Therapeutic hypothermia in acute ischemic stroke

Groysman, Leonid; Kim-Tenser, May; Sung, Gene; Mack, William J.

doi:10.3171/2011.4.focus1154

Cited by 37 publications

(30 citation statements)

References 51 publications

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“…Several small human trials have investigated the safety and feasibility of TH after thrombolysis after ischemic stroke, given safety concerns of increased coagulopathy in TH [118][119][120][121][122]. Currently, a larger randomized, multicenter phase 2/3 trial is being conducted to further evaluate safety and efficacy of TH in ischemic stroke (Clinicaltrials.gov.…”

Section: Ischemic Strokementioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

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Section: Ischemic Strokementioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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“…use of a venous catheter-based temperature management system) with concomitant surface warming (e.g. application of a forced warm air blanket) can prevent shivering by modifying the input to the thermoregulatory centers, allowing for a greater degree of hypothermia [99]. While hypothermic, patients should be monitored for changes in blood pressure, arrhythmias, and other cardiac events [3,10,11].…”

Section: Indications For Intraoperative Hypothermiamentioning

confidence: 99%

“…Adverse effects from hypothermia should be minimized. Shivering can be prevented in conscious, moderately hypothermic, spontaneously breathing patients with a combination of meperidine and buspirone [85,99,100]. Alternately, endovascular cooling (e.g.…”

Section: Indications For Intraoperative Hypothermiamentioning

confidence: 99%

“…Packing the patient in ice or using a traditional cooling blanket is inadequate, and these methods can cause significant skin damage [31,34,84,98,99]. Catheter-based heat exchange devices [34,79,85,86], advanced surface cooling devices [34,87], and intravenous infusions of cooled liquids [7,31,83], have all been found to be highly effective at reducing body temperature.…”

Section: Indications For Intraoperative Hypothermiamentioning

confidence: 99%

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Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

Sappenfield¹,

Hong²,

Galvagno³

2013

J Anesthesiol Clin Sci

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Intraoperative management of patient body temperature is a standard of care for practicing anesthesiologists. Merely complying with the Surgical Care Improvement Project (SCIP) measurement is inadequate for optimizing perioperative outcomes. Clinicians should have a sound understanding of available temperature monitoring sites, deleterious effects of hypothermia, and indications for therapeutic hypothermia. This foundation will help physicians use indicated modalities to improve patient outcomes throughout the perioperative period. The purpose of this paper is to review appropriate intraoperative temperature monitoring, the importance of maintaining normothermia, and indications for intraoperative hypothermia.

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“…In addition, muscular blockades are often required to reduce shivering [25]. Intravascular cooling decreases body temperature via blood, by infusing cold fluid through intravenous catheters or devices containing temperature sensors [26][27][28]. The main advantages of intravascular cooling are shorter time to target temperature and more precise hypothermic control.…”

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confidence: 99%

Drug-Induced Hypothermia in Stroke Models: Does it Always Protect?

Zhang¹,

Wang²,

Zhao³

et al. 2013

CNSNDDT

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Ischemic stroke is a common neurological disorder lacking a cure. Recent studies show that therapeutic hypothermia is a promising neuroprotective strategy against ischemic brain injury. Several methods to induce therapeutic hypothermia have been established; however, most of them are not clinically feasible for stroke patients. Therefore, pharmacological cooling is drawing increasing attention as a neuroprotective alternative worthy of further clinical development. We begin this review with a brief introduction to the commonly used methods for inducing hypothermia; we then focus on the hypothermic effects of eight classes of hypothermia-inducing drugs: the cannabinoids, opioid receptor activators, transient receptor potential vanilloid, neurotensins, thyroxine derivatives, dopamine receptor activators, hypothermia-inducing gases, adenosine, and adenine nucleotides. Their neuroprotective effects as well as the complications associated with their use are both considered. This article provides guidance for future clinical trials and animal studies on pharmacological cooling in the setting of acute stroke. KeywordsBrain ischemia; Hypothermic; Neuroprotection; Pharmacological cooling Send correspondence to: Dr. Feng Zhang, Department of Neurology, University of Pittsburgh School of Medicine, 3500 Terrace Street, Pittsburgh, PA, 15213, USA, Telephone: 412-383-7604, Fax: 412-648-1239, zhanfx2@upmc.edu NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript 1. Hypothermia and strokes IntroductionTherapeutic hypothermia is defined as a 2-6°C reduction of core body temperature [1][2][3] and is a promising neuroprotective approach against brain injury induced by strokes. In hemorrhagic stroke, hypothermia reduces brain edema [4,5] and improves neurologic function [4][5][6][7]. In ischemic stroke, hypothermia is also protective, which has been proven in randomized clinical trials in human cardiac arrest and in animal studies of focal and global ischemia [8,9]. However, the impact of hypothermia on patients with acute ischemic stroke still needs to be explored [10]. During the past decades, studies on hypothermia and ischemic stroke have suggested that the required amplitude of protective hypothermia depends on its time of initiation relative to stroke onset, duration, and depth of hypothermia [1,9,11]. Optimal protection is typically gained when hypothermia is induced as early as possible after stroke onset, with a mild-to-moderate hypothermia of 32 to 35°C that lasts at least one to two hours [1, 2, 12-14]. Protective mechanism of hypothermia in ischemic strokeAlthough hypothermia is effective in protecting against experimental models of ischemic stroke, the precise protective mechanisms are not yet fully understood. It has been suggested that the protective mechanisms are multifold, including reductions in metabolic rate, cerebral blood flow, blood-brain barrier damage, as well as decreases in excitotoxicity, apoptosis, inflammation and free radical production [15]. On average, hypothermia red...

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Therapeutic hypothermia in acute ischemic stroke

Cited by 37 publications

References 51 publications

Therapeutic Hypothermia for Acute Neurological Injuries

Therapeutic Hypothermia for Acute Neurological Injuries

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

Drug-Induced Hypothermia in Stroke Models: Does it Always Protect?

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