The Polar Express: Sustained Hypothermia for Severe TBI & Low-Dose Theophylline for COPD
Freddy Frost and Alex Pickard return to The Rounds Table this week. Together they cover the use of sustained prophylactic hypothermia in the management of traumatic brain injury (TBI) and the effectiveness of adding low-dose theophylline to inhaled corticosteroids in chronic obstructive pulmonary disease (COPD).
TBI is a leading cause of death and disability, especially in young individuals. Almost half of patients with a Glasgow Coma Scale (GCS) of less than 8 will have an unfavourable outcome including death, severe disability, or persistent vegetative state. Alex tells listeners about the POLAR trial, which compares the use of early prophylactic hypothermia versus the current gold standard, normothermia, in managing patients after severe traumatic brain injury. Neurologic outcomes 6 months after injury were compared between the groups.
Higher doses of theophylline were used in the past for bronchodilatory effect; however, this was associated with side effects. Preclinical investigations have suggested potential anti-inflammatory effects of theophylline at lower doses. Freddy discusses the TWICS trial, in which patients with COPD treated with inhaled corticosteroids were either given low-dose theophylline or placebo. The number of exacerbations were compared between the groups.
Finally, the Good Stuff segment. Parental concerns frequently arise as children ingest various toy objects; Freddy outlines a study of the transit time of a Lego figurine. Alex tells listeners the story of an F-16 fighter jet used to transport an ECMO machine 280 miles to save a patient’s life.
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