Therapeutic hypothermia is associated with a decrease in urine output in acute stroke patients

Abstract

Aims-It is unclear what effect therapeutic hypothermia may have on renal function, because its effect has so far been primarily evaluated in settings in which there may be possible confounding perturbations in cardiovascular and renal physiology, such deep intra-operative hypothermia, general anesthesia, and post-cardiac arrest. We sought to determine if therapeutic hypothermia affects renal function in awake patients with normal renal function who were enrolled into a clinical trial of hypothermia plus intravenous thrombolysis for acute ischemic stroke.Methods-Eleven patients with normal renal function were cooled to 33°C for 24 hours using an endovascular catheter, and then re-warmed over 12 hours to 36.5°C, while hourly temperature, Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Previous presentation:Early portions of this work were presented at the 32th International Stroke Conference, San Francisco, CA at a poster session, NIH Public Access Author ManuscriptResuscitation. Author manuscript; available in PMC 2011 December 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript blood pressure, and fluid status data was recorded. Blood samples for blood urea nitrogen (BUN), creatinine, and hematocrit were drawn prior to treatment (baseline), immediately after hypothermia and re-warming (day 2), and again at day 7 or discharge, and values compared. Conclusion-Inducing hypothermia in patients with relatively unperturbed renal physiology results in a decrease in urine output that is linearly correlated with the decrease in core temperature. This has important implications for fluid management in patients undergoing therapeutic hypothermia. Results-On

Endovascular Therapeutic Hypothermia for Acute Ischemic Stroke: ICTuS 2/3 Protocol

“…We observed no increased risk of peripheral bleeding, intracerebral hemorrhage, catheter‐related complications, sepsis, pancreatitis, coagulopathy, or liver dysfunction in ICTuS‐L. We observed transient oliguria in the hypothermia treatment group that reversed completely .…”

Urine Output Changes During Postcardiac Arrest Therapeutic Hypothermia

“…Guluma et al (2010) evaluated urine output in conscious stroke patients undergoing TH, but found a 5.1-mL/hour decrease in urine output per 1°C decrease in body temperature that persisted during hypothermia maintenance. There are important differences between the Guluma et al and our study.…”

Pharmacological hypothermia: a potential for future stroke therapy?

“…δ-opioid agonist (79) Reduced inflammation 40 mg/kg -4.13 ± 0.20 °C NMRI mice (33,84,85) DADLE δ-opioid agonist Toxicity at 10 mg/kg: (33) 6 mg/kg -3.2 ± 0.20 °C (33) Mice (84) ↓ Blood pressure (85) Arrhythmia Neurotensin (90) NT69L Neurotensin analog (92) Reduced apoptosis, reduced inflammation 2 mg/kg -2 -5 °C Wistar rats (90) Anti-shivering thermoregulatory effects (86) no cold intolerance response (113,114) Heliox Unknown (113,114) Maintenance of animal temperature at 37 °C still elicited neuroprotection 70%/30% helium/oxygen Sprague-Dawley rats (114) Improved regulation of mitochondrial respiration (114) Reduced adverse effects of nitrogen, inflammation, coagulant actions (116) Hydrogen (119,122) AMP (122) A1 receptor agonist (119) No neuroprotection (119) Larger infarct volume (119) 4 mmol/kg (~1.39 g/kg) (119) 33.1 ± 0.7 °C (119) Sprague-Dawley rats (122) C57/BI6 mice (122) Reduced infarct volume ↑ Incidences of hemorrhagic transformation (122) 50-100 mg/ kg (122) Reduced mortality seizure, and, mortality ↓ Blood pressure ↓ Heart rate Hyperglycemia…”

“…14,29 Further, physiologically, hypothermia can lead to cardiovascular compromise, 30 immune suppression, 6 platelet dysfunction, 31 coagulopathy, 32 and decreased urine output. 33 All of these factors would need to be taken into account before hypothermia becomes the standard of care in the future.…”