The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury

Aug 31, 2026

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Aim: assess whether only a subgroup of patients with less primary brain damage after severe head injury benefits from therapeutic hypothermia. Methods: prospective randomized analysis of 72 patients, given mild hypothermia at 34°C for 72 hours (n=37) versus normothermia (n=35). Results: hypothermia lowered ICP and increased CPP across injury types. However, outcome improved mainly in patients with extracerebral hematomas, while those with primary lesions showed no clear benefit.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

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Summary

Study aim and design

Measured outcomes (ICP, CPP, neurological outcome)

Introduction

Prognosis and role of primary brain damage

Cerebral perfusion pressure and secondary ischemic injury

Rationale for mild hypothermia

Material and method

Patient selection and monitoring

Randomization and cooling protocol

Classification by injury type and follow-up

Acta Neurochir (2005) [Suppl] 95: 273–275 6 Springer-Verlag 2005 Printed in Austria The inﬂuence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury M. Smrˇcka1, M. Vidl´ak1, K. M´aca1, V. Smrˇcka1, and R. G´al2 1 Neurosurgical Department, University Hospital Brno, Brno, Czech Republic 2 Anaesthesiological Department, University Hospital Brno, Brno, Czech Republic Summary Aim of this study was to examine the hypothesis that only a subgroup of patients with lesser primary brain damage after severe head injury may beneﬁt from therapeutic hypothermia. We prospectively analysed 72 patients with severe head injury, randomized into groups with (n ¼ 37) and without (n ¼ 35) hypothermia of 34 􀀃 C maintained for 72 hours. The inﬂuence of hypothermia on ICP, CPP and neurological outcome was analysed in the context of the extent of primary brain damage. Patients with normothermia and primary lesions (n ¼ 17) – values: GCS on admission 5 (median), ICP 18.9 (mean), CPP 73 (mean), GOS 4 (median) . Patients with normothermia and extracerebral hematomas (n ¼ 20): GCS 4, ICP 16, CPP 71, GOS 3 . Patients with hypothermia and primary lesions (n ¼ 21): GCS 4,62, ICP 10,81, CPP 78,1, GOS 4 . Patients with hypothermia and extracerebral hematomas (n ¼ 14): GCS 5, ICP 13 .2, CPP 78, GOS 5 . Hypothermia decreased ICP and increased CPP regardless of the type of brain injury. Hypothermia was not able to improve outcome in patients with primary brain lesions but this pilot study suggests that it signiﬁcantly improves outcome in patients with extracerebral hematomas. Keywords: Severe head injury; primary and secondary brain damage; mild hypothermia. Introduction Severe head injuries (Glasgow Coma Scale – GCS a 8) generally have a very serious prognosis. About 30% of patients have a good result, but 25% are severely disabled, 5% end up in a vegetative state and about 40% of patients die [6] . Most important for the ﬁnal result is the extent of primary brain damage This study was supported by a grant of the Internal Grant Agency of the Czech Ministry of Health No 6844-3 and 7671-3 and the development of secondary ischemic brain damage. Modern methods of the management of patients after severe head injury are therefore based on the principle of maintaining an adequate cerebral perfusion pressure (CPP) above 60 mmHg (see European and American guidelines) [3, 4] . Despite all e¤ort, secondary ischemic changes may continue to evolve in many patients after severe head injury. It seems that neither the early evacuation of the hematoma, nor the correct management on the intensive care unit is able to protect many patients from secondary ischemic brain damage. One option to improve the results is the use of mild hypothermia. Hypothermia is not anew neuroprotective method, it has been in use already for several decades. Contemporary technology, however, has improved. Hypothermia now is used in accordance with modern knowledge of the pathophysiology of brain injury. In the clinical setting it is necessary to use hypothermia together with multimodal monitoring of the brain physiology, which was not available previously. The laboratory results after application of mild hypothermia (30–34 􀀃 C) conﬁrm less neuronal damage, decreased release of neurotransmitters and a prevention of blood-brain barrier breakdown as a consequence of ischemic insult, which is the most frequent cause of secondary brain damage [2] . Not all experimental and clinical studies, however, conﬁrm a positive e¤ect of hypothermia. Despite the fact that hypothermia inﬂuences physiological variables important for the patient s prognosis (intracranial pressure – ICP and cerebral perfusion pressure – CPP), the results of clinical studies are often controversial [1, 5] . 274 M. Smrˇcka et al. Material and method We studied 72 patients after severe head injury (GCS a 8) treated in our hospital during the years 2001–2003 . Th

FAQs

What was the main aim of this study on hypothermia after severe head injury?

To test the hypothesis that only a subgroup of patients with less primary brain damage may benefit from therapeutic hypothermia.

How was mild hypothermia administered, and for how long?

Patients randomized to hypothermia received mild hypothermia at 34°C for 72 hours, using surface cooling, with passive rewarming afterward to reach normothermia.

What effects did hypothermia have on ICP and CPP, and did it improve outcome?

Hypothermia decreased ICP and increased CPP regardless of injury type. It did not clearly improve outcome in patients with primary brain lesions, but the pilot results suggest significant improvement in patients with extracerebral hematomas.

Aug 31, 2026

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