Journal of neurotrauma
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Journal of neurotrauma · Mar 2009
ReviewManagement of pitfalls for the successful clinical use of hypothermia treatment.
Therapeutic hypothermia is a promising method for controlling intracranial pressure (ICP) in severely brain-injured patients. However, clinical data regarding the effect of brain hypothermia on overall outcome of these patients is limited. This may be because there are specific pitfalls associated with the clinical management of induced hypothermia in patients with severe traumatic brain injury (TBI). ⋯ For example, in our experience, posttraumatic hyperglycemia, exacerbated by cooling, may be ameliorated by the administration of a ketone body with mannitol. Prevention of selective free radical damage to neurons is also an important target for successful brain hypothermia treatment. Taken together, it is clear that several orchestrated steps should be initiated to enhance the protective effects of hypothermia therapy and prevent these possible pitfalls.
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Journal of neurotrauma · Mar 2009
ReviewPosthypothermic rewarming considerations following traumatic brain injury.
To date, considerable attention has been focused upon the use of hypothermia as a therapeutic strategy for attenuating many of the damaging consequences of traumatic brain injury (TBI). Despite the promise of hypothermic intervention following TBI, many questions remain regarding the optimal use of hypothermic intervention, including, but not limited to, the rewarming rates needed to assure optimal brain protection. In this review, we revisit the relatively limited literature examining the issue of hypothermia and differing rewarming rates following TBI. ⋯ In contrast, hypothermia followed by rapid rewarming not only reverses the protective effects associated with hypothermic intervention, but in many cases, exacerbates the traumatically induced pathology and its functional consequences. While similar evaluations have not been conducted in the clinical setting, multiple lines of clinical evidence suggest the benefits of posttraumatic hypothermia are optimized through the use of slow rewarming, with the suggestion that such a strategy reduces the potential for rebound vasodilation, elevated intracranial pressure (ICP), and impaired neurocognitive recovery. Collectively, this review highlights not only the benefits of hypothermic intervention, but also the rate of posthypothermic rewarming as an important variable in assuring maximal efficacy following the use of hypothermic intervention.
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Journal of neurotrauma · Mar 2009
ReviewThe use of pre-hospital mild hypothermia after resuscitation from out-of-hospital cardiac arrest.
Hypothermia has emerged as a potent neuroprotective modality following resuscitation from cardiac arrest. Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest, in-field cooling begun immediately following the return of spontaneous circulation may be more beneficial. ⋯ Rapid infusion of intravenous fluid at 4 degrees C, the use of a cooling helmet, and cooling plates have all been proposed as methods for field cooling, and are all in various stages of clinical and animal testing. Whether field cooling will improve survival and neurologic outcome remains an important unanswered clinical question.
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Journal of neurotrauma · Mar 2009
ReviewHypothermia after cardiac arrest: lessons learned from national registries.
Therapeutic hypothermia has been shown to improve outcome in comatose survivors after cardiac arrest of cardiac origin. After the clinical implementation of this novel treatment, several international web-based registries were opened to facilitate the prospective collection of patient treatment data. The aim was to evaluate the actual use of hypothermia in clinical practice, safety aspects, resource utilization, and outcome in large cohorts of patients. ⋯ The three registries have different strengths and weaknesses, but the clinical outcome compares well with that of the two randomized trials. Our conclusions are that hypothermia is feasible to implement, that it seems reasonably safe, and that the outcome compares well with previous reports. We also conclude that the treatment with hypothermia after cardiac arrest is more widely applied than what is strictly evidence based.