Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 4, 2015; 4(4): 296-301
Published online Nov 4, 2015. doi: 10.5492/wjccm.v4.i4.296
Therapeutic temperature modulation is associated with pulmonary complications in patients with severe traumatic brain injury
Kristine H O’Phelan, Amedeo Merenda, Katherine G Denny, Kassandra E Zaila, Cynthia Gonzalez
Kristine H O’Phelan, Amedeo Merenda, Departments of Neurology and Neurosurgery, University of Miami, Miami, FL 33136, United States
Katherine G Denny, Department of Neurology, University of California Davis, Sacramento, CA 95817, United States
Kassandra E Zaila, Hamilton College, Clinton, NY 13323, United States
Cynthia Gonzalez, Division of Neurocritical Care, University of California San Diego, La Jolla, CA 92093-0662, United States
Author contributions: O’Phelan KH and Gonzalez C designed the research; Zaila KE and Gonzalez C performed the research; Denny KG performed the statistical analysis; O’Phelan KH and Merenda A wrote the paper.
Institutional review board statement: This study was reviewed and approved by the IRB (institutional review board) for the University of Miami and the Jackson Memorial Hospital.
Informed consent statement: Informed consent was waived due to negligible risk of harm and the significant importance of evaluating a complete data set. All personal identifiers were removed prior to analysis.
Conflict-of-interest statement: None of the authors have any conflicts of interests. This work was performed without funding.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at kophelan@med.miami.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kristine H O’Phelan, MD, Associate Professor of Clinical Neurology, Departments of Neurology and Neurosurgery, University of Miami, 1120 NW 14th St, Miami, FL 33136, United States. kophelan@med.miami.edu
Telephone: +1-305-2434621 Fax: +1-305-2437081
Received: May 14, 2015
Peer-review started: May 14, 2015
First decision: June 24, 2015
Revised: July 8, 2015
Accepted: August 4, 2015
Article in press: August 7, 2015
Published online: November 4, 2015
Processing time: 176 Days and 14 Hours
Abstract

AIM: To examine complications associated with the use of therapeutic temperature modulation (mild hypothermia and normothermia) in patients with severe traumatic brain injury (TBI).

METHODS: One hundred and fourteen charts were reviewed. Inclusion criteria were: severe TBI with Glasgow Coma Scale (GCS) < 9, intensive care unit (ICU) stay > 24 h and non-penetrating TBI. Patients were divided into two cohorts: the treatment group received therapeutic temperature modulation (TTM) with continuous surface cooling and indwelling bladder temperature probes. The control group received standard treatment with intermittent acetaminophen for fever. Information regarding complications during the time in the ICU was collected as follows: Pneumonia was identified using a combination of clinical and laboratory data. Pulmonary embolism, pneumothorax and deep venous thrombosis were identified based on imaging results. Cardiac arrhythmias and renal failure were extracted from the clinical documentation. acute respiratory distress syndrome and acute lung injury were determined based on chest imaging and arterial blood gas results. A logistic regression was conducted to predict hospital mortality and a multiple regression was used to assess number and type of clinical complications.

RESULTS: One hundred and fourteen patients were included in the analysis (mean age = 41.4, SD = 19.1, 93 males), admitted to the Jackson Memorial Hospital Neuroscience ICU and Ryder Trauma Center (mean GCS = 4.67, range 3-9), were identified and included in the analysis. Method of injury included motor vehicle accident (n = 29), motor cycle crash (n = 220), blunt head trauma (n = 212), fall (n = 229), pedestrian hit by car (n = 216), and gunshot wound to the head (n = 27). Ethnicity was primarily Caucasian (n = 260), as well as Hispanic (n = 227) and African American (n = 223); four patients had unknown ethnicity. Patients received either TTM (43) or standard therapy (71). Within the TTM group eight patients were treated with normothermia after TBI and 35 patients were treated with hypothermia. A logistic regression predicting in hospital mortality with age, GCS, and TM demonstrated that GCS (Beta = 0.572, P < 0.01) and age (Beta = -0.029) but not temperature modulation (Beta = 0.797, ns) were significant predictors of in-hospital mortality [χ2 (3) = 22.27, P < 0.01] A multiple regression predicting number of complications demonstrated that receiving TTM was the main contributor and was associated with a higher number of pulmonary complications (t = -3.425, P = 0.001).

CONCLUSION: Exposure to TTM is associated with an increase in pulmonary complications. These findings support more attention to these complications in studies of TTM in TBI patients.

Keywords: Hypothermia, Fever, Pneumonia, Traumatic brain injury, Head injury

Core tip: Therapeutic hypothermia and normothermia (fever control) are used in patients with traumatic brain injury. This is most commonly done for intracranial hypertension control. The potential complications associated with this therapy when it is used outside of the scope of a closely regulated clinical trial are not well known. This is a retrospective review of patients with traumatic brain injury treated with therapeutic temperature modulation carried out to quantify the non neurological complications associated with this therapy.