Background: Severe traumatic brain injury (sTBI) is a leading cause of death and neurologic disability worldwide. Although numerous previous studies have reported a positive effect of mild hypothermia treatment on sTBI, recent randomised controlled trials have not shown consistent benefits.
Objective: The objective of this study was to explore the effects of mild hypothermia on prognosis in patients with sTBI and provide the best evidence to clinical practice.
Methods: The databases PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and China National Knowledge Infrastructure (CNKI) were systematically searched from their inception to December 31, 2018, to identify relevant randomised controlled trials. Two authors independently reviewed and extracted data from included studies. The outcomes of interest were mortality and favourable neurological outcome. Review Manager, version 5.3, and trial sequential analysis (TSA) (beta = 0.9) were used to evaluate the collected data.
Results: A total of 15 trials involving 2523 patients with sTBI were included. The pooled results showed that there was no significant statistical difference of mortality between two groups (risk ratio [RR] = 0.94, 95% confidence interval [CI] = 0.77-1.14, P = 0.53), and TSA indicated that the current available evidence was conclusive. However, patients receiving mild hypothermia therapy had better neurological outcome than those receiving normothermia therapy (RR = 1.20, 95% CI = 1.01-1.42, P = 0.04), and TSA indicated that more studies should be conducted to clarify this issue.
Conclusion: Our findings suggest that mild hypothermia can improve long-term neurological recovery for patients with sTBI, but which is not helpful to decrease the mortality. More well-designed rigorous clinical trials are needed to verify these results.
Keywords: Hypothermia; Meta-analysis; Prognosis; Traumatic brain injury.
Copyright © 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.