Authors: Kazuma Nakagawa Nancy K Hills Hooman Kamel Diane Morabito Pratik V Patel Geoffrey T Manley J Claude Hemphill
Publish Date: 2010/11/09
Volume: 15, Issue: 1, Pages: 101-106
Abstract
Animal studies have shown that even a small temperature elevation of 1°C can cause detrimental effects after brain injury Since the skull acts as a potential thermal insulator we hypothesized that decompressive hemicraniectomy facilitates surface cooling and lowers brain temperatureFortyeight patients with severe brain injury TBI = 38 ICH = 10 with continuous brain temperature monitoring were retrospectively studied and grouped into “hemicraniectomy” n = 20 or “no hemicraniectomy” n = 28 group The paired measurements of core body T Core and brain T Br temperature were recorded at 1min intervals over 12 ± 7 days As a surrogate measure for the extent of surface heat loss from the brain ∆T Core−Br was calculated as the difference between T Core and T Br with each recording In order to accommodate withinpatient temperature correlations mixedmodel regression was used to assess the differences in ∆T Core−Br between those with and without hemicraniectomy adjusted for core body temperature and diagnosisA total of 295883 temperature data pairs were collected median IQR per patient 5047 3125–8457 Baseline characteristics were similar for age sex diagnosis incidence of sepsis Glasgow Coma Scale score ICU mortality and ICU length of stay between the two groups The mean difference in ∆T Core−Br was 129 ± 087°C for patients with and 080 ± 086°C for patients without hemicraniectomy P 00001 In mixedmodel regression accounting for temperature correlations within patients hemicraniectomy and higher T Core were associated with greater ∆T Core−Br hemicraniectomy estimated effect = 060 P = 0003 T Core estimated effect = 021 P 00001
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