Each year, in the United States, 235,000 individuals sustain a traumatic brain injury requiring hospitalization. Patient outcome from severe traumatic brain injury is improved with intensive care management of pathophysiological processes developing in the days following the injury. An important secondary complication of traumatic brain injury is fever, which is known to worsen neurologic outcome. Our institution has recently developed an approach to combat fever through the prophylactic use of intravascular cooling catheters, a treatment termed controlled normothermia.
We have recently demonstrated that controlled normothermia reduces both core and brain temperature and can improve the intracranial milieu that may facilitate recovery. A major drawback to the systematic use of controlled normothermia is an increased risk of infection, or delayed diagnosis of infection by masking of fevers. In the current study, we evaluated whether controlled normothermia, the prophylactic use of intravascular cooling catheters in severe traumatic brain injury, is associated with increased infection rates during the intensive care stay.
Utilizing a matched cohort study and data from the Brain Trauma Research Centers database, a retrospective study was performed. The data was taken from the Brain Trauma Research Centers traumatic brain injury registry, and was matched on age, gender, and Glasgow Coma Score. After analysis, the results of the study indicated fewer infections in the controlled normothermia group; the rates of bloodstream infections were statistically lower in the controlled normothermia group.
The current study demonstrates that prophylactic use of intravascular cooling catheters in severe traumatic brain injury is not associated with an increased risk of infection. The public health significance is that these results lend further support to the concept of controlled normothermia as a treatment for severe traumatic brain injury. Further study may prove that controlled normothermia is effective in improving neurologic outcomes from traumatic brain injury, which remain the leading cause of death under age 45 in the United States.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04112008-105239 |
| Date | 26 June 2008 |
| Creators | Schleicher II, Donald Thomas |
| Contributors | Kristen Mertz MD MPH, David Okonkwo MD PhD, Maria Brooks PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-04112008-105239/ |
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