The Outcomes of the Use of Induced Hypothermia in Patients Victims of Traumatic Brain Injury: An Integrative Review of the Literature

Layza Hellen Fernandes Menezes, Italo Kauan Ribeiro de Carvalho Martins, Luís Phelipe Gama de Moraes, Amanda Cavalcanti Pinheiro Barbas, Ian Gabriel Lucchese de Sá Cruz, Breno Dias Lima Ribeiro, José Alberto Pereira Pires

Abstract

Introduction: Traumatic brain injury (TBI) is characterized by lesions caused by external forces to the skull that result in neurological impairment. Induced hypothermia (IH) has been proposed as a strategy to minimize secondary complications. This condition predominantly affects young men; however, mortality rates are higher among older adults. Such a scenario imposes a substantial burden on public health systems due to initial treatment costs and long-term care related to sequelae. Therefore, this study aimed to gather evidence regarding outcomes associated with the use of IH as a therapeutic approach in TBI.

Methods: This study consists of a literature review developed based on a research question structured according to the PICO strategy (Patient, Intervention, Comparison, and Outcome). A search was conducted in the PubMed database using the descriptors “Brain Injuries, Traumatic” and “Hypothermia” combined with the Boolean operator AND. The selected articles were screened and analyzed, and the findings were organized accordingly. Studies available electronically, published in English, and presenting titles and abstracts addressing the association between TBI and IH were included. Of the 46 articles identified, 36 were excluded after application of the selection criteria, and 10 were included in the final review.

Results: Andrews et al. [1] conducted a systematic review that did not demonstrate a significant difference in mortality with the use of IH in patients with TBI, although lower-quality studies tended to suggest potential efficacy. Cooper et al. [2], in a randomized clinical trial, found no benefit associated with IH treatment. In contrast, Crompton et al. [3] reported beneficial effects of IH in TBI. Wu X et al. [4] did not support the use of IH for neuroprotection but suggested its effectiveness in reducing intracranial pressure (ICP). Andrews et al. [1] indicated that IH may be harmful in less severe injuries and does not provide benefits in more severe cases. Dunkley and McLeod [5] suggested that IH may improve neurological outcomes, whereas Tasker et al. [6] observed that the mortality benefits of IH were not statistically significant. Huang et al. [7] found no significant difference in mortality rates but suggested that mild IH may be beneficial for neurological recovery.

Conclusion: The efficacy of IH in TBI appears to vary according to factors such as injury severity and duration of exposure. Although IH may contribute to the reduction of ICP, most studies do not demonstrate a significant reduction in mortality and suggest a potential increase in the risk of sepsis and pneumonia.