Targeted temperature management in neurological intensive care unit

Abstract

Targeted temperature management (TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy (HIE). In addition, TTM is also useful for treatment of elevated intracranial pressure (ICP). HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit (ICU). The most common cause of HIE is cardiac arrest. Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest. Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies. Several methods of TTM have been reported in the literature. TTM can apply to various clinical conditions associated with hypoxic/ischemic brain injury and elevated ICP in Neurologic ICU.

Comparison of a Continuous Noninvasive Temperature to Monitor Core Temperature Measures During Targeted Temperature Management

“…TTM improves outcomes by reducing effects of the primary insult and minimizing the secondary neurological insult often associated with hypoxic/ischemic encephalopathy (HIE) and intracranial hypertension [1][2][3]21]. Ideally, all patients undergoing TTM should have continuous core temperature measurements.…”

“…2 Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, USA. 3 Department of Nursing, University of Maryland Medical Center, Baltimore, USA. 4 Department of Nursing, Hood College, Frederick, USA.…”

“…The detrimental effects of hyperthermia in the neurologically injured patient, along with the beneficial effects of normothermia, have been widely studied in the critically ill neurological population [1][2][3]. For these reasons, targeted temperature management (TTM) has become a mainstay therapy in this population.…”

Noteworthy Literature published in 2017 for Cardiac Critical Care

“…The term therapeutic hypothermia has largely been replaced by "targeted temperature management" (TTM) after the meeting of 5 major professional physician societies in 2011. 31,32 TTM is used to treat elevations in intracranial pressure, provide neuroprotection from hypoxic/ ischemic encephalopathy, and most commonly, for cardiac arrest victims. However, the use of TTM has come under scrutiny recently with some authors advocating a moratorium on the practice.…”

Hipotermia terapéutica controlada. Experiencia en un Hospital de Tercer Nivel

“…Solís ADA et al Experiencia en hipotermia terapéutica anóxicas después de un paro cardiaco, trauma craneoencefálico grave, enfermedad vascular cerebral grave (isquémica y hemorrágica), hipertensión intracraneal, encefalopatía hepática, entre otras. 5,6 Ochenta por ciento de los pacientes sometidos a hipotermia terapéutica en el estudio correspondió a neurocríticos, cuya indicación fue edema cerebral grave; destaca que el total de estos pacientes (n = 4) tenía una etiología no traumática.…”