A phase II study of moderate hypothermia in severe brain injury

ABSTRACT Forty-six patients with severe nonpenetrating brain injury [Glasgow Coma Scale (GCS) 4–7] were randomized to standard management at 37°C (n = 22) and to standard management with systemic hypothermia to 32 to 33°C (n = 24). The two groups were balanced in terms of age (Wilcoxon's rank sum test, p > 0.95), randomizing GCS (chi-square test, p = 0.54), and primary diagnosis. Cooling was begun within 6 h of injury by use of cooling blankets. Metocurine and morphine were given hourly during induction and maintenance of hypothermia. Rewarming was at a rate of 1°C per 4 h beginning 48 h after intravascular temperature had reached 33°C. Muscle relaxants and sedation were continued until core temperature reached 35°C. There were no cardiac or coagulopathy-related complications. Seizure incidence was lower in the hypothermia group (Fisher's exact text, p = 0.019). Sepsis was seen more commonly in the hypthermia group, but difference was not statistically significant (chi-square test). Mean Glasgow Outcome S...