Therapeutic hypothermia for acute brain injuries

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Maximiliano Rovegno²  Tomas Regueira²  Arnaldo Marín²  Jose Tomás Gazmuri¹  Max Andresen² 

[1] Hospital de Urgencia Asistencia Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile;Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile

关键词: Cardiac arrest and brain injuries;    Target temperature management;    Hypothermia;   

Others  :  1213812
DOI  :  10.1186/s13049-015-0121-3

 received in 2014-08-26, accepted in 2015-04-29,  发布年份 2015

【 摘 要 】

Therapeutic hypothermia, recently termed target temperature management (TTM), is the cornerstone of neuroprotective strategy. Dating to the pioneer works of Fay, nearly 75 years of basic and clinical evidence support its therapeutic value. Although hypothermia decreases the metabolic rate to restore the supply and demand of O₂, it has other tissue-specific effects, such as decreasing excitotoxicity, limiting inflammation, preventing ATP depletion, reducing free radical production and also intracellular calcium overload to avoid apoptosis. Currently, mild hypothermia (33°C) has become a standard in post-resuscitative care and perinatal asphyxia. However, evidence indicates that hypothermia could be useful in neurologic injuries, such as stroke, subarachnoid hemorrhage and traumatic brain injury. In this review, we discuss the basic and clinical evidence supporting the use of TTM in critical care for acute brain injury that extends beyond care after cardiac arrest, such as for ischemic and hemorrhagic strokes, subarachnoid hemorrhage, and traumatic brain injury. We review the historical perspectives of TTM, provide an overview of the techniques and protocols and the pathophysiologic consequences of hypothermia. In addition, we include our experience of managing patients with acute brain injuries treated using endovascular hypothermia.

【 授权许可】

   
2015 Andresen et al.

【 图 表 】

Figure 1.

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