Therapeutic Hypothermia for Traumatic Brain Injury

摘要: Experimental evidence demonstrates that therapeutic temperature modulation with the use of mild induced hypothermia (MIH, defined as maintenance body at 32-35 °C) exerts significant neuroprotection and attenuates secondary cerebral insults after traumatic brain injury (TBI). In adult TBI patients, MIH has been used during acute "early" phase prophylactic neuroprotectant in sub-acute "late" to control edema. When edema, is effective reducing elevated intracranial pressure (ICP), a valid therapy refractory hypertension patients. Based on available evidence, we recommend: applying standardized algorithms for management cooling; paying attention limit potential side effects (shivering, infections, electrolyte disorders, arrhythmias, reduced cardiac output); using controlled, slow (0.1-0.2 °C/h) rewarming, avoid rebound ICP. The optimal target should be titrated maintain ICP <20 mmHg temperatures <35 °C. duration cooling individualized until resolution may longer than 48 h. Patients following focal (e.g. hemorrhagic contusions) respond better those diffuse injury. Randomized controlled trials are underway evaluate impact neurological outcome patients early not supported by clinical recommended.