Journal of neurotrauma
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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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In this article, the role of hypothermia and neuroprotection for neonatal encephalopathy will be discussed. The incidence of encephalopathy due to hypoxia ischemia as well as the pathophysiology will be presented. ⋯ The current data from randomized control trials of hypothermia as neuroprotection for full-term infants will be presented along with the results of meta-analyses of these trials. Lastly, the status of ongoing neonatal hypothermia trials will be summarized.
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Journal of neurotrauma · Mar 2009
ReviewUse of prolonged hypothermia to treat ischemic and hemorrhagic stroke.
Therapeutic (induced) hypothermia (TH) has been extensively studied as a means to reduce brain injury following global and focal cerebral ischemia, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Here, we briefly review the clinical and experimental evidence supporting the use of TH in each condition. ⋯ However, there is presently insufficient evidence to support the clinical use of TH for ICH and SAH. In any case, further animal work is needed to develop optimized protocols for treating cardiac arrest (global ischemia), and to maximize the likelihood of successful clinical translation in focal cerebral ischemia.
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Journal of neurotrauma · Mar 2009
Clinical application of modest hypothermia after spinal cord injury.
There is widespread interest in the use of hypothermia in the treatment of CNS injury. While there is considerable experience in the use of cooling for a variety of brain pathologies, limited data exist after spinal cord injury. In the past few years, technological advances in the induction and maintenance of cooling have been achieved and can potentially allow for a more accurate evaluation of this form of treatment. ⋯ Most documented adverse events were respiratory in nature. We were able to effectively deliver systemic cooling using the cooling catheters with minimal variation in body temperature. The study represents the largest, modern series of hypothermia treatment of acute spinal cord injury with intravascular cooling techniques and provides needed baseline data for outcome studies to include larger multi-center, randomized trials.
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Journal of neurotrauma · Mar 2009
Historical ArticleTherapeutic hypothermia: applications in pediatric cardiac arrest.
There is a rich history for the use of therapeutic hypothermia after cardiac arrest in neonatology and pediatrics. Laboratory reports date back to 1824 in experimental perinatal asphyxia. Similarly, clinical reports in pediatric cold water drowning victims represented key initiating work in the field. ⋯ Uncontrolled application (too deep and too long) and unique facets of asphyxial cardiac arrest in children (a very difficult insult to affect any benefit) likely combined to result in abandonment of therapeutic hypothermia in the mid to late 1980s. Important studies in perinatal medicine have built upon the landmark clinical trials in adults, and are once again bringing therapeutic hypothermia into standard care for pediatrics. Although more work is needed, particularly in the use of mild therapeutic hypothermia in children, there is a strong possibility that this important therapy will ultimately have broad applications after cardiac arrest and central nervous system (CNS) insults in the pediatric arena.