by Watson, Hannah I.; Shepherd, Andrew A.; Rhodes,
Jonathan K. J.; Andrews, Peter J. D.
Objectives: Therapeutic hypothermia has been of topical
interest for many years and with the publication of two international,
multicenter randomized controlled trials, the evidence base now needs updating.
The aim of this systematic review of randomized controlled trials is to assess
the efficacy of therapeutic hypothermia in adult traumatic brain injury
focusing on mortality, poor outcomes, and new pneumonia. Data Sources: The
following databases were searched from January 1, 2011, to January 26, 2018: Cochrane
Central Register of Controlled Trial, MEDLINE, PubMed, and EMBASE. Study
Selection: Only foreign articles published in the English language were
included. Only articles that were randomized controlled trials investigating
adult traumatic brain injury sustained following an acute, closed head injury
were included. Two authors independently assessed at each stage. Data
Extraction: Quality was assessed using the Cochrane Collaboration’s tool for
assessing the risk of bias. All extracted data were combined using the
Mantel-Haenszel estimator for pooled risk ratio with 95% CIs. p value of less
than 0.05 was considered statistically significant. All statistical analyses
were conducted using RevMan 5 (Cochrane Collaboration, Version 5.3, Copenhagen:
The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Data Synthesis:
Twenty-two studies with 2,346 patients are included. Randomized controlled
trials with a low risk of bias show significantly more mortality in the
therapeutic hypothermia group (risk ratio, 1.37; 95% CI, 1.04–1.79; p = 0.02),
whereas randomized controlled trials with a high risk of bias show the opposite
with a higher mortality in the control group (risk ratio, 0.70; 95% CI,
0.60–0.82; p < 0.00001). Conclusions: Overall, this review is in-keeping
with the conclusions published by the most recent randomized controlled trials.
High-quality studies show no significant difference in mortality, poor
outcomes, or new pneumonia. In addition, this review shows a place for fever
control in the management of traumatic brain injury.
No comments:
Post a Comment