Abstract
Many drugs with proven efficacy in the preclinical stage have failed to show any benefit in improving the outcome of severe traumatic brain injury (TBI) when tested in controlled clinical trials. Hypothermia is still the most powerful neuroprotective method in experimental models of TBI. Its ability to influence the multiple biochemical cascades that are set in motion after TBI is quite unique. In experimental models hypothermia protects against mechanical neuronal and axonal injury and improves behavioral outcome. Encouraging results from phase II and III clinical trials of hypothermia in TBI reported in the 1990s generated great enthusiasm. However, enthusiasm faded in 2001 after the final report of the multicenter phase III trial in which the neuroprotective effects of moderate hypothermia in TBI were formally tested. This study found no significant effect on outcome in the hypothermia group, leading many clinicians to lose interest in this therapy. The present article reviews the historical background of the use of hypothermia, presents the rationale for using both immediate and deferred hypothermia, and summarizes both experimental and clinical evidence supporting its potential benefits in the management of severe TBI. New technologies using intravascular methods to induce fast hypothermia have recently become available. Cooling either through the intravenous or intra-arterial route is an exciting alternative with great potential. We argue that moderate hypothermia is still the most powerful neuroprotective candidate for severe TBI and that it merits further research and discussion. We also defend the need for further clinical trials to prove or refute its potential for treating high intracranial pressure refractory to first level therapeutic measures. The premature abandonment of hypothermia could close new avenues for improving the devastating effects of TBI.
Keywords: traumatic brain injury, hypothermia, high intracranial pressure, intravascular cooling methods, neuroprotection
Current Pharmaceutical Design
Title: Moderate Hypothermia in the Management of Severe Traumatic Brain Injury: A Good Idea Proved Ineffective?
Volume: 10 Issue: 18
Author(s): J. Sahuquillo, M. P. Mena, A. Vilalta and M. A. Poca
Affiliation:
Keywords: traumatic brain injury, hypothermia, high intracranial pressure, intravascular cooling methods, neuroprotection
Abstract: Many drugs with proven efficacy in the preclinical stage have failed to show any benefit in improving the outcome of severe traumatic brain injury (TBI) when tested in controlled clinical trials. Hypothermia is still the most powerful neuroprotective method in experimental models of TBI. Its ability to influence the multiple biochemical cascades that are set in motion after TBI is quite unique. In experimental models hypothermia protects against mechanical neuronal and axonal injury and improves behavioral outcome. Encouraging results from phase II and III clinical trials of hypothermia in TBI reported in the 1990s generated great enthusiasm. However, enthusiasm faded in 2001 after the final report of the multicenter phase III trial in which the neuroprotective effects of moderate hypothermia in TBI were formally tested. This study found no significant effect on outcome in the hypothermia group, leading many clinicians to lose interest in this therapy. The present article reviews the historical background of the use of hypothermia, presents the rationale for using both immediate and deferred hypothermia, and summarizes both experimental and clinical evidence supporting its potential benefits in the management of severe TBI. New technologies using intravascular methods to induce fast hypothermia have recently become available. Cooling either through the intravenous or intra-arterial route is an exciting alternative with great potential. We argue that moderate hypothermia is still the most powerful neuroprotective candidate for severe TBI and that it merits further research and discussion. We also defend the need for further clinical trials to prove or refute its potential for treating high intracranial pressure refractory to first level therapeutic measures. The premature abandonment of hypothermia could close new avenues for improving the devastating effects of TBI.
Export Options
About this article
Cite this article as:
Sahuquillo J., Mena P. M., Vilalta A. and Poca A. M., Moderate Hypothermia in the Management of Severe Traumatic Brain Injury: A Good Idea Proved Ineffective?, Current Pharmaceutical Design 2004; 10 (18) . https://dx.doi.org/10.2174/1381612043384051
DOI https://dx.doi.org/10.2174/1381612043384051 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Vaccine Development for Group A Streptococcus Infections and Associated Diseases
Current Drug Targets Exploitation of the 3-Quinolinecarbonitrile Template for Src Tyrosine Kinase Inhibitors
Current Topics in Medicinal Chemistry Recent Patents Relating to siRNAs and Therapeutic Strategies for Genetic Diseases
Recent Patents on DNA & Gene Sequences Erratum:
Endocrine, Metabolic & Immune Disorders - Drug Targets Peripheral Neuropathy Induced by Paclitaxel: Recent Insights and Future Perspectives
Current Neuropharmacology Nanoparticulate Carrier Mediated Intranasal Delivery of Insulin for the Restoration of Memory Signaling in Alzheimer’s Disease
Current Nanoscience An Update on Natural Occurrence and Biological Activity of Chromones
Current Medicinal Chemistry Development of Nucleic Acid Drugs for Neurological Disorders
Current Topics in Medicinal Chemistry Acute Human Toxicity of Macrocyclic Lactones
Current Pharmaceutical Biotechnology Interleukin-18, From Neuroinflammation to Alzheimers Disease
Current Pharmaceutical Design Drugs in Newborn Resuscitation: The More We Learn the Least We Use
Current Medicinal Chemistry Oxidative Stress in the ICU
Current Nutrition & Food Science Amyloid-like Fibril Formation by Trypsin in Aqueous Ethanol. Inhibition of Fibrillation by PEG
Protein & Peptide Letters Multiscale Modelling of Relationships between Protein Classes and Drug Behavior Across all Diseases Using the CANDO Platform
Mini-Reviews in Medicinal Chemistry Activation of Latent HIV-1 Expression by Protein Kinase C Agonists. A Novel Therapeutic Approach to Eradicate HIV-1 Reservoirs
Current Drug Targets Nanomedicinal Approach of Getting Across the Brood-Brain Barrier with Nanomedicinal Nanoparticles
Current Medicinal Chemistry Old Strategies and New Perspectives in Modulating the Endocannabinoid System
Current Bioactive Compounds Fuzzy Bee Segmentation-Meta-Heuristic Approach for the Medical Image Segmentation Problem
Current Signal Transduction Therapy Potential Role of Hydrogen Sulfide in the Pathogenesis of Vascular Dysfunction in Septic Shock
Current Vascular Pharmacology EEG Upper/Low Alpha Frequency Power Ratio and the Impulsive Disorders Network in Subjects with Mild Cognitive Impairment.
Current Alzheimer Research