Effects of intravascular hypothermia on intracranial pressure and cerebral hemodynamics in patients with severe traumatic brain injury after standard decompression craniectomy

Abstract

Objective To investigate the effects of intravascular hypothermia on intracranial pressure (ICP) and cerebral hemodynamics in patients with severe traumatic brain injury (sTBI) after standard decompression craniectomy. Methods A retrospective cohort study was carried out on 82 sTBI patients admitted to Chongqing Emergency Medical Center from January 2019 to March 2021. All patients received standard decompressive craniectomy (ICP>20 mmHg). Among them, 38 patients were treated with intravascular hypothermia as the experimental group, and 44 patients were not as the control group. The effects of intravascular hypothermia on ICP, cerebral hemodynamics, and brain injury markers were analyzed, and the results were compared between the 2 groups. Glasgow coma scale was used to evaluate the prognosis. Results ICP in the experimental group began to decrease after hypothermia treatment, and decreased to less than 20 mmHg in 12 h later. In the control group, ICP fluctuated greatly, and decreased to below 20 mmHg in 18 h later. At 22 and 24 h after operation, ICP was more significantly decreased in the experimental group than the control group (P < 0.05). At 1 week after operation, the peak systolic blood flow velocity and average blood flow velocity of middle cerebral artery were increased, the pulsatile index was decreased, the serum contents of glial fibrillary acidic protein, S-100β and neuron-specific enolase were decreased in the 2 groups. And above changes were more obviously in the experimental group than the control group (all P < 0.05). In 6 months after operation, 22 cases (57.90%) in the experimental group and 15 cases (34.09%) in the control group achieved a good prognosis, with significant difference between them (P=0.042). Conclusion Intravascular hypothermia can reduce ICP and improve cerebral hemodynamics in sTBI patients after standard decompression craniectomy.

Keywords

• severe taumatic brain injury
• standard decompressive craniectomy
• intravascularhypothermia therapy
• intracranial pressure
• cerebral hemodynamics