Hypothermia for Traumatic Brain Injury in Intensive Care

Abstract

Introduction: Therapeutic hypothermia (TH) has been investigated for neuroprotection after severe traumatic brain injury (TBI) for decades, but trials show conflicting results. This review synthesizes current evidence.
Methods: Literature review (2010–2024) of RCTs and meta-analyses comparing TH (32–35°C) to normothermia in adults with severe TBI (GCS ≤8). Primary outcomes: mortality and favorable neurological outcome (GOS 4–5) at 6 months.
Results: Fifteen RCTs (n=2,934) demonstrated no mortality benefit (RR 0.95, p=0.42) nor improved favorable outcome (RR 1.06, p=0.31). Subgroup analysis: TH initiated early (<3 hours) showed possible benefit (RR 1.22, p=0.08). Rewarming increased intracranial pressure (ICP) rebound and pneumonia (OR 1.8).
Discussion: Failure of TH in TBI trials likely relates to prolonged duration, uncontrolled rewarming, and inclusion of heterogeneous patients. Early, short-duration (24–48h) hypothermia with slow rewarming may benefit specific subgroups (e.g., younger patients with refractory ICP).
Conclusions: Routine therapeutic hypothermia for severe TBI is not recommended. Targeted temperature management for refractory intracranial hypertension may be considered with expert protocols.