Journal of neurotrauma
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Journal of neurotrauma · Mar 2009
ReviewClinical study of mild hypothermia treatment for severe traumatic brain injury.
Clinical randomized controlled trials (RCTs) suggest that mild hypothermia may improve the outcome of severe traumatic brain injured patients with intracranial hypertension when cooling is maintained for longer than 48 h. However, the results are not yet conclusive, and more RCTs are required. Mild hypothermia significantly decreases intracranial pressure (ICP) values when refractory intracranial hypertension cannot be controlled by conventional measures in patients with severe traumatic brain injury (TBI). Prolonged mild-to-moderate hypothermia may be associated with high incidence of pneumonia and hypokalemia, which should be prevented.
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Journal of neurotrauma · Mar 2009
ReviewHospital-based use of therapeutic hypothermia after cardiac arrest in adults.
Improving survival and brain function after initial resuscitation from cardiac arrest remains a critical challenge with few therapeutic options. The publication of several randomized controlled trials supporting the use of therapeutic hypothermia in cardiac arrest survivors has provided a remarkable opportunity to reduce mortality and neurologic disability from this leading cause of death. ⋯ This review will focus on the hospital-based application of therapeutic hypothermia in adult cardiac arrest survivors, with special attention to practical aspects of cooling, protocol development, and evaluation of recent data from "real world" experiences using hypothermia as a treatment option. Finally, remaining research questions and directions for future improvements in therapy will be discussed.
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Journal of neurotrauma · Mar 2009
ReviewUse of prolonged hypothermia to treat ischemic and hemorrhagic stroke.
Therapeutic (induced) hypothermia (TH) has been extensively studied as a means to reduce brain injury following global and focal cerebral ischemia, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Here, we briefly review the clinical and experimental evidence supporting the use of TH in each condition. ⋯ However, there is presently insufficient evidence to support the clinical use of TH for ICH and SAH. In any case, further animal work is needed to develop optimized protocols for treating cardiac arrest (global ischemia), and to maximize the likelihood of successful clinical translation in focal cerebral ischemia.
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Induced hypothermia after ischemic stroke is a promising neuroprotective therapy and is the most potent in pre-clinical models. Technological limitations and homeostatic mechanisms that maintain core body temperature, however, have limited the clinical application of hypothermia. Advances in intravascular cooling and successful trials of hypothermia after global cerebral ischemia, such as in cardiac arrest and neonatal asphyxia, have renewed interest in hypothermia for stroke.
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Journal of neurotrauma · Mar 2009
ReviewProtection in animal models of brain and spinal cord injury with mild to moderate hypothermia.
For the past 20 years, various laboratories throughout the world have shown that mild to moderate levels of hypothermia lead to neuroprotection and improved functional outcome in various models of brain and spinal cord injury (SCI). Although the potential neuroprotective effects of profound hypothermia during and following central nervous system (CNS) injury have long been recognized, more recent studies have described clinically feasible strategies for protecting the brain and spinal cord using hypothermia following a variety of CNS insults. In some cases, only a one or two degree decrease in brain or core temperature can be effective in protecting the CNS from injury. ⋯ This paper reviews the experimental data obtained in animal models of brain and SCI demonstrating the benefits of mild to moderate hypothermia. These studies have provided critical data for the translation of this therapy to the clinical arena. The mechanisms underlying the beneficial effects of mild hypothermia are also summarized.