Moderate hypothermia

Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 1998 29 2461-2466. 

Kolhnar R, Henninger N, Bardutzky J, Schellinger PD, Schabitz WR, Schwab S. Combination therapy of moderate hypothermia and thrombolysis in experimental thromboembohc stroke—an MRI study. Exp Neurol 2004 190 204-212. 

Berger C, Schramm P, Schwab S. Reduction of diffusion-weighted MRI lesion volume after early moderate hypothermia in ischemic stroke. Stroke 2005 36 e56-e58. 

Schwab et al. Stroke 1999 30(5) 1153 Prospective pilot study moderate hypothermia in severe stroke and ICP 25 of 25 tx with hypothermia Hypothermia to 33-34°C with cooling blankets in pts with compete MCA infarct and ICP monitor 44% mortality, all by herniation after secondary rise in ICP after rewarming period. Good control of ICP during hypothermia period. Forty percent rate of pneumonia... 

Decompressive hemicraniectomy was indirectly compared with moderate hypothermia (33°C) in a series of 36 patients from Georgiadis et al. They found a lower mortality rate for the patients who underwent hemicraniectomy (47% vs. 12%), as well as a lower complication rate. However, this was not a randomized study, and there was no comparison arm of patients who did not undergo either experimental therapy. 

Steiner T, Eriede T, Aschoff A, Schelhnger PD, Schwab S, Hacke W. Effect and feasibihty of controlled rewarming after moderate hypothermia in stroke patients with malignant infarction of the middle cerebral artery. Stroke 2001 32(12) 2833-5. 

Georgiadis D, Schwarz S, Aschoff A, Schwab S. Hemicraniectomy and moderate hypothermia in patients with severe ischemic stroke. Stroke 2002 33(6) 1584-1588. 

Aibiki M, Maekawa S, Yokono S. 2000. Moderate hypothermia improves imbalances ofthromboxane A2 and prostaglandin 12 production after traumatic brain injury in humans. Crit... 

Schwab S, Georgiadis D, Berrouschot J, Schellinger PD, Graffagnino C, Mayer SA (2001) Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 32 2033-2035... 

Schwab S., Schwarz S., Aschoff A., Keller E., and Hacke W. (1998) Moderate hypothermia and brain temperature in patients with severe middle cerebral artery infarction. Acta Neurochir. Suppl. 71, 131-134. 

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. 

Piepgras A., Roth H., Schurer L., et al. (1998) Rapid active internal core cooling for induction of moderate hypothermia in head injury by use of an extracorporeal heat exchanger. Neurosurgery 42, 311-317 discussion 317-318. 

Georgiadis D., Schwarz S., Kollmar R., and Schwab S. (2001) Endovascular cooling for moderate hypothermia in patients with acute stroke first results of a novel approach. Stroke 32, 2550-2553. 

Clifton G. L., Allen S., Barrodale P., et al. (1993) A phase II study of moderate hypothermia in severe brain injury. J. Neurotrauma 10, 263-271 discussion 273. 

Marion D. W. (2001) Therapeutic moderate hypothermia and fever. Curr. Pharm. Des. 7, 1533-1536. 

MODULATION OF ISCHEMIC INJURY BY MILD TO MODERATE HYPOTHERMIA... 

The extent to which the BBB is influenced by ischemia is highly temperature dependent. Early BBB breakdown to protein tracers is demonstrable after normothermic global ischemia but is suppressed by mild to moderate hypothermia and is greatly accentuated by intraischemic hyperthermia (71,112). Similarly, postischemic edema following global ischemia is reduced by moderate hypothermia (113). 

Lundgren J., Smith M. L., and SiesjoB. K. (1991) Influence of moderate hypothermia on ischemic brain damage incurred under hyperglycemic conditions. Exp. Brain Res. 84,91-101. 

Busto R., Dietrich W. D., Globus M. Y., and Ginsberg M. D. (1989) Postischemic moderate hypothermia inhibits CA1 hippocampal ischemic neuronal injury. Neurosci. Lett. 101, 299-304. 

Coimbra C. and Wieloch T. (1994) Moderate hypothermia mitigates neuronal damage in the rat brain when initiated several hours following transient cerebral ischemia. Acta Neuropathol. 87,325-331. 

Dempsey R. J., Combs D. J., MaleyM.E.,CowenD.E., Roy M.W., and Donaldson D. L. (1987) Moderate hypothermia reduces postischemic edema development and leukotriene production. Neurosurgery 21,177-181. 

Kollmar R., Schabitz W. R., Heiland S., et al. (2002) Neuroprotective effect of delayed moderate hypothermia after focal cerebral ischemia an MRI study. Stroke 33, 1899-1904. 

Trauma-induced axonal injury (TAI)is an important feature of human TBI. Some investigations have reported that moderate hypothermia can also reduce the generation of traumatically induced axonal injury (6,13). In one study, moderate hypothermia (32°C/4 h) initiated 10 min or 25 min after injury significantly reduced the number of abnormally stained axonal profiles (6). A study by Koizumi and Povlishock (13) reported that posttraumatic hypothermia (32°C/1 h) initiated as late as 1 h after trauma significantly reduced the density of amyloid precursor protein (APP) immunoreacti ve damaged axons within the corticospinal tract. Together, these data indicate that posttraumatic hypothermia in two models of TBI provides substantial protection in terms of axonal... 

Marion D. W. and White M. J. (1996) Treatment of experimental brain injury with moderate hypothermia and 21-aminosteroids. J. Neurotrauma 13, 139-147. 

Dixon C. E., Markgraf C. G., Angileri F., et al. (1998) Protective effects of moderate hypothermia on behavioral deficits but not necrotic cavitation following cortical impact injury in the rat. J. Neurotrauma 15, 95-103. 

Clifton G. L., Jiang J. Y., Lyeth B. G., Jenkins L. W., Hamm R. J., and Hayes R. L. (1991) Marked protection by moderate hypothermia after experimental traumatic brain injury../. Cereb. Blood Flow Metab. 11, 114—121. 

Lantos J., Temes G., andTorokB. (1986) Changes during ischaemia in extracellular potassium ion concentration of the brain under nitrous oxide or hexobarbital-sodium anaesthesia and moderate hypothermia. Acta Physiol. Hung. 67,141-153. 

Chatzipanteli K., Wada K., Busto R., and Dietrich W. D. (1999) Effects of moderate hypothermia on constitutive and inducible nitric oxide synthase activities after traumatic brain injury in the rat. J. Neurochem. 72, 2047-2052. 

Kline A. E., Bolinger B. D., Kochanek P. M., et al. (2002) Acute systemic administration of interleukin-10 suppresses the beneficial effects of moderate hypothermia following traumatic brain injury in rats. Brain Res. 937, 22-31. 

Leonov Y., Sterz F., Safar P., and Radovsky A. (1990) Moderate hypothermia after cardiac arrest of 17 minutes in dogs. Effect on cerebral and cardiac outcome. Stroke 21, 1600-1606. 

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