Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence

Abstract

Although induced hypothermia appears to be a highly promising treatment, it should be emphasized that it is associated with a number of potentially serious side effects, which may negate some or all of its potential benefits. Prevention and/or early treatment of these complications are the key to successful use of hypothermia in clinical practice. These side effects, as well as various physiological changes induced by cooling, are discussed in a separate review.

Abordagem do paciente reanimado, pós-parada cardiorrespiratória

“…On the other hand, also in the experimental ischemic BVA, cerebral cooling decreased the volume of the infracted region 16 . After CA, increase of the systemic temperature can be noted and consequent cerebral hyperthermia.…”

“…In the injured brain this difference is signifi cantly higher and may reach up to 3º C. In acute cerebral ischemia there is also a regional increase of temperature, asymmetric to the rest of the brain mass 16 . Animal studies have shown that increment of cerebral temperature is accompanied by neurological deterioration and that its controlled decrease reduces these injuries.…”

“…After CA, increase of the systemic temperature can be noted and consequent cerebral hyperthermia. Upon admission or in the fi rst 24 hours, such an event worsens prognosis, although it remains unclear if this change is an indicator of severity of neurological disease or the determinant of clinical worsening 16,19 . Thus, in the presence of acute brain injury, diffuse or not, after CA or after any other etiology, fever must be aggressively avoided 20 in the fi rst 72 hours of evolution.…”

Therapeutic Hypothermia for Acute Neurological Injuries

“…Hippocrates advocated the packing of wounded soldiers in snow and ice in 400 BC [10]. Clinical interest in hypothermia was regained in the 1930s and 1940s, with observations and case reports describing successful resuscitation of drowning victims who were hypothermic, even after prolonged periods of asphyxia [11]. The first scientific report describing clinical applications of TH in traumatic brain injury (TBI) was published in 1943 [12].…”

“…During the maintenance phase, tight control of the target temperature should be achieved, with minor or no fluctuations (maximum, 0.2°C to 0.5°C). In this phase, attention should shift toward the prevention of longer term side effects, such as pneumonia, wound infections, and bedsores [60]. Finally, the rewarming phase can lead to severe electrolyte abnormalities (mostly hyperkalemia), caused by shifts from the intracellular to the extracellular compartment, and elevation of ICP.…”