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

Abstract

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.

Hipotermia intravascular prolongada en un paciente con hipertensión endocraneana refractaria

“…En relación a su efi cacia, Schreckinger, M. y cols., en una revisión de la literatura, compararon el empleo de hipotermia con otras medidas convencionales para la HEC post TEC 18 . En un total de 16 estudios, que incluyeron un grupo control con normotermia, se analizaron 367 pacientes.…”

“…En un total de 16 estudios, que incluyeron un grupo control con normotermia, se analizaron 367 pacientes. La hipotermia logró reducir la PIC en 9,97 ± 6,66 mmHg, lo que fue tan efectivo como otras terapias convencionales: hiperventilación, manitol o barbitúricos 18 .…”

“…Nuestro caso refl eja la efi cacia de la hipotermia descrita para el manejo de la HEC 18 . Nuestra intención fue prolongar su uso por 48 h, pero estuvimos obligados a mantenerla por 13 días, debido a los rebotes de HEC durante los intentos de recalentamiento.…”

Therapeutic Hypothermia for Acute Neurological Injuries

“…In a recent review, TH was compared to other therapies for reduction of elevated ICP [115]. The effect of TH on lowering ICP was as effective as hyperventilation, mannitol, and barbiturates, but less effective than hypertonic saline, cerebrospinal fluid drainage, and decompressive craniectomy.…”

Investigating the Effects of Mild Induced Hypothermia on Cognition using a Measure of Sustained Attention

“…Induced mild therapeutic hypothermia; where a patients core body temperature is reduced to [30][31][32][33][34] ∘ C [1] has come to be recognised a major neuro-protective factor in the treatment of TBI [2,3], ischemic stroke [4] and cardiac arrest [5]. It is thought that the main benefits include the triggering of cerebral anti-inflammatory processes and a reduction in neuronal apoptosis [6], though the precise mechanisms leading to these effects are still poorly understood [7].…”