Experience with prolonged induced hypothermia in severe head injury

Although nosocomial pneumonia (defined in this study as both new chest radiograph changes and culture of a respiratory pathogen from tracheal aspirate) was quite common (45%), death from sepsis was rare (5%). Other findings included hypokalaemia on induction of hypothermia and a decreasing total white cell and platelet count over 10 days. There were no major cardiac arrhythmias. There was a satisfactory neurological outcome in 20 out of 43 patients (47%).Moderate hypothermia may be induced for more prolonged periods, and is a relatively safe and feasible therapeutic option in the treatment of selected patients with severe traumatic brain injury. Thus, further prospective controlled trials using induced hypothermia for longer periods than 48 h are warranted.Induced hypothermia (IH) was first used in clinical practice as an adjunct to the therapy of traumatic brain injury (TBI) over 50 years ago [1]. Between 1950 and 1960, several (uncontrolled) series were reported [2,3,4,5] in which IH was included in the management of patients with TBI. Although IH is still commonly used for neurological protection during cardiac surgery [6], the use of IH in TBI was largely abandoned after 1960 due to perceived problems of sepsis, cardiac arrhythmias and coagulopathy [7,8,9]. Recently, the first prospective controlled trials of IH in TBI were reported [10,11,12]. These have suggested benefit in intracranial pressure control and outcome when IH was used for 24–48 h in the treatment of TBI. Further improvements in outcome may be possible if IH could be used for longer periods, but the effects of prolonged IH have not been well described in the literature. We used IH in 43 patients with severe TBI for periods longer than 48 h and report the incidence of complications of prolonged IH in patients with severe TBI.Dandenong Hospital is a 385-bed hospital situated in southeast Melbourne, Victoria, Australia. It services a population of approximately 500000 people. The intensive care unit