Journal of neurotrauma
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Journal of neurotrauma · Mar 2009
ReviewClinical study of mild hypothermia treatment for severe traumatic brain injury.
Clinical randomized controlled trials (RCTs) suggest that mild hypothermia may improve the outcome of severe traumatic brain injured patients with intracranial hypertension when cooling is maintained for longer than 48 h. However, the results are not yet conclusive, and more RCTs are required. Mild hypothermia significantly decreases intracranial pressure (ICP) values when refractory intracranial hypertension cannot be controlled by conventional measures in patients with severe traumatic brain injury (TBI). Prolonged mild-to-moderate hypothermia may be associated with high incidence of pneumonia and hypokalemia, which should be prevented.
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Journal of neurotrauma · Mar 2009
ReviewHospital-based use of therapeutic hypothermia after cardiac arrest in adults.
Improving survival and brain function after initial resuscitation from cardiac arrest remains a critical challenge with few therapeutic options. The publication of several randomized controlled trials supporting the use of therapeutic hypothermia in cardiac arrest survivors has provided a remarkable opportunity to reduce mortality and neurologic disability from this leading cause of death. ⋯ This review will focus on the hospital-based application of therapeutic hypothermia in adult cardiac arrest survivors, with special attention to practical aspects of cooling, protocol development, and evaluation of recent data from "real world" experiences using hypothermia as a treatment option. Finally, remaining research questions and directions for future improvements in therapy will be discussed.
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Journal of neurotrauma · Mar 2009
ReviewHypothermia in focal ischemia: implications of experiments and experience.
Beside aspirin administration and stroke unit care, thrombolysis is the only approved and effective therapy in acute ischemic stroke. Thrombolysis is essentially limited by the short therapeutic window and its potential side effects. Although there is a robust body of evidence on the neuroprotective characteristics of hypothermia in animal models of focal ischemia, the clinical data on hypothermia in stroke are inconclusive in terms of effectiveness. ⋯ This lack of efficacy might be explained by the fact that hypothermia is not appropriately used in patients and animal data are not correctly interpreted. This review summarizes the major conclusions of animal studies and presents results of clinical stroke trials to date. Methods of delivery and maintenance of hypothermia are discussed, as well as a variety of open questions in the relevant animal and clinical research.
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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.