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2015 ; 23
(ä): 42
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Therapeutic hypothermia for acute brain injuries
#MMPMID26043908
Andresen M
; Gazmuri JT
; Marín A
; Regueira T
; Rovegno M
Scand J Trauma Resusc Emerg Med
2015[Jun]; 23
(ä): 42
PMID26043908
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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 O?, 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.
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