Targeted temperature management in neurocritical care: Boon or bust

Abstract

Temperature management in neurocritical care is important and has gained due importance in recent years. Targeted temperature management (TTM) includes deliberate reduction of core body temperature to a range of 32–34°C in comatose survivors of cardiac arrest after return of spontaneous circulation and also therapeutic hypothermia (33–35°C) in normothermic patients or controlled normothermia (cooling patients to 37°C) in hyperthermic patients. This review focuses on the practical aspects of cooling and temperature management in neurocritical care. An electronic search of Google Scholar, MEDLINE (OVID), EMBASE and the Cochrane library was performed. The physiological changes, potential side effects along with significant research and clinical applications in the field of temperature management are main highlights. Currently, the research evidence is available for TTM in adults following cardiac arrest, neonatal hypoxic ischaemic encephalopathy and raised intracranial pressure. Controlled normothermia in neurocritical care population is rapidly gaining popularity. However, data on disease specific therapeutic markers, therapeutic depth and duration and prognostication of this modality are limited. Overall in experienced hands, the technique is safe to execute without the major morbidity and a potential to improve the outcome. Though over the years, clinical applications are unable to consistently demonstrate its benefits, but TTM in neurological insult has become an established and promising concept.

Targeted Temperature Management in Traumatic Brain Injury

“…This sys tem facilitates its use in clinical practice [57]. This TTM machine is connected with circulating cold water blankets/pads or cold airblow blankets [88,89]. Core temperature measurement is mandatory for automatic feedback system.…”

Hipotermia terapéutica controlada. Experiencia en un Hospital de Tercer Nivel

“…Por otro lado, este sistema multimodal hace que los efectos sean difíciles de predecir, y un efecto benefi cioso podría ser superado por limitaciones, efectos secundarios o complicaciones. 3 Existen varios aspectos importantes al considerar la hipotermia terapéutica, entre los que destacan: el momento de iniciarla, la técnica, la profundidad, la duración y el proceso de recalentamiento. Se deben considerar las terapias combinadas con hipotermia, fármacos o cirugía de descompresión (en el caso de lesión cerebral aguda), que son cotratamientos que generan sinergia.…”