NCCEd: Neurocritical Care Education for Residents

Case-Based Modules > Case 5 > Stage 4

Unfortunately, therapeutic hypothermia should generally just not be performed for TBI. We know from the Eurotherm3235 trial that adding hypothermia to standard care for intracranial hypertension actually increases mortality and worsens morbidity. Therapeutic hypothermia also raises a couple of problems in general: need for continued high levels of sedation (less of a problem here as we're already sedating for ICP issues), coagulopathy, need for additional medications to treat shivering (this leads some to start neuromuscular blockade in some cases).

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Suggested Reading:

• Andrews PJ, Sinclair HL, Rodríguez A, et al. Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: the Eurotherm3235 RCT. Health Technol Assess. 2018;22(45):1-134. doi:10.3310/hta22450