A Systematic Review of the Effects of Body Temperature on Outcome After Adult Traumatic Brain Injury.
A Systematic Review of the Effects of Body Temperature on Outcome After Adult Traumatic Brain Injury.
复制标题
DOI：
10.1097/jnn.0000000000000142
复制
发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
DeVon HA
中科院分区：
文献类型：
--
作者：
Madden LK;DeVon HA
本综述描述了体温变化对成人创伤性脑损伤(TBI)预后的影响。体温变化定义为发热、可控常温、自发或诱导低温。使用PubMed、Cochrane图书馆数据库、CINAHL、EMBASE和ISI Web of Science在2013年7月进行了检索，除诱导降温(2009)外，没有追溯日期限制。在确定的1366种图书中，有712种得到了审查。符合纳入标准的文章有16篇：2009年以来体温过低的随机对照试验(RCT)(上一次Cochrane综述)或脑损伤温度的队列研究；测量核心和/或脑温度；神经学结果报告；主要是成人患者，以及英文出版物。排除标准：大多数患者为非创伤性脑损伤，主要是儿科患者、病例报告或实验室/动物研究。大多数研究发现，避免发热会带来积极的结果，包括：减少重症监护病房的住院时间和死亡率；以及高血压、颅内压升高和心动过速的发生率。入院时体温过低与不良预后相关。受控常温改善了代孕结局。来自随机对照试验的现有证据不支持预防性的体温过低。制定一个常温的目标，避免发热，积极治疗发热可能是脑外伤后最重要的。还需要进一步的研究：确定颅脑损伤后体温变化的幅度和持续时间；确定体温变化是否影响或预测神经系统结果；确定温度变化速度是否影响或预测神经系统结果；比较受控常温与标准做法或低温。
This systematic review describes effects of body temperature alterations defined as fever, controlled normothermia, and spontaneous or induced hypothermia on outcome following traumatic brain injury (TBI) in adults. A search was conducted using PubMed, Cochrane Library database, CINAHL, EMBASE, and ISI Web of Science in July 2013 with no back date restriction except for induced hypothermia (2009). Of 1366 titles identified, 712 were reviewed. Sixteen articles met inclusion criteria: Randomized Controlled Trials (RCT) in hypothermia since 2009 (last Cochrane review) or cohort studies of temperature in TBI; measure core and/or brain temperature; neurologic outcome reporting; primarily adult patients, and English language publications. Exclusion criteria: majority of patients were non-TBI, primarily pediatric patients, case reports, or lab/animal studies. The majority of studies found that fever avoidance resulted in positive outcomes including: decreased intensive care unit length of stay, mortality; and incidence of hypertension, elevated intracranial pressure, and tachycardia. Hypothermia on admission correlated with poor outcomes. Controlled normothermia improved surrogate outcomes. Prophylactic induced hypothermia is not supported by the available evidence from RCT. Setting a goal of normothermia, avoiding fever, and aggressively treating fever may be most important after TBI. Further research is needed to: characterize the magnitude and duration of temperature alteration after TBI; determine if temperature alteration influences or predicts neurologic outcome; determine if rate of temperature change influences or predicts neurologic outcome; and compare controlled normothermia versus standard practice or hypothermia.