Hutchison said there may be a number of reasons why they didn't see an effect from cooling in the current trial. "Possibly, we may need to keep it going longer after a brain injury, because the brain keeps swelling for days after an injury. Perhaps 24 hours is too short a duration," he theorized.
Also, he said that there was a significantly higher incidence of low blood pressure during re-warming, and that the re-warming period may have been too quick.
The bottom line, said Hutchison, is that cooling for brain injury in children should not be used in the same context it was for this trial: 24 hours of cooling with re-warming occurring over 18 hours.
He said that several other studies of hypothermia for pediatric brain injury are already under way, but they're cooling for longer periods and re-warming more slowly.
Dr. P. David Adelson, director of neurotrauma at Children's Hospital of Pittsburgh, is leading one of the newer trials. He said this was a well-done study, and that other researchers have learned from it, but that "the jury is still out" on hypothermia for brain injury.
In his current study, Adelson said they are starting the cooling sooner, cooling for a longer period of time and re-warming at a far slower pace.
"This is a promising therapy that's going through an evolution. I think this study shows the difficulty of looking at complex disease processes [like traumatic brain injury], and trying to look at interventions. No one therapy will be the end-all treatment for brain trauma," said Adelson.
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