Clinical application of target temperature management in children with acute encephalopathy–A practical review

Abstract

Acute encephalopathy is a life-threatening disease involving acute brain dysfunction, and it is one of the most important causes of mortality and severe neurological sequelae in infants and children. Approximately 30% of cases of acute encephalopathy result in some degree of neurological sequelae. Although many strategies have been proposed, effective therapies to ameliorate the outcomes of acute encephalopathy have not yet been established. Target temperature management (TTM), previously termed therapeutic hypothermia, has been shown to be effective for various brain injuries due to multiple neuroprotective mechanisms, and it may be considered to be the cornerstone of neuroprotective strategies. Consequently, TTM is currently used in the neurocritical care of adult patients with cardiac arrest with shockable rhythm and perinatal asphyxia. In addition, increasing evidence also indicates that TTM could be useful in other acute encephalopathies, including status epilepticus, acute encephalitis/encephalopathy and traumatic brain injury. In this review, we discuss the recent practical aspects of TTM as a potential intervention for various acute encephalopathies in children.

Therapeutic hypothermia for pediatric refractory status epilepticus May Ameliorate post-status epilepticus epilepsy

“…Applying TH within 6 h after birth is considered a standard treatment for moderate to severe neonatal hypoxic ischemic encephalopathy [ 21 , 22 ]. Further, TH reportedly improves the survival rate and neurologic outcome of neonatal hypoxic ischemic encephalopathy survivors [ 17 , 18 ].…”

Brain Hypothermia Therapy and Targeted Temperature Management for Acute Encephalopathy in Children: Status and Prospects

“…These mechanisms include lowering metabolic rate to balance oxygen supply and demand; lowering the levels of excitatory neurotransmitters, such as glutamate; preventing ATP depletion; and lowering intracellular calcium overload to prevent neuronal apoptosis. Additionally, hypothermia suppresses free-radical toxicity, has favorable effects on intracellular mediator systems, and reduces intracellular acidosis [ 39 , 40 ].…”

Protecting the blossoming brain – Neurocritical care in children

“…Lin et al. describe one candidate therapy, termed target temperature management (TTM), which consists in subjecting the patient to a state of controlled hypothermia [ 35 ]. The rationale behind the strategy is similar to the expected benefits from cooling down any injured tissue: decreasing inflammation, metabolic rates, and oxidative stress.…”

“…In this same issue of the Biomedical Journal , members of the Department of Pediatrics of the Kaohsiung Chang Gung Memorial Hospital in Taiwan advocate for a broader use of target temperature management as a neuroprotective treatment, notably in children [ 35 ].…”