Diego Rise


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Diego Rise

  1. 1. 1 Introduction Hypothermia is a medical condition that occurs when your core body temperature drops beneath 36.1 degrees Celsius (Cold Environments ...[updated October 2, 2008]). As their temperature lowers it can cause the person to lose consciousness, you may not be able to feel their pulse, and may appear if their core temperature continues dropping. Even if a person with hypothermia appears dead they can still be revived if handled and warmed properly. Different tests have been done over the years that show both in animals and people that lowering the core temperature to around 32-33 degrees Celsius can lower a person’s heart rate and intercranial pressure (ICP). This has been shown to help in the treatment of severe non-penetrating head injuries. Although different experiments were done, the ones that will be used for this work include two by Clifton in (1993, 2001) and the one by Marion, (1997). Two of them show hypothermia being effective in if used along with the regular treatment for this type of injury; however in the larger of the two studies by Clifton results indicate that there is no difference. In all of the studies used the patients where in comas and had scores of 3~8 in the Glasgow Coma Scale. The GSC works by assigning each characteristic of a coma a number, and it being seppareted by eye, verbal, and motor responses, then adding them all. The table above shows the different characteristics in each of the groups, as you can see the highest score means the better
  2. 2. 2 condition, and is a score of 15, while the worst is a 3, in which no responses are show at all. Experimental Evidence Clifton’s first work in 1993 showed that in a test with 46 patients, that 16% more of the hypothermia group, consisting of 24 patients, had a successful recovery, while 8 of them died, also 8 out of the 22 normothermia (normal body temperature) group patients died. In Marion’s study (1997) 62% and 38% of the hypothermia and normothermia groups had a successful recovery (scores of 4-5 in the Glasgow Outcome Scale [GOS], seen below) after 12 months. http://www.neurocirugia.com/escalas/GOS.htm (translated) It was also found that Clifton’s first test and in Marion’s the hypothermia group had less incidents of seizures or other complications, however in Clifton’s second neither group had seizures, and all the tests showed that the hypothermia group had less ICP and neurotoxins. Below are two tables, the one on the left showing patient information for Clifton’s second test, and the right one of Marion’s. These tables show that both groups, in each test, are very similar in terms of injury and age, and the patients in both tests are
  3. 3. 3 of similar ages.
  4. 4. 4 http://nejm.highwire.org/content/vol344/issue8 http://content.nejm.org/content/vol336/i /images/large/03t1.jpeg ssue8/images/large/03t1.jpeg Current understanding The results from the first two experiments (Clifton et al. 1993, Marion et al. 1997) conflicts with the results from the most recent (Clifton et al. 2001), seeing in the latest both groups had very similar results, both in general outcome and in deaths. Other
  5. 5. 5 information that has been observed in the hypothermia group agrees with each other, for example: lower ICP, less neurotoxins, and fewer seizure incidents Controversy As stated before in both of the small clinical trials (less than 90 patients each) the hypothermia group showed much better end results than the normothermia group although the temperatures differed by some degrees. However, the larger test 392 patients, shows evidence that hypothermia may not help patients. According to the multi- clinical test by Clifton (2001), patients in the hypothermia group spent more time in the hospital and required more medications to maintain stabilized. According to Grände (2009) if you only look at the bigger trails that have done hypothermia treatment seems to be more damaging than normal therapy Conclusion After analyzing the available literature the benefit of hypothermia on patients with severe non-penetrating head injuries it is not clear. More tests are needed in this research area in order to prove, or disprove, the usefulness of hypothermia and the otherwise regular therapy on patients with severe non-penetrating head injuries. Different tests have shown conflicting results, larger tests have said that hypothermia is not a good method, where as smaller tests say they are. The difference might be caused by the difference in the persons regular temperature varying in the place where they were
  6. 6. 6 treated, also in Clifton's second study the patients in the hypothermia group were reheated slower than in the other two tests. Citations: Adelson P. D. 2009. Hypothermia following Pediatric Traumatic Brain Injury, Journal of Neurotrauma [Internet]. [Cited 2009 Dec 17] 26(3): 429-436. Available from: http://www.liebertonline.com/doi/abs/10.1089/neu.2008.0571? url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov Clifton, G. L., Allen, S., Barrodale, P., Plenger, P., Berry, J., Koch S., Fletcher, J., Hayes, R. L., Choi, S. C. 1993. A Phase II Study Of Moderate Hypothermia In Severe Brain Injury, Journal Of Neurotrauma [Internet]. [Cited 2009 Dec 17] 10(3): 263-271. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8258839 Clifton, G. L., Miller, E. R., Choi, S. C., Levin, H. S., McCauley, S., Smith, K. R., Muizelaar, P., Wagner, F. C., Marion, D. W., Luerssen, T. G., Chesnut, R. M., Schwartz, M. 2001. Lack of Effect of Induction of Hypothermia after Acute Brain Injury, The New England Journal of Medicine [Internet]. [Cited 2009 Dec 17], 344:556-563. Available from: http://nejm.highwire.org/cgi/content/full/344/8/556#R5 Cold Environments- Health Effects and Frist Aid [Internet]. Canadian Center for Occupational Health and Safety; [Cited 2009 Dec 18]. Available from: http://www.ccohs.ca/oshanswers/phys_agents/cold_health.html Glasgow Coma Scale (GCS) [Internet]. [updated July 30, 2001] University of Northen Carolina; [cited 2009 Dec 18]. Available from:
  7. 7. 7 http://www.unc.edu/~rowlett/units/scales/glasgow.htm Glasgow Outcome Scale [Internet]. Neurocirugia; [Cited 2009 Dec 18]. Available from: http://www.neurocirugia.com/escalas/GOS.htm Grände PO, Reinstrup P, Romner B. 2009. Active cooling in traumatic brain- injured patients: a questionable therapy?, Acta Anaesthesiol Scand. [Internet]. [Cited 2009 Dec 17] 53(10): 1233-8 Hypothermia [Internet]. Survive the Outdoors Inc.; [cited 2009 Dec 18]. Available from: http://www.surviveoutdoors.com/reference/hypothermia.asp Marion, D. W., Penrod, L. E., Kelsey, S. F., Obrist, W. D., Kochanek, P. M., Palmer, A. M., Wisniewski, S. R., DeKosky, S. T. 1997. Treatment of Traumatic Brain Injury with Moderate Hypothermia, The New England Journal of Medicine [Internet]. [Cited 2009 Dec 17] 336: 540-546. Available from: http://content.nejm.org/cgi/content/abstract/336/8/540