Meta-analysis of efficacy and safety of mild hypothermia for patients with severe traumatic brain injury
Objective To evaluate the efficacy and safety of mild hypothermia for patients with severe traumatic brain injury(sTBI).Methods PubMed,Embase,Cochrane Library,Web of Science,China Biology Medicine Disc,China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,and VIP Database were searched for prospective randomized controlled researches on mild hypothermia and normothermia for patients with sTBI.The search time was from the establishment of the databases to February 2023.RevMan 5.3 software was used for Meta-analysis.The evaluation indicators included literature search results,basic characteristics and quality of the literature,poor prognosis rate and mortality at 6 and 12 months after treatment,incidence of pulmonary infection,arrhythmia,thrombocytopenia,intracranial infection,renal insufficiency,gastrointestinal ulcer/bleeding and electrolyte disorder during the treatment,and publication bias.Results A total of 16 papers involving 2 640 patients were included,comprising 1 381 patients in the mild hypothermia group and 1 259 patients in the normothermia group.The poor prognosis rate in the mild hypothermia group was significantly lower than that in the normothermia group at 6 and 12 months after treatment(RR=0.81,95％CI 0.69,0.95,P＜0.01;RR=0.65,95％CI 0.51,0.84,P＜0.01).There was no significant difference in the mortality between the two groups at 6 and 12 months after treatment(RR=0.81,95％CI 0.61,1.08,P＞0.05;RR=0.69,95％CI 0.47,1.03,P＞0.05).In contrast with the the normothermia group,in the mild hypothermia group the incidence of pulmonary infection was significantly different(RR=1.18,95％CI 1.04,1.34,P＜0.01);the incidence of arrhythmia was not significantly different(RR=1.35,95％CI 0.73,2.49,P＞0.05);the incidence of thrombocytopenia was significantly different(RR=1.78,95％CI 1.34,2.37,P＜0.01);the incidence of intracranial infection was not significantly different(RR=1.32,95％CI 0.54,3.23,P＞0.05);the incidence of renal insufficiency was not significantly different(RR=1.22,95％CI 0.71,2.09,P＞0.05);the incidence of gastrointestinal ulcer/bleeding was not significantly different(RR=0.98,95％CI 0.73,1.31,P＞0.05);the incidence of electrolyte disorders was not significantly different(RR=1.39,95％CI 1.00,1.94,P＞0.05).The funnel plot was approximately symmetrical and the scattered points were concentrated in the narrow area in the upper part of the funnel plot,suggesting no publication bias.Conclusions In comparison with normothermia for sTBI,mild hypothermia can not reduce the mortality at 6 and 12 months after treatment,but it can reduce the incidence of poor prognosis at 6 and 12 months after treatment.Moreover,mild hypothermia has no obvious effect on the incidence of arrhythmia,intracranial infection,renal insufficiency,gastrointestinal ulcer/bleeding,and electrolyte disorder,but it can increase the incidence of pulmonary infection and thrombocytopenia.
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