Hypothermia for traumatic brain injury

Lewis, Sharon R; Evans, David; Butler, Andrew; Schofield‐Robinson, Oliver J; Alderson, Phil

doi:10.1002/14651858.cd001048.pub5

Cited by 59 publications

(55 citation statements)

References 78 publications

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“…From the literature, it is difficult to discern the evidence for reactive TTM norm to manage neurogenic fever from the data published on the use of prophylactic TTM norm or TTM hypo for neuroprotection in TBI and stroke. 5,12,14,15 Overall, the panel felt that the evidence for TTM hypo in patients with neurogenic fever in ICH, SAH, and AIS was poor, and that, on balance, hypothermia could be associated with negative outcomes. The panel, therefore, recommended TTM norm for these patients, and hence, the focus of this paper.…”

Section: Discussionmentioning

confidence: 99%

Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: consensus recommendations

Andrews

Verma

Healy

et al. 2018

British Journal of Anaesthesia

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Section: Discussionmentioning

confidence: 99%

Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: consensus recommendations

Andrews

Verma

Healy

et al. 2018

British Journal of Anaesthesia

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“…Further approaches for improvement could exploit the possibilities of enhancing PpIX accumulation as described in the introduction, where rather instantaneous clinical applicability might be the delivery of vitamin D3. Also, the application of brain hypothermia is an established procedure in neurology . Apart from applying 100% oxygen breathing during PDT, it may be important to exploit preclinical observations of an improved tumor tissue response to PDT by fractionated irradiation .…”

Section: ‐Ala Based Photodynamic Therapy Of Malignant Gliomamentioning

confidence: 99%

5‐ALA in the management of malignant glioma

Stepp¹,

2018

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Background: Patients suffering from malignant gliomas have a poor prognosis. For the surgical treatment of these tumors, 5-aminolevulinic acid (5-ALA) has become a new standard. Aims: This review intends to provide an overview over current status, significance, limitations, and future perspectives of 5-ALA based fluorescence guided surgery and photodynamic therapy for brain tumor patients. Materials and Methods: From peer reviewed publications on the many aspects connected with this topic, those with potential clinical relevance were selected and put in the context of our own experience. Results and Discussion: The high tumor selectivity of accumulation of fluorescent protoporphyrin IX (PpIX) after systemic administration of 5-ALA enables intra-operative fluorescence guidance, which is unimpaired by brainshift and does not require expensive equipment. The neurosurgical aim of complete resection of enhancing tumor can now more easily be achieved, which improves prognosis in these patients. Nevertheless, despite better surgery tumors will inevitably recur. In order to further prolong survival, the phototoxic properties of PpIX are presently being exploited in clinical trials of post-operative or interstitial photodynamic therapy (PDT). Conclusion: 5-ALA based fluorescence guidance and PDT offer an intriguing new option for the management of malignant gliomas. Lasers Surg. Med. 50:399-419, 2018.

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“…Hypothermia is being investigated as a potential therapy for TSCI [58] based on data that hypothermia is neuroprotective in animal models by targeting many pathological processes, e.g., reducing metabolic rate, inflammation, edema, oxidative stress, excitotoxicity, electrolyte imbalance, as well as apoptotic and necrotic cell death in damaged CNS tissue [59][60][61][62][63][64][65][66]. Despite the encouraging findings of animal studies, randomized controlled human trials have failed to show functional benefit of hypothermia in human TBI [67][68][69]. Though small, nonrandomized studies of TSCI patients suggest improved outcome after local [70,71] or systemic [58,72] hypothermia, there are no published randomized controlled trials of hypothermia for TSCI.…”

Section: Hypothermiamentioning

confidence: 99%

Targeted Perfusion Therapy in Spinal Cord Trauma

Saadoun

Papadopoulos

2020

Neurotherapeutics

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We review state-of-the-art monitoring techniques for acute, severe traumatic spinal cord injury (TSCI) to facilitate targeted perfusion of the injured cord rather than applying universal mean arterial pressure targets. Key concepts are discussed such as intraspinal pressure and spinal cord perfusion pressure (SCPP) at the injury site, respectively, analogous to intracranial pressure and cerebral perfusion pressure for traumatic brain injury. The concept of spinal cord autoregulation is introduced and quantified using spinal pressure reactivity index (sPRx), which is analogous to pressure reactivity index for traumatic brain injury. The Ushaped relationship between sPRx and SCPP defines the optimum SCPP as the SCPP that minimizes sPRx (i.e., maximizes autoregulation), and suggests that not only ischemia but also hyperemia at the injury site may be detrimental. The observation that optimum SCPP varies between patients and temporally in each patient supports individualized management. We discuss multimodality monitoring, which revealed strong correlations between SCPP and injury site metabolism (tissue glucose, lactate, pyruvate, glutamate, glycerol), monitored by surface microdialysis. Evidence is presented that the dura is a major, but unappreciated, cause of spinal cord compression after TSCI; we thus propose expansion duroplasty as a novel treatment. Monitoring spinal cord blood flow at the injury site has revealed novel phenomena, e.g., 3 distinct blood flow patterns, local steal, and diastolic ischemia. We conclude that monitoring from the injured spinal cord in the intensive care unit is a safe technique that appears to enable optimized and individualized spinal cord perfusion.

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Hypothermia for traumatic brain injury

Abstract: Editorial group: Cochrane Injuries Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 9, 2017.

Cited by 59 publications

References 78 publications

Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: consensus recommendations

Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: consensus recommendations

5‐ALA in the management of malignant glioma

Targeted Perfusion Therapy in Spinal Cord Trauma

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