DOI: https://doi.org/10.22141/2224-0586.4.91.2018.137865

Maintaining normothermia in intensive care of severe traumatic brain injury

A.V. Tsarev

Abstract


Background. The objective was to study the effectiveness of controlled normothermia in the intensive care of patients with severe traumatic brain injury (TBI) complicated by central hyperthermia refractory to pharmacological therapy, to evaluate its influence on the factors that indirectly determine the rheological properties of the blood. Materials and methods. Eighty patients were divided into 2 groups. Group I (n = 40) — individuals with hyperthermia > 38.3 to 39.5 °C refractory to pharmacological therapy with antipyretics; controlled normothermia was achieved by means of Blanketrol II. With the development of hyperthermia > 39.5 °C, the induction of cooling was primarily carried out by the fastest infusion of 4% Ringer’s lactate solution in a dose of 20–23 ml/kg of body weight through the central vein, followed by maintenance of controlled normothermia with Blanketrol II. Controlled normothermia was performed with a target temperature of the body correspon­ding to 37 °C. Group II (n = 40) — patients with hyperthermia > 38.3 °C without using technology of controlled normothermia, they were retrospectively examined, hyperthermia was suppressed in them by pharmacological antipyretic therapy, ice packs in the projections of the main vessels. Patients of both groups were mechanically ventilated. Results. Despite development of severe hyperthermia in both groups of patients, there was no significant increase in leukocyte count at all stages of the study, which was indicative of the central origin of hyperthermia syndrome in patients with severe TBI. There was a significant increase in fibrinogen content from 2.92 ± 0.64 g/l to 5.24 ± 1.37 g/l (P = 0.00001) at the stage of hyperthermia in group I and from 2.99 ± 0.67 g/l to 5.32 ± 2.06 g/l (P = 0.00006) in group II of patients compared with baseline. In patients of group I, under controlled normothermia, a decrease in the level of fibrinogen was revealed, which did not differ significantly from the baseline at the stage of 48 hours (P = 0.47). In contrast, patients in group II showed an increase in fibrinogen content, and by 48 hours, an increase in this index compared to the baseline was significant (P = 0.00015). Differences in the level of fibrinogen at the stage of 48 hours of observation between groups of patients were also significant (p < 0.05). Conclusions. Controlled normothermia normalizes the level of fibrinogen to the initial values, which indirectly may indicate improvement of rheological properties of the blood and, accordingly, syste­mic microcirculation in severe TBI.

Keywords


traumatic brain injury; hyperthermia; controlled normothermia; intensive care

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