Hypothermia therapy

Shiozaki T., Kato A., Taneda M., et al. (1999) Little benefit from mild hypothermia therapy for severely head injured patients with low intracranial pressure. J. Neurosurg. 91,185-191. 

Yanamoto H., Nagata I., Niitsu Y., et al. (2001) Prolonged mild hypothermia therapy... 

Jiang J.,YuM., and Zhu C. (2000) Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury 1 -year follow-up review of 87 cases. J. Neurosurg. 93,546-549. 

Aibiki M., Kawaguchi S. and Maekawa N. (2001) Reversible hypophosphatemia during moderate hypothermia therapy for brain-injured patients. Crit. Care Med. 29, 1726-1730. 

Naritomi H., Shimizu T., and Oe H. (1996) Mild hypothermia therapy in acute embolic stroke a pilot study. J. Stroke Cerebrovasc. Dis. 6, 193-196. 

MILD HYPOTHERMIA THERAPY IN ACUTE STROKE Experimental Findings... 

General anesthesia is needed to perform hypothermia therapy. Without general anesthesia, the cerebral temperature cannot be lowered satisfactorily because of shivering, which usually starts at levels of 35°C. The requirement of anesthesia limits the indications for therapy. From an ethical viewpoint, general anesthesia may be permitted only in patients with consciousness disturbance. Hypothermia may be best indicated for patients with embolic occlusion of major cerebral arteries,... 

Fig. 4. CT and MRI findings in a patient undergoing hypothermia therapy in the hyperacute phase. In this patient, the hypothermia therapy was induced 4 h after embolic occlusion of the right MCA. Only a very small infarction developed in the right temporal cortex.

In the acute group, in which the hypothermia was initiated at KM-2 h after stroke, the clinical outcome varied depending on the time of hypothermia initiation. A patient who underwent the therapy beginning at 10 h after stroke became completely independent. Another patient who underwent the therapy at 24 h after stroke had a moderate right hemiparesis, but was able to walk with a cane. The remaining patient who underwent the therapy at 42 h after stroke became disabled and died in the chronic phase. Thus, it seems that the time for initiating hypothermia critically influences the clinical outcome. This supports the view that the hypothermia therapy may be best indicated for hyperacute stroke. 

Hypothermia is known to cause cardiac dysfunction, particularly arrhythmias (36,37). Careful temperature control and optimal antiar-rhythmic therapy can minimize this problem. However, to avoid severe circulatory dysfunction, knowledge of arrhythmias is required. Hypothermia may be associated with a suppression of the immunological system, which exposes patients to the danger of severe infections. Schwab et al. reported that 7 of 25 stroke patients undergoing hypoth-ermiatherapy suffered a septic syndrome (17). In our hypothermic study, none of the 13 patients who underwent hypothermia therapy for 3-7 d developed severe infectious diseases. However, the remaining patient, who underwent 10 d of hypothermia because of massive cerebral edema, developed septic shock on the 10th day of hypothermia treatment. The immunosuppressive effect appears to be correlated with the depth and... 

In the clinical field, technological advances such as the development of transvenous catheters for rapid patient cooling are making implementation of hypothermia therapy more feasible and safer. More definitive trials on the use of therapeutic hypothermia are underway. 

Resurgence of Hypothermia as a Treatment for Brain Injury. The Effects of Hypothermia and Hyperthermia in Global Cerebral Ischemia. Mild Hypothermia in Experimental Focal Cerebral Ischemia. Hypothermic Protection in Traumatic Brain Injury. Postischemic Hypothermia Provides Long-Term Neuroprotection in Rodents. Combination Therapy With Hypothermia and Pharmaceuticals for the T reatment of Acute Cerebral Ischemia. Intraoperative and Intensive Care Management of the Patient Undergoing Mild Hypothermia. Management of Traumatic Brain Injury With Moderate Hypothermia. Hypothermia Clinical Experience in Stroke Patients. Hypothermia Therapy Future Directions in Research and Clinical Practice. Index. 

Hutchison JS, Ward RE, Lacroix J, Hebert PC, Barnes MA, Bohn DJ, Dirks PB, Doucette S, Fergusson D, Gottesman R et al (2008) Hypothermia therapy after traumatic brain injury in children. N Engl J Med 358 2447-2456... 

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