Temperature difference between jugular bulb and pulmonary artery is associated with neurological outcome in patients with severe traumatic brain injury: A post hoc analysis of a brain hypothermia study

Motoki Fujita; Yasutaka Oda; Kotaro Kaneda; Tadashi Kaneko; Eiichi Suehiro; Kenji Dohi; Yasuhiro Kuroda; Hitoshi Kobata; Ryosuke Tsuruta; Tsuyoshi Maekawa

doi:10.1371/journal.pone.0285525

Temperature difference between jugular bulb and pulmonary artery is associated with neurological outcome in patients with severe traumatic brain injury: A post hoc analysis of a brain hypothermia study

PLoS One. 2023 May 8;18(5):e0285525. doi: 10.1371/journal.pone.0285525. eCollection 2023.

Authors

Motoki Fujita¹, Yasutaka Oda¹, Kotaro Kaneda², Tadashi Kaneko³, Eiichi Suehiro⁴, Kenji Dohi⁵, Yasuhiro Kuroda⁶, Hitoshi Kobata⁷, Ryosuke Tsuruta^{1

2}, Tsuyoshi Maekawa⁸

Affiliations

¹ Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan.
² Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan.
³ Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan.
⁴ Department of Neurosurgery, International University of Health and Welfare School of Medicine, Narita, Japan.
⁵ Department of Emergency and Critical Care Medicine, Showa University Hospital, Tokyo, Japan.
⁶ Department of Emergency, Disaster, and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan.
⁷ Department of Emergency and Critical Care Medicine/Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
⁸ Katakura Hospital, Ube, Japan.

Abstract

Background: The purpose of this study was to examine whether the temperature difference between the jugular bulb and pulmonary artery (ΔTjb-pa) is associated with the neurological outcome of patients with severe traumatic brain injury (TBI).

Methods: We conducted a post hoc analysis of a multicenter randomized controlled trial of mild therapeutic hypothermia (TH, 32.0-34.0°C) or fever control (FC, 35.5-37.0°C) for the patients with severe TBI. ΔTjb-pa averaged every 12 h and the variation in ΔTjb-pa were compared between patients with favorable (n = 39) and unfavorable (n = 37) neurological outcomes. These values were also compared in the TH and FC subgroups.

Results: The average ΔTjb-pa values in patients with favorable and unfavorable outcomes were 0.24 ± 0.23 and 0.06 ± 0.36°C, respectively (P < 0.001). ΔTjb-pa trended significantly higher in the favorable outcome patients than in the unfavorable outcome patients throughout the 120 h after onset of severe TBI (P < 0.001). The variation in ΔTjb-pa from 0 to 72 h was significantly lower in the favorable outcome patients than in the unfavorable outcome patients (0.8 ± 0.8 vs 1.8 ± 2.5°C, respectively, P = 0.013). From 72 to 120 h, there was no significant difference in the variation in ΔTjb-pa. Significant differences between patients with favorable and unfavorable outcomes in ΔTjb-pa and the variation in ΔTjb-pa were similar in the TH subgroup, but not evident in the FC subgroup.

Conclusions: A reduction in ΔTjb-pa and greater variation in ΔTjb-pa were associated with an unfavorable outcome in patients with severe TBI, especially those treated with TH. When treating severe TBI patients, it is important to understand that there will be differences in temperature reflecting the brain environment and the systemic temperature, depending on the severity and outcome of TBI during TH.

Copyright: © 2023 Fujita et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Randomized Controlled Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Brain
Brain Injuries, Traumatic* / therapy
Humans
Hypothermia* / etiology
Hypothermia, Induced* / adverse effects
Pulmonary Artery
Temperature

Grants and funding

This study was supported (to TM) by research project grants from the Japanese Ministry of Health, Labor, and Welfare (H-14-shinkin-005, H-15-shinkin-001, and H-16-shinkin-001) and by the Japanese Human Science Association, 2002–2004. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.