Temperature dependence of hypoxia-induced calcium accumulation in gerbil hippocampal slices. Brain Res. 562:159–163. 1991. View Article : Google Scholar : PubMed/NCBI
16	Chatzipanteli K, Wada K, Busto R and Dietrich WD: Effects of moderate hypothermia on constitutive and inducible nitric oxide synthase activities after traumatic brain injury in the rat. J Neurochem. 72:2047–2052. 1999. View Article : Google Scholar : PubMed/NCBI
17	Sakamoto KI, Fujisawa H, Koizumi H, Tsuchida E, Ito H, Sadamitsu D and Maekawa T: Effects of mild hypothermia on nitric oxide synthesis following contusion trauma in the rat. J Neurotrauma. 14:349–353. 1997. View Article : Google Scholar : PubMed/NCBI
18	Choi HA, Badjatia N and Mayer SA: Hypothermia for acute brain injury - mechanisms and practical aspects. Nat Rev Neurol. 8:214–222. 2012.PubMed/NCBI
19	Clifton GL, Miller ER, Choi SC, et al: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med. 344:556–563. 2001. View Article : Google Scholar : PubMed/NCBI
20	Clifton MG, Valadka PA, Aisuku IP and Okonkwo DO: Future of rewarming in therapeutic hypothermia for traumatic brain injury: a personalized plan. Ther Hypothermia Temp Manag. 1:3–7. 2011. View Article : Google Scholar : PubMed/NCBI
21	Tokutomi T, Morimoto K, Miyagi T, Yamaguchi S, Ishikawa K and Shigemori M: Optimal temperature for the management of severe traumatic brain injury: effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. Neurosurgery. 52:102–112. 2003.
22	Soukup J, Zauner A, Doppenberg EM, Menzel M, Gilman C, Young HF and Bullock R: The importance of brain temperature in patients after severe head injury: relationship to intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and outcome. J Neurotrauma. 19:559–571. 2002. View Article : Google Scholar : PubMed/NCBI
23	Dearden NM, Gibson JS, McDowall DG, Gibson RM and Cameron MM: Effect of high-dose dexamethasone on outcome from severe head injury. J Neurosurg. 64:81–88. 1986. View Article : Google Scholar : PubMed/NCBI
24	Cooper PR, Moody S, Clark WK, Kirkpatrick J, Maravilla K, Gould AL and Drane W: Dexamethasone and severe head injury. A prospective double-blind study. J Neurosurg. 51:307–316. 1979. View Article : Google Scholar : PubMed/NCBI
25	Piek J, Chesnut RM, Marshall LF, et al: Extracranial complications of severe head injury. J Neurosurg. 77:901–907. 1992. View Article : Google Scholar : PubMed/NCBI
26	Halloran LG, Zfass AM, Gayle WE, Wheeler CB and Miller JD: Prevention of acute gastrointestinal complications after severe head injury: a controlled trial of cimetidine prophylaxis. Am J Surg. 139:44–48. 1980. View Article : Google Scholar : PubMed/NCBI
27	Jeremitsky E, Omert LA, Dunham CM, Wilberger J and Rodriguez A: The impact of hyperglycemia on patients with severe brain injury. J Trauma. 58:47–50. 2005. View Article : Google Scholar : PubMed/NCBI
28	Clifton GL, Robertson CS, Grossman RG, Hodge S, Foltz R and Garza C: The metabolic response to severe head injury. J Neurosurg. 60:687–696. 1984. View Article : Google Scholar : PubMed/NCBI
29	Mayumi H, Zhang QW, Nakashima A, Masuda M, Kohno H, Kawachi Y and Yasui H: Synergistic immunosuppression caused by high-dose methylprednisolone and cardiopulmonary bypass. Ann Thorac Surg. 63:129–137. 1997. View Article : Google Scholar : PubMed/NCBI
30	Groysman LI, Emanuel BA, Kim-Tenser MA, Sung GY and Mack WJ: Therapeutic hypothermia in acute ischemic stroke. Neurosurg Focus. 30:E172011. View Article : Google Scholar : PubMed/NCBI
31	Geffroy A, Bronchard R, Merckx P, Seince PF, Faillot T, Albaladejo P and Marty J: Severe traumatic head injury in adults: which patients are at risk of early hyperthermia? Intensive Care Med. 30:785–790. 2004. View Article : Google Scholar : PubMed/NCBI