From the Guidelines
Therapeutic hypothermia is not recommended for pediatric Traumatic Brain Injury (TBI) management, and instead, maintaining normothermia while preventing fever is the preferred approach. Recent guidelines from a French expert panel suggest that targeted temperature management (TTM) at normothermia is recommended for children with severe TBI 1. Additionally, the panel states that TTM at 32-34°C is not recommended to improve outcome or control intracranial hypertension in children with severe TBI 1. The rationale behind this recommendation is supported by randomized studies that have shown no benefit of moderate hypothermia in terms of outcome in severely brain-injured children 1.
Some key points to consider in pediatric TBI management include:
- Preventing and promptly treating fever to improve outcomes 1
- Maintaining adequate cerebral perfusion pressure 1
- Providing appropriate neuroprotective care within a multidisciplinary approach
- Avoiding potential complications of cooling therapy, such as coagulopathy, increased infection risk, electrolyte disturbances, and cardiac arrhythmias
It is essential to prioritize maintaining normothermia and preventing fever in pediatric TBI management, rather than inducing hypothermia, to improve morbidity, mortality, and quality of life outcomes 1.
From the Research
Recent Studies on Therapeutic Hypothermia for Pediatric Traumatic Brain Injury
- A 2013 meta-analysis 2 found that pediatric patients with traumatic brain injury treated with hypothermia had more unfavorable outcomes than those in the normothermia group.
- A 2014 review 3 of 19 studies on therapeutic hypothermia for severe traumatic brain injury in children and adults found no signs of improvement in outcome from hypothermia in the five pediatric studies.
- A 2012 critically appraised topic 4 found that current cumulative evidence does not support the general use of therapeutic hypothermia for acute severe traumatic brain injury, but further investigation may be warranted for specific TBI subgroups.
- A 2015 randomized controlled trial 5 found that prolonged mild therapeutic hypothermia did not improve neurological outcomes or reduce mortality compared to fever control with tight hemodynamic monitoring and slow rewarming in patients with severe traumatic brain injury.
- A 2013 phase 3 randomized controlled trial 6 found that hypothermia for 48-72 hours with slow rewarming did not reduce mortality or improve global functional outcome after pediatric severe traumatic brain injury.
Key Findings
- Therapeutic hypothermia may not be beneficial for pediatric patients with traumatic brain injury 2, 3, 6.
- The use of therapeutic hypothermia in TBI patients may be associated with increased risk of cardiac arrhythmia and other adverse events 2, 3.
- Further research is needed to determine the effectiveness and safety of therapeutic hypothermia for pediatric traumatic brain injury 2, 3, 4, 5, 6.