Temperature difference between jugular bulb and pulmonary artery is associated with neurological outcome in patients with severe traumatic brain injury: A post hoc analysis of a brain hypothermia study

BackgroundThe purpose of this study was to examine whether the temperature difference between the jugular bulb and pulmonary artery (Delta Tjb-pa) is associated with the neurological outcome of patients with severe traumatic brain injury (TBI). MethodsWe conducted a post hoc analysis of a multicenter randomized controlled trial of mild therapeutic hypothermia (TH, 32.0-34.0 degrees C) or fever control (FC, 35.5-37.0 degrees C) for the patients with severe TBI. Delta Tjb-pa averaged every 12 h and the variation in Delta Tjb-pa were compared between patients with favorable (n = 39) and unfavorable (n = 37) neurological outcomes. These values were also compared in the TH and FC subgroups. ResultsThe average Delta Tjb-pa values in patients with favorable and unfavorable outcomes were 0.24 +/- 0.23 and 0.06 +/- 0.36 degrees C, respectively (P < 0.001). Delta Tjb-pa trended significantly higher in the favorable outcome patients than in the unfavorable outcome patients throughout the 120 h after onset of severe TBI (P < 0.001). The variation in Delta Tjb-pa from 0 to 72 h was significantly lower in the favorable outcome patients than in the unfavorable outcome patients (0.8 +/- 0.8 vs 1.8 +/- 2.5 degrees C, respectively, P = 0.013). From 72 to 120 h, there was no significant difference in the variation in Delta Tjb-pa. Significant differences between patients with favorable and unfavorable outcomes in Delta Tjb-pa and the variation in Delta Tjb-pa were similar in the TH subgroup, but not evident in the FC subgroup. ConclusionsA reduction in Delta Tjb-pa and greater variation in Delta Tjb-pa were associated with an unfavorable outcome in patients with severe TBI, especially those treated with TH. When treating severe TBI patients, it is important to understand that there will be differences in temperature reflecting the brain environment and the systemic temperature, depending on the severity and outcome of TBI during TH.