Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Sep 2015
ReviewCan Therapeutic Hypothermia Be Guided by Advanced Neuromonitoring in Neurocritical Care Patients? A Review.
The impact of therapeutic hypothermia (TH) on long-term neurological outcome is still controversial. Data on the effects of TH on brain homeostasis are mostly derived from experimental research. ⋯ In this study we describe the principles of multimodal neuromonitoring and its potential in the clinical setting of TH. We call for more research using multimodal neuromonitoring techniques in patients undergoing TH to optimize cooling and rewarming strategies.
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Ther Hypothermia Temp Manag · Sep 2015
Randomized Controlled TrialTherapeutic Hypothermia Reduces Intracranial Pressure and Partial Brain Oxygen Tension in Patients with Severe Traumatic Brain Injury: Preliminary Data from the Eurotherm3235 Trial.
Traumatic brain injury (TBI) is a significant cause of disability and death and a huge economic burden throughout the world. Much of the morbidity associated with TBI is attributed to secondary brain injuries resulting in hypoxia and ischemia after the initial trauma. Intracranial hypertension and decreased partial brain oxygen tension (PbtO2) are targeted as potentially avoidable causes of morbidity. ⋯ There was a mean decrease in PbtO2 of 7.8±3.1 mmHg (p<0.05) from 30.2 to 22.4 mmHg, from precooling to stable hypothermia, which was not seen in the control group. This research supports others in demonstrating a decrease in ICP with temperature, which could facilitate a reduction in the use of hyperosmolar agents or other stage II interventions. The decrease in PbtO2 is not below the suggested treatment threshold of 20 mmHg, but might indicate a decrease in CBF.
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Ther Hypothermia Temp Manag · Sep 2015
Observational StudyClinical Practice Variability in Temperature Correction of Arterial Blood Gas Measurements and Outcomes in Hypothermia-Treated Patients After Cardiac Arrest.
Mechanical ventilation in patients treated with mild therapeutic hypothermia (MTH) for the postcardiac arrest syndrome may be challenging given changes in solubility of arterial blood gases (ABGs) with cooling. Whether ABG measurements should be temperature corrected (TC) remain unknown. We sought to describe practice variability in TC at a single institution and explored the association between TC and neurological outcome. ⋯ Favorable 6-month outcomes were more common in the mostly TC than no TC group (48% vs. 25%; OR [95% CI]: 2.9 [1.2-7.1]), but not after adjustment (OR 1.5, 95% CI 0.33-6.9). There was substantial practice variability in the temperature correction strategy. Availability of temperature-corrected ABGs was not associated with improved neurological outcomes after adjusting for covariates.
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Ther Hypothermia Temp Manag · Sep 2015
Prolonged Local Hypothermia Has No Long-Term Adverse Effect on the Spinal Cord.
Hypothermia is known to be neuroprotective and is one of the most effective and promising first-line treatments for central nervous system (CNS) trauma. At present, induction of local hypothermia, as opposed to general hypothermia, is more desired because of its ease of application and safety; fewer side effects and an absence of severe complications have been noted. Local hypothermia involves temperature reduction of a small and specific segment of the spinal cord. ⋯ The weekly somatosensory evoked potential and motor behavioral (Basso, Beattie and Bresnahan) assessments of rats that underwent 5 and 8 hours of semi-invasive local hypothermia, which revealed no statistically significant changes in electrical conductivity and behavioral outcomes. In addition, 4 weeks after local hypothermia induction, histological examination showed no anatomical damages or morphological changes in their spinal cord structure and parenchyma. We concluded that this method of prolonged local hypothermia is feasible, safe, and has the potential for clinical translation.