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Recent advances in anesthesia for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Haley Reis, Onat Akyol, Vadim Gospodarev, Cesar Reis, Gocke Yilmaz, Richard Applegate, Sheng Chen, John Zhang
When the overall results of the National Acute Brain Injury Study: Hypothermia regarding benefits of hypothermia after SCI were negative,22 efforts were made to understand how to improve the treatment effects of mild therapeutic hypothermia. These hypotheses included speeding up the time to reach hypothermia,22 as well as maintaining appropriate fluid volume, cerebral perfusion pressure, and ICP.23 Prolonged therapeutic hypothermia (32°C–34°C) starting within a median time of 3.0 hours, and lasting for at least 72 hours, followed by slow rewarming at a rate of <1°C per day under tight hemodynamic management for severe TBI did not improve neurologic outcomes, as determined by the Glasgow Outcome Scale at 6 months follow-up, or decrease the risk of mortality compared with control groups with strict temperature control (35.5°C–37°C).24 Using therapeutic hypothermia with standard care within 10 days after injury on patients with >20 mmHg ICP despite conventional treatment after TBI did not result in better outcomes compared with those who received standard care alone.25
Temperature
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
Measurement of body temperature often underestimates brain temperature, especially when central nervous system is vulnerable. Usefulness of Therapeutic hypothermia in human beings is still debated though its being used in severe TBI, Subarachnoid hemorrhage, stroke. Fever management in the perioperative period as well in neurosurgical ICUs is of importance to avoid secondary insults.
Perinatal asphyxia
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Perinatal asphyxia is an important cause of death and disability in the term neonate. Although the pathophysiology of the asphyxial process is understood, there are currently few interventions available that preserve brain function and few treatment modalities have been subject to RCTs. Mild therapeutic hypothermia has recently shown positive results and is discussed later in the chapter.
Mild Hypothermia via External Cooling Improves Lung Function and Alleviates Pulmonary Inflammatory Response and Damage in Two-Hit Rabbit Model of Acute Lung Injury
Published in Journal of Investigative Surgery, 2022
Onat Akyol, Serdar Demirgan, Aslıhan Şengelen, Hasan Cem Güneyli, Duygu Sultan Oran, Funda Yıldırım, Damla Haktanır, Mehmet Salih Sevdi, Kerem Erkalp, Ayşin Selcan
Hypothermic targeted temperature management (TTM) is an area of ongoing investigation for several different medical conditions (27, 28). It is the most established clinical application in patients after cardiac arrest. In critical care medicine, it is recommended to maintain the core body temperature of 32–34 °C for comatose patients after cardiac arrest (11). Besides the post-cardiac arrest situation, several experimental studies documented beneficial outcomes by therapeutic hypothermia, especially in different brain injury animal models (9). Apart from these, various experimental and clinical studies reported the protective effects of hypothermia in lung injury, pneumonia, and COVID-19 (12–15). Significant molecular mechanisms of controlled therapeutic hypothermia (TH) include the modulating and suppressing the mitogen-activated protein kinase (MAPK), nuclear factor-kappa B (NF-κB), and tumor necrosis factor-alpha (TNF-α) pathways, ameliorating inflammation, decreasing free radical generation, inhibiting excitotoxicity and apoptosis, and slowing down of metabolism. Importantly, hypothermia plays a protective role during the inflammatory response by suppressing the inflammatory cascade and decreasing nitric oxide, cytokine, and leukotriene production (8, 29–31). In addition, some studies have revealed that action mechanism of TH include the improvement of gas exchange and lung mechanics in patients (15, 32, 33).
The Effect of Mild Hypothermia on Nogo-A and Neurological Function in the Brain after Cardiopulmonary Resuscitation in Rats
Published in Fetal and Pediatric Pathology, 2022
Mild therapeutic hypothermia (MTH) is currently the only proven effective method of brain protection from ischemia/reperfusion injury that can improve survival rates and reduce neurologic sequelae [6]. The different degrees of therapeutic hypothermia include profound therapeutic hypothermia, moderate therapeutic hypothermia, and MTH. Profound therapeutic hypothermia and moderate therapeutic hypothermia have been applied in neurosurgery and cardiac surgery, and were associated with cerebral protection after traumatic brain injury [7]. However, the mechanism of cerebral protection associated with MTH is unclear. When hypothermia is too low, the patient may experience serious complications including blood coagulation dysfunction and arrhythmia [8]. However, if hypothermia only reduces the temperature by 2–3 °C, cerebral protection is achieved and none of the complications associated with profound therapeutic hypothermia are induced. Therefore, therapeutic hypothermia has attracted interest, and the benefits of MTH were acknowledged in cardiopulmonary resuscitation (CPR) guidelines in 2010. A recent study showed that with every hypothermic reduction of 1 °C, the cerebral metabolic rate reduced by 6–10% [9]. Cerebral protection is not only associated with a reduced cerebral metabolic rate, but also with the slowing of a series of injurious reactions including the generation of free radicals, mitochondrial and cell membrane damage, and calcium ion pump dysfunction. Thus, hypothermia can protect against cerebral ischemic and reperfusion injury [9].
Pre-hospital mild therapeutic hypothermia for patients with severe traumatic brain injury
Published in Brain Injury, 2022
Wusi Qiu, Mingmin Chen, Xu Wang, Ws Qiu, Mm Chen, X Wang
The best effects of therapeutic hypothermia in our present study might lie in the following factors. We excluded the patients with GCS 3, and all patients in our study reached their target temperature. While in POLAR-RCT (The Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury-Randomized Clinical Trial) study (18), a significant number of patients in the hypothermia group never reached the target temperature of 33°C (19% had hypothermia withdrawn early and a further 13% did not reach 33°C), and enrollment of patients without sTBI in the out-of-hospital setting before full evaluation might be another factor for the incorrect application of prophylactic hypothermia rather than therapeutic hypothermia. Furthermore, the clinicians and patients’ families were not blinded to the intervention in the POLAR-RCT study.