Multimodal monitoring combined with hypothermia for the management of severe traumatic brain injury: A case report

Chen,Jun‑Hui; Xu,Yi‑Nong; Ji,Meng; Li,Pei‑Pei; Yang,Li‑Kun; Wang,Yu‑Hai

doi:10.3892/etm.2018.5994

Multimodal monitoring combined with hypothermia for the management of severe traumatic brain injury: A case report

Authors:
- Jun‑Hui Chen
- Yi‑Nong Xu
- Meng Ji
- Pei‑Pei Li
- Li‑Kun Yang
- Yu‑Hai Wang
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Affiliations: Department of Neurosurgery, 101st Hospital of The People's Liberation Army, Wuxi, Jiangsu 214044, P.R. China, Department of Neurosurgery, Taizhou No. 4 Hospital, Taizhou, Jiangsu 225300, P.R. China
Published online on: March 22, 2018 https://doi.org/10.3892/etm.2018.5994
Pages: 4253-4258
Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Traumatic brain injury (TBI) is a prominent public health issue that has a significant negative impact on patients and their family members. It is the leading cause of mortality and disability among young (below 50 years old) individuals. Intracranial hypertension (ICH) remains the single most difficult therapeutic challenge for the management of severe TBI. Therapeutic hypothermia may reduce intracranial hypertension and improve patient outcomes; however, the use of hypothermia is controversial. It has been reported that therapeutic hypothermia elicits no therapeutic benefit for patients with TBI. The present study presents two patients with severe(s) TBI who were admitted to 101st Hospital of the People's Liberation Army Between June 2017 to October 2017. Multimodal brain monitoring measurements of intracranial pressure, cerebral perfusion pressure (CPP) and bispectral index (BIS) were used during assisted hypothermia for management of patients with sTBI. The duration, degree of hypothermia treatment and speed of re‑warming were assessed.

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1	Roozenbeek B, Maas AI and Menon DK: Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 9:231–236. 2013. View Article : Google Scholar : PubMed/NCBI
2	Corrigan JD, Selassie AW and Orman JA: The epidemiology of traumatic brain injury. J Head Trauma Rehabil. 25:72–80. 2010. View Article : Google Scholar : PubMed/NCBI
3	Selassie AW, Zaloshnja E, Langlois JA, Miller T, Jones P and Steiner C: Incidence of long-term disability following traumatic brain injury hospitalization, United States, 2003. J Head Trauma Rehabil. 23:123–131. 2008. View Article : Google Scholar : PubMed/NCBI
4	Abbasi HR, Mousavi SM, Akerdi Taheri A, Niakan MH, Bolandparvaz S and Paydar S: Pattern of traumatic injuries and injury severity score in a major trauma center in Shiraz, Southern Iran. Bull Emerg Trauma. 1:81–85. 2013.PubMed/NCBI
5	Centers for Disease Control and Prevention: Rates of TBI-related emergency department visits, hospitalizations and deaths-United States, 2001–2010. http://www.cdc.gov/traumaticbraininjury/data/rates.htmlAugust 10–2015
6	Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ and Kirkpatrick PJ: Specialist neurocritical care and outcome from head injury. Intensive Care Med. 28:547–553. 2002. View Article : Google Scholar : PubMed/NCBI
7	Juul N, Morris GF, Marshall SB and Marshall LF: Intracranial hypertension and cerebral perfusion pressure: Influence on neurological deterioration and outcome in severe head injury. The executive committee of the international selfotel trial. J Neurosurg. 92:1–6. 2000. View Article : Google Scholar : PubMed/NCBI
8	Sadaka F and Veremakis C: Therapeutic hypothermia for the management of intracranial hypertension in severe traumatic brain injury: A systematic review. Brain Inj. 26:899–908. 2012. View Article : Google Scholar : PubMed/NCBI
9	Fay T: Observations on prolonged human refrigeration. NY State J Med. 40:1351–1354. 1940.
10	Clifton GL, Miller ER, Choi SC, Levin HS, McCauley S, Smith KR Jr, Muizelaar JP, Wagner FC Jr, Marion DW, Luerssen TG, 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
11	Zhi D, Zhang S and Lin X: Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury. Surg Neurol. 59:381–385. 2003. View Article : Google Scholar : PubMed/NCBI
12	Qiu W, Zhang Y, Sheng H, Zhang J, Wang W, Liu W, Chen K, Zhou J and Xu Z: Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy. J Crit Care. 22:229–235. 2007. View Article : Google Scholar : PubMed/NCBI
13	Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, et al: Targeted temperature management at 33°C vs. 36°C after cardiac arrest. N Engl J Med. 369:2197–2206. 2013. View Article : Google Scholar : PubMed/NCBI
14	Hutchison JS, Ward RE, Lacroix J, Hébert PC, Barnes MA, Bohn DJ, Dirks PB, Doucette S, Fergusson D, Gottesman R, et al: Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 358:2447–2456. 2008. View Article : Google Scholar : PubMed/NCBI
15	Clifton GL, Valadka A, Zygun D, Coffey CS, Drever P, Fourwinds S, Janis LS, Wilde E, Taylor P, Harshman K, et al: Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): A randomised trial. Lancet Neurol. 10:131–139. 2011. View Article : Google Scholar : PubMed/NCBI
16	Le Roux P, Menon DK, Citerio G, Vespa P, Bader MK, Brophy G, Diringer MN, Stocchetti N, Videtta W, Armonda R, et al: The international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: Evidentiary tables: A statement for healthcare professionals from the neurocritical care society and the european society of intensive care medicine. Neurocrit Care. 21 Suppl 2:S2822014. View Article : Google Scholar : PubMed/NCBI
17	Young AM, Donnelly J, Czosnyka M, Jalloh I, Liu X, Aries MJ, Fernandes HM, Garnett MR, Smielewski P, Hutchinson PJ and Agrawal S: Continuous multimodality monitoring in children after traumatic brain injury-preliminary experience. PLoS One. 11:e01488172016. View Article : Google Scholar : PubMed/NCBI
18	Irimia A, Goh SY, Torgerson CM, Stein NR, Chambers MC, Vespa PM and Van Horn JD: Electroencephalographic inverse localization of brain activity in acute traumatic brain injury as a guide to surgery, monitoring and treatment. Clin Neurol Neurosurg. 115:2159–2165. 2013. View Article : Google Scholar : PubMed/NCBI
19	Prins SA, de Hoog M, Blok JH, Tibboel D and Visser GH: Continuous noninvasive monitoring of barbiturate coma in critically ill children using the Bispectral index monitor. Crit Care. 11:R1082007. View Article : Google Scholar : PubMed/NCBI
20	Steinbaugh LA, Lindsell CJ, Shutter LA and Szaflarski JP: Initial EEG predicts outcomes in a trial of levetiracetam vs. fosphenytoin for seizure prevention. Epilepsy Behav. 23:280–284. 2012. View Article : Google Scholar : PubMed/NCBI
21	Steiner T, Ringleb P and Hacke W: Treatment options for large hemispheric stroke. Neurology. 57 5 Suppl 2:S61–S68. 2001. View Article : Google Scholar : PubMed/NCBI
22	Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, et al: Guidelines for the management of severe traumatic brain injury, 4th Edition. Neurosurgery. 80:6–15. 2017.PubMed/NCBI
23	Schreckinger M and Marion DW: Marion. Contemporary management of traumatic intracranial hypertension: Is there a role for therapeutic hypothermia? Neurocrit Care. 11:427–436. 2009. View Article : Google Scholar : PubMed/NCBI
24	Corry JJ: The use of targeted temperature management for elevated intracranial pressure. Curr Neurol Neurosci Rep. 14:4532014. View Article : Google Scholar : PubMed/NCBI
25	Raj R, Bendel S, Reinikainen M, Kivisaari R, Siironen J, Lång M and Skrifvars M: Hyperoxemia and long-term outcome after traumatic brain injury. Crit Care. 17:R1772013. View Article : Google Scholar : PubMed/NCBI
26	Kilgannon JH, Jones AE, Shapiro NI, Angelos MG, Milcarek B, Hunter K, Parrillo JE and Trzeciak S: Emergency Medicine Shock Research Network (EMShockNet) Investigators: Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 303:2165–2171. 2010. View Article : Google Scholar : PubMed/NCBI
27	Lafrance WC Jr, Deluca M, Machan JT and Fava JL: Traumatic brain injury and psychogenic nonepileptic seizures yield worse outcomes. Epilepsia. 54:718–725. 2013. View Article : Google Scholar : PubMed/NCBI
28	Vespa PM, McArthur DL, Xu Y, Eliseo M, Etchepare M, Dinov I, Alger J, Glenn TP and Hovda D: Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology. 75:792–798. 2010. View Article : Google Scholar : PubMed/NCBI
29	Cottenceau V, Petit L, Masson F, Guehl D, Asselineau J, Cochard JF, Pinaquy C, Leger A and Sztark F: The use of bispectral index to monitor barbiturate coma in severely brain-injured patients with refractory intracranial hypertension. Anesth Analg. 107:1676–1682. 2008. View Article : Google Scholar : PubMed/NCBI
30	Bader MK, Arbour R and Palmer S: Refractory increased intracranial pressure in severe traumatic brain injury, barbiturate coma and bispectral index monitoring. AACN Clin Issue. 16:526–541. 2005. View Article : Google Scholar
31	Amyot F, Arciniegas DB, Brazaitis MP, Curley KC, Diaz-Arrastia R, Gandjbakhche A, Herscovitch P, Hinds SR II, Manley GT, Pacifico A, et al: A Review of the effectiveness of neuroimaging modalities for the detection of traumatic brain injury. J Neurotrauma. 32:1693–1721. 2015. View Article : Google Scholar : PubMed/NCBI
32	Tan H, Feng H, Gao L, Huang G and Liao X: Outcome prediction in severe traumatic brain injury with transcranial Doppler ultrasonography. Chin J Traumatol. 4:156–160. 2001.PubMed/NCBI
33	Zweifel C, Czosnyka M, Carrera E, de Riva N, Pickard JD and Smielewski P: Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients. Neurosurgery. 71:853–861. 2012. View Article : Google Scholar : PubMed/NCBI
34	Mayans DR, Meads DB and Reynolds PS: Transcranial doppler identifies a malfunctioning extraventricular drain. J Neuroimaging. 24:518–519. 2013. View Article : Google Scholar : PubMed/NCBI
35	Daboussi A, Minville V, Leclerc-Foucras S, Geeraerts T, Esquerre JP, Payoux P and Fourcade O: Cerebral hemodynamic changes in severe head injury patients undergoing decompressive craniectomy. J Neurosurg Anesthesiol. 21:339–345. 2009. View Article : Google Scholar : PubMed/NCBI
36	Moppett IK and Mahajan RP: Transcranial Doppler ultrasonography in anaesthesia and intensive care. Br J Anaesth. 93:710–724. 2004. View Article : Google Scholar : PubMed/NCBI