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To evaluate the efficacy and safety of mild induced hypothermia for intracranial hypertension in patients with traumatic brain injury after decompressive craniectomy.A total of 60 adults with intracranial pressure (ICP) of more than 20 mm Hg after decompressive craniectomy were randomly assigned to standard care (control group) or hypothermia (32°C-35°C) plus standard care. Then, ICP, cerebral perfusion pressure, Glasgow Outcome Scale score, and complications were assessed.There was a significant difference in ICP and cerebral perfusion pressure between the 2 groups. Favorable outcomes occurred in 12 (40.0%) and 7 (36.5%) patients in the hypothermia and control groups, respectively (P = .267). Kaplan-Meier curves revealed a marked difference in survival between the hypothermia and control groups (P = .032). There were significant differences in pulmonary infection and electrolyte disorders between the hypothermia and control groups (P = .038 and .033, respectively).Mild induced hypothermia can reduce intracranial hypertension after decompressive craniectomy, decreasing patient mortality. Hypothermia should be considered one of the main treatments for intracranial hypertension after decompressive craniectomy in patients with traumatic brain injury.This is a randomized controlled trial research.Mild induced hypothermia therapeutics can reduce the intracranial hypertension after the decompressive craniectomy and can reduce the mortality of the patients.