Evaluation of Therapeutic Hypothermia Tolerability in the Complex of Intensive Therapy of Severe Traumatic Brain Injury

The article presents the results of studying neurological outcomes in 24 patients aged 20 to 66 with severe traumatic brain injury (TBI). The purpose of the study was to research the tolerability and safety of therapeutic hypothermia in the intensive care of patients with severe TBI, in comparison with the control group. Materials and methods. The patients were divided into 2 groups. Group 1 (n=12) patients were examined with standard intensive care complex, according to the “Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition, 2016” in the treatment of the ICU. Group 2 (n=12) patients were examined with the therapeutic hypothermia "Blanketrol II" (CSZ) with using non-invasive technology to achieve the target core body temperature of 34.50C. Induction of therapeutic hypothermia was performed by intravenous drip as fast as possible infusion of 40C with a saline at a dose of 30 ml/kg, followed by maintenance of therapeutic hypothermia with the hypotherm "Blanketrol-II" through blankets with circulating cold water. In the induction phase, there was an analgesia and pharmacological prevention of cold shiver development. The body core temperature was continuously measured by means of an esophageal temperature sensor connected to the "Blanketrol-II" during induction, maintenance of therapeutic hypothermia, and warming of patients. Criteria for the involving patients in the study: the first 24 hours from the moment of receiving severe TBI (both with the carrying out and without an operative neurosurgical intervention), the initial level of neurological deficit, which was assessed on the Glasgow Coma Scale (GCS), in the range of 5-7 points. Exclusion criteria were: age ≤18 years, neurological status on the GCS ≥8 and ≤4 points at the time of the study, pregnancy, refractory arterial hypotension using high doses of vasopressors. Patients of both groups were mechanically ventilated. Results and discussion. As a result of the study, there were no significant intergroup differences in the frequency of vasopressor support: 41.7% and 33.3% in the Group 1 and Group 2, respectively. This indicated a good tolerability of therapeutic hypothermia, the use of which was not associated with the development of hemodynamic instability in patients. A significant increase in the volume of diuresis at 24 hours was revealed in the Group 2 (1991.6±160.5 ml/day) compared with the Group 1 (1738.3±264.8 ml/day) (p<0.05), which was due to the need to infuse 40C with 0.9% NaCl solution to induce therapeutic hypothermia. This was evidenced by a significantly higher volume of infusion therapy in the group of patients with therapeutic hypothermia (2504.1±110.7 ml/day) compared with the Group 1 (1718.333±205.0 ml/day) (p<0,05). A similar dynamics of diuresis increase in the Group 2 were registered and at the stage of 48 hours: 1908.3±125.5 ml/day in comparison with 1633.3±228.5 ml/day in patients of the Group 1. These changes were of a valid nature and were explained by the onset of cold diuresis. In connection with this, for the maintenance of euvolemia, a significantly higher volume of infusion therapy was used in Group 2 (1708.3±180.1 ml/day), compared with Group 1 (1479.167±108.8 ml/day) (p<0.05). Conclusion. Thus, therapeutic hypothermia in patients with severe TBI was characterized by good tolerability and safety. Complications in the group of patients using therapeutic hypothermia were not revealed.