Intracranial hypertension hypothermia

Jalan R., Damink S. W., Deutz N. E., Lee A., and Hayes P. C. (1999) Moderate hypothermia for uncontrolled intracranial hypertension in acute liver failure. I/meet 354, 1164-1168. 

Shiozaki T., Sugimoto H., Taneda M., et al. (1993) Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J. Neurosurg. 79, 363-368. 

Tateishi A., Soejima Y., Taira Y., et al. (1998) Feasibility of the titration method of mild hypothermia in severely head-injured patients with intracranial hypertension. Neurosurgery 42,1065-1069 discussion 1069-1070. 

Shapiro H. M., Wyte S. R., and Loeser J. (1974) Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension. J. Neurosurg. 40,90-100. 

However, rewarming has to be considered as the critical phase of hypothermic therapy. This rebound intracranial hypertension after rewarming might be due to a proposed hypermetabolic response after induced hypothermia, as it was described after cardiopulmonary bypass surgery (40). 

A study by Georgiadis et al. (31) induced hypothermia (target temperature 33°C) in 14 patients with an acute anterior circulation infarction involving at least two thirds of the left MCA territory. Patients received norepinephrine via continuous intravenous infusion and were mechanically ventilated. Hypothermia was initiated 26 h after onset of symptoms as a means to control intracranial hypertension and not for neuroprotection. In that study, static cerebral autoregulation did not appear impaired in the unaffected hemisphere with the use of alpha-stat for pH maintenance. However, the main concern in patients with acute stroke is the perfusion of the affected hemisphere, specifically of the penumbra (18). 

Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension. Gastroenterology 2004 127 ... 

Hypothermia extends the survival time and prevents the development of brain edema in rats with ALE, caused by hepatic devascularization and mild hypothermia (33—35°C), reduces ammonia-induced brain swelling and increased intracranial pressure in portacaval-shunted rats administered ammonium salts. These findings have led to the successful use of mild hypothennia for the treatment of uncontrolled intracranial hypertension in patients with ALF (Jalan et al., 1999). Mechanisms so far identified that underhe the beneficial effect of hypothermia in ALF include reduced blood-brain transfer of ammonia, improved cerebrovascular hemodynamics and normafization of extracellular brain amino acid patterns (for review of these mechanisms, see Vaquero et al., 2005). Mild hypothermia also improves hepatic function in experimental toxic fiver injury (Vaquero et al., 2(X)7) Mild-to-moderate hypothermia has the potential to serve as an important strategy in the management of patients with ALF awaiting liver transplantation. 

Jacobs EH, Yamatodani A, Ummerman H. Is histamine the final neurotransmitter in the entrainment of circadian rhythms in mammals Trends Pharmacol Scl, 21 S), 293-298, 2000 Jalan R, Damink SW, Deutz NE, Lee A, Hayes PC. Moderate hypothermia for uncontrolled intracranial hypertension in acute liver failure. Lcmcet, 354(9185), 1164-1168, 1999 Jalan R, Pollok A, Shah SH, Madhavan K, Simpson KJ. Liver derived pro-infltunmatory cytokines may be important in producing intracranial hypertension in ALE J. Hepatol, 37, 536-538, 2002... 

Considering the results of recent studies in experimental animals, some groups studied the effect of moderate hypothermia (32-33 °C) on ICP in patients with ALF. Jalan et al. (2004) were able to show that cooling to 32 °C decreased ICP to <20 mm Hg even in patients with refractory intracranial hypertension. Although their results were quite impressive other groups call for a randomized, controlled... 

Ogilvy C. S., Chu D., and Kaplan S. (1996) Mild hypothermia, hypertension, and mannitol are protective against infarction during experimental intracranial temporary vessel occlusion. Neurosurgery 38,1202-1209 discussion 1209-1210. 

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