Hyperemia prior to acute brain swelling during rewarming of patients who have been treated with moderate hypothermia for severe head injuries

Iida, Koji; Kurisu, Kaoru; Arita, Kazunori; Ohtani, Minako

doi:10.3171/jns.2003.98.4.0793

Cited by 36 publications

(18 citation statements)

References 34 publications

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“…This is unlikely to occur in cardiac arrest for which intracranial hypertension and brain edema may not be important factors in such patients. Iida and colleagues [13] recently monitored the velocity of blood flow in the internal carotid arteries in 11 patients with severe head injury who were cooled within 6 h of injury to 32-358C for 48-72 h. Three of them had evidence of cerebral hyperemia followed by an increase in ICP during rewarming. The hyperemia resolved and ICP decreased when the patients were cooled again with mannitol, and barbiturates.…”

Section: Duration Of Mild Hypothermia On Traumatic Brain Injurymentioning

confidence: 96%

Current status of cerebral protection with mild-to-moderate hypothermia after traumatic brain injury

Jiang

Yang

2007

Current Opinion in Critical Care

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Section: Duration Of Mild Hypothermia On Traumatic Brain Injurymentioning

confidence: 96%

Current status of cerebral protection with mild-to-moderate hypothermia after traumatic brain injury

Jiang

Yang

2007

Current Opinion in Critical Care

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“…Finally, the study confirms previous reports on ICP reductions during hypothermia in patients with acute brain injury [16][17][18]33]. In order to avoid rebound of ICP, rewarming should be performed ICP-controlled and no faster than 0.5-1 °C per 24 h. Furthermore, an abnormal increase in Doppler blood flow velocities during rewarming may serve as an index in the prediction of acute brain swelling, undermining the use of TCD as a rapid and noninvasive method to monitor cerebral hemodynamics during hypothermia [34]. Hypothermia is a therapeutic approach that likely interferes with a variety of processes leading to secondary brain injury, of these the suppression of cerebral metabolic rates of oxygen and glucose has been regarded as its most prevalent neuroprotective effect [12].…”

Section: Discussionmentioning

confidence: 63%

Therapeutic Hypothermia Reduces Middle Cerebral Artery Flow Velocity in Patients with Severe Aneurysmal Subarachnoid Hemorrhage

et al. 2013

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Background: Transcranial Doppler (TCD) is widely used to detect and follow up cerebral vasospasm after sub-arachnoid hemorrhage (SAH). Therapeutic hypothermia might influence blood flow velocities assessed by TCD. The aim of the study was to evaluate the effect of hypo-thermia on Doppler blood flow velocity after SAH. Methods: In 20 patients treated with hypothermia (33°) due to refractory intracranial hypertension or delayed cerebral ischemia (DCI), mean flow velocity of the middle cerebral artery (MFVMCA) was assessed by TCD. Thirteen patients were treated with combined hypothermia and barbiturate coma and seven with hypothermia alone. MFVMCA was obtained within 24 h before and after induction of hypothermia as well as before and after rewarming. Results: Hypothermia was induced on average 5 days after SAH (range 1-12) and maintained for 144 h (range 29-270). After hypothermia induction, MFVMCA decreased from 113.7 ± 49.0 to 93.8 ± 44.7 cm/s (p = 0.001). The decrease was independent of SAH-related complications and barbiturate coma. MFVMCA further decreased by 28.2 cm/s between early and late hypothermia (p < 0.001). This second decrease was observed in patients with DCI (p < 0.001), but not in patients with intracranial hypertension (p = 0.715). Compared to late hypothermia, MFVMCA remained unchanged after rewarming (65.6 ± 32.1 vs 70.3 ± 36.8 cm/s; p = 0.219). However, patients treated with hypothermia alone showed an increase in MFVMCA after rewarming (p = 0.016). Conclusion: Therapeutic hypothermia after SAH decrea-ses Doppler blood flow velocity in both intracranial hypertension and DCI cases. The results can be the effect of hypothermiarelated mechanisms or resolving cerebral vasospasm during prolonged hypothermia. AbstractBackground: Transcranial Doppler (TCD) is widely used to detect and follow up cerebral vasospasm after sub-arachnoid hemorrhage (SAH). Therapeutic hypothermia might influence blood flow velocities assessed by TCD. The aim of the study was to evaluate the effect of hypo-thermia on Doppler blood flow velocity after SAH. Methods: In 20 patients treated with hypothermia (33°) due to refractory intracranial hypertension or delayed cerebral ischemia (DCI), mean flow velocity of the middle cerebral artery (MFVMCA) was assessed by TCD. Thirteen patients were treated with combined hypothermia and barbiturate coma and seven with hypothermia alone. MFVMCA was obtained within 24 h before and after induction of hypothermia as well as before and after rewarming. Results: Hypothermia was induced on average 5 days after SAH (range 1-12) and maintained for 144 h (range 29-270). After hypothermia induction, MFVMCA decreased from 113.7 ± 49.0 to 93.8 ± 44.7 cm/s (p = 0.001). The decrease was independent of SAH-related complications and barbiturate coma. MFVMCA further decreased by 28.2 cm/s between early and late hypothermia (p < 0.001). This second decrease was observed in patients with DCI (p < 0.001), but not in patients with intracranial hypertension (p = 0.715). Compared to late hypotherm...

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“…During or shortly after rewarming, 15 of the 50 patients died as a result of a rebound increase in the ICP and associated herniation. To provide a more objective scientific approach to optimal timing for rewarming, Iida et al investigated middle cerebral artery flow velocity with transcranial Doppler (TCD) in TBI patients who did or did not have acute brain swelling when they were rewarmed [35]. They found that TCD detection of hyperemia predicted acute brain swelling with rewarming, and advised that patients with this TCD finding should have longer periods of hypothermia and slower rates of rewarming.…”

Section: Clinical Use Of Hypothermia For Ichmentioning

confidence: 96%

Contemporary Management of Traumatic Intracranial Hypertension: Is There a Role for Therapeutic Hypothermia?

Schreckinger

Marion

2009

Neurocrit Care

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Therapeutic moderate hypothermia is as effective, or more effective, than most other treatments for ICH. If used for 2-3 days or less there is no evidence that it causes clinically significant adverse events. The lack of consistent evidence that hypothermia improves long-term neurologic outcome should not preclude consideration of its use for the primary treatment of ICH since no other ICP therapy is held to this standard.

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Hyperemia prior to acute brain swelling during rewarming of patients who have been treated with moderate hypothermia for severe head injuries

Abstract: Hyperemia, detectable by TCD ultrasonography, may serve as an index in the prediction of acute brain swelling, and rewarming should be terminated when such a hemodynamic phenomenon is observed.

Cited by 36 publications

References 34 publications

Current status of cerebral protection with mild-to-moderate hypothermia after traumatic brain injury

Current status of cerebral protection with mild-to-moderate hypothermia after traumatic brain injury

Therapeutic Hypothermia Reduces Middle Cerebral Artery Flow Velocity in Patients with Severe Aneurysmal Subarachnoid Hemorrhage

Contemporary Management of Traumatic Intracranial Hypertension: Is There a Role for Therapeutic Hypothermia?

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