Current Advances in the Use of Therapeutic Hypothermia (original) (raw)
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Therapeutic hypothermia has been advocated for neuroprotection in cardiac arrest-induced encephalopathy, neonatal hypoxic-ischemic encephalopathy, traumatic brain injury, stroke, hepatic encephalopathy, and spinal cord injury, and as an adjunct to certain surgical procedures. In this review, we address physiological mechanism of hypothermia to mitigate neurological injury, the trials that have been performed for each of these indications, the strength of the evidence to support treatment with mild/moderate hypothermia. Evidence is strongest for prehospital cardiac arrest and neonatal hypoxicischemic encephalopathy. For traumatic brain injury, a recent meta-analysis suggests that cooling may increase the likelihood of a good outcome, but does not change mortality rates. For many of the other indications, such as stroke and spinal cord injury, trials are ongoing, but the data is insufficient to recommend routine use of hypothermia at this time. Although induced hypothermia appears to be a highly promising treatment, it should be emphasized that it is associated with a number of potentially serious side effects, which may negate some or all of its potential benefits. Prevention and/or early treatment of these complications are the key to successful use of hypothermia in clinical practice.
Novel applications of therapeutic hypothermia: report of three cases
Critical care (London, England), 2004
Therapeutic hypothermia can provide neuroprotection in various situations where global or focal neurological injury has occurred. Hypothermia has been shown to be effective in a large number of animal experiments. In clinical trials, hypothermia has been used in patients with postanoxic injury following cardiopulmonary resuscitation, in traumatic brain injury with high intracranial pressure, in the perioperative setting during various surgical procedures and for various other indications. There is thus evidence that hypothermia can be effective in various situations of neurological injury, although a number of questions remain unanswered. We describe three patients with unusual causes of neurological injury, whose clinical situation was in fundamental aspects analogous to conditions where hypothermia has been shown to be effective.
Therapeutic hypothermia: a state-of-the-art emergency medicine perspective
The American Journal of Emergency Medicine, 2012
Therapeutic hypothermia (TH) has gained popularity as a brain-protective strategy for victims of sudden cardiac death in whom return of spontaneous circulation has been achieved but coma persists. Trials have also demonstrated some advantageous effects of lowering core body temperature after stroke and hypoxic-ischemic encephalopathy of the newborn. In a variety of clinical conditions, TH is still being studied (eg, hepatic encephalopathy and traumatic brain injury). This study describes the historical development of TH, its current applications in emergency medicine, and its potential future uses.
Current Management of Hypothermia: From Theory to Application
Respiratory Case Reports, 2012
Objectives: To systematically review the literature on the current data in managing accidental hypothermia victims in the pre-hospital and hospital settings. Methods: We identified studies published from 1 January 1977 through 31 May 2012 by searching the MEDLINE, EMBASE and CINAHL and database of the National Library of Medicine. Initial search terms were 'definition of hypothermia', 'prehospital management', 'hospital management', and 'rewarming techniques'. Findings: Accidental hypothermia occurs due to body heat redistribution between core and peripheral tissues as well as imbalance between heat loss and production. Hypothermia may develop within a few minutes after immersion in cold water or exposure to cold weather. The prognosis in accidental hypothermia depends to great extent on the degree and duration of the hypothermia, patient's premorbid condition, and the degree of exhaustion and metabolic derangement that result from the physiologic attempts to compensate for the heat loss. Interpretations and implications: Management of deep hypothermia require rapid internal re-warming in order to support body core organs but all possible precautions should be undertaken to minimize the risk of "rewarming shock". Such care require a medical team with very well understanding of the pathophysiologic that accompanied hypothermia and the implications of various treatment strategies.
From therapeutic hypothermia towards targeted temperature management: a decade of evolution
Anestezjologia Intensywna Terapia, 2014
More than a decade after the first randomised controlled trials with targeted temperature management (TTM), it remains the only treatment with proven favourable effect on postanoxemic brain damage after out-of-hospital cardiac arrest. Other well-known indications include neurotrauma, subarachnoidal haemorrhage, and intracranial hypertension. When possible pitfalls are taken into consideration when implementing TTM, the side effects are manageable. After the recent TTM trials, it seems that classic TTM (32−34°C) is as effective and safe as TTM at 36°C. This supports the belief that fever prevention is one of the pivotal mechanisms that account for the success of TTM. Uncertainty remains concerning cooling method, timing, speed of cooling and rewarming. New data indicates that TTM is safe and feasible in cardiogenic shock, one of its classic contra-indications. Moreover, there are limited indications that TTM might be considered as a therapy for cardiogenic shock per se.
Complications in therapeutic hypothermia: diagnosis and interventions
Revista de Pesquisa: Cuidado é Fundamental Online, 2014
Objetivo: identificar os diagnósticos de enfermagem, segundo a NANDA, mediante as complicações potenciais dos pacientes submetidos à Hipotermia Terapêutica Pós-parada Cardiorrespiratória e propor as intervenções de enfermagem, conforme a Classificação de Intervenções de Enfermagem (NIC). Método: trata-se de uma revisão bibliométrica de literatura a partir de janeiro de 2003 até maio 2013, nas bases de dados LILACS, MEDLINE e SCIELO. Resultados: foram selecionados 5 artigos, os quais possibilitou identificar 8 diagnósticos de Enfermagem, bem como, as intervenções de Enfermagem correspondentes. Conclusão: apesar da alta eficácia da Hipotermia Terapêutica em reduzir a extensão do dano neurológico Pós-parada Cardiorrespiratória, sua utilização não é tão ampla na prática clínica. Dessa forma, esta pesquisa tem intuito de fornecer uma base inicial de reflexão para a prática do profissional enfermeiro que assiste este paciente.
Diagnosis and treatment of hypothermia
American family physician, 2004
Although hypothermia is most common in patients who are exposed to a cold environment, it can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems. The clinical presentation of hypothermia includes a spectrum of symptoms and is grouped into the following three categories: mild, moderate, and severe. Management depends on the degree of hypothermia present. Treatment modalities range from noninvasive, passive external warming techniques (e.g., removal of cold, wet clothing; movement to a warm environment) to active external rewarming (e.g., insulation with warm blankets) to active core rewarming (e.g., warmed intravenous fluid infusions, heated humidified oxygen, body cavity lavage, and extracorporeal blood warming). Mild to moderate hypothermia is treated easily with supportive care in most clinical settings and has good patient outcomes. The treatment of severe hypothermia is more complex, and outcomes ...