Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Jan 2011
Neuroprotection of Selective Brain Cooling After Penetrating Ballistic-like Brain Injury in Rats.
Induced hypothermia has been reported to provide neuroprotection against traumatic brain injury. We recently developed a novel method of selective brain cooling (SBC) and demonstrated its safety and neuroprotection efficacy in a rat model of ischemic brain injury. The primary focus of the current study was to evaluate the potential neuroprotective efficacy of SBC in a rat model of penetrating ballistic-like brain injury (PBBI) with a particular focus on the acute cerebral pathophysiology, neurofunction, and cognition. ⋯ However, these acute neuroprotective benefits of SBC did not translate into improved cognitive performance in the Morris water maze task. These results indicate that 34°C SBC is effective in protecting against acute brain damage and related neurological dysfunction. Further studies are required to establish the optimal treatment conditions (i.e., duration of cooling and/or combined therapeutic approaches) needed to achieve significant neurocognitive benefits.
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Ther Hypothermia Temp Manag · Jan 2011
Should advanced age be a limiting factor in providing therapeutic hypothermia to cardiac arrest survivors? A single-center observational study.
As octogenarians represent the fastest growing segment of the elderly population and the incidence of out-of-hospital cardiac arrest (OHCA) increases with age, the outcome benefit of therapeutic hypothermia (TH) in comatose cardiac arrest survivors is of great interest. The first randomized controlled trials of TH excluded all patients older than 75 years and there exists considerable uncertainty whether the positive findings from these studies apply to older patients. This is a retrospective study of all unconscious OHCA survivors from 2002 to 2008 treated with TH in our intensive care unit who fulfilled the Hypothermia After Cardiac Arrest study inclusion criteria (witnessed, shockable OHCA receiving bystander-cardiopulmonary resuscitation (CPR), interval from collapse to ambulance arrival <15 minutes, and return of spontaneous circulation [ROSC] within 60 minutes) but with no upper age limit. ⋯ Still, 54% of all patients aged >75 years achieved good outcome. Although age seems to influence outcome, we found that more than half of comatose OHCA survivors above 75 years showed a favorable outcome. Hence, our data do not support a limitation of postresuscitation TH based on age alone but highlights the need for more clinical trials of TH in the advanced age group.
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Ther Hypothermia Temp Manag · Jan 2011
Induction of mild hypothermia by noninvasive body cooling in healthy, unanesthetized subjects.
The induction of mild hypothermia has been considered as an important means to provide protection against cerebral ischemia. Yet, to date, the relative clinical efficacies of different noninvasive methods for reducing core body temperature have not been thoroughly studied. The aim of the current investigation was to compare the relative effectiveness of several noninvasive cooling techniques for reducing core temperatures in healthy volunteers. ⋯ With each employed methodology, rectal temperature reductions were induced, with combined evaporative/conductive (n=4, 1.44°C±0.99°C) and convective/conductive (n=4, 1.51°C±0.89°C) approaches yielding the largest decreases: note, that evaporative cooling alone was not as efficient in lowering core body temperature (n=10, 0.56°C±0.20°C; n=16, 0.58°C±0.27°C). In this study on healthy volunteers, the evaporative/conductive and convective/conductive combination methods were more effective in reducing core temperatures as compared with an evaporative approach alone. These therapeutic approaches for the induction of mild hypothermia (including the use of facial warming) could be employed in warranted clinical cases, importantly without the need for administration of anesthetics or paralytics.