Effect and feasibility of controlled rewarming after moderate hypothermia in stroke patients with malignant infarction of the middle cerebral artery.
OBJECTIVE
Moderate hypothermia has been found to reduce intracranial pressure (ICP) significantly in patients who have severe middle cerebral artery infarction. However, during passive rewarming, ICP continuously rises and some patients suffer transtentorial herniation.


METHODS
We investigated the question of whether slower rewarming leads to slower increase in ICP and slower decrease in cerebral perfusion pressure (CPP). Furthermore, we studied feasibility of slow, controlled rewarming. ICP, CPP, and core body temperature were monitored continuously. Achievement of rewarming protocol was assessed by hit rate of temperature target intervals. Side effects of hypothermia were assessed.


RESULTS
Rates of change of both ICP and CPP were correlated significantly with increase in temperature (ICP r=0.62, P=0.002; CPP r=-0.50, P=0.017). In feasibility analysis of 13 controlled rewarmed patients, hit rate of temperature target intervals was 63% (median; range 48% to 81%); hit rate within the target interval or below was 79% (median; range 62% to 94%).


CONCLUSIONS
Slow, controlled rewarming is feasible and may be used for ICP and CPP control after moderate hypothermia for space-occupying infarction.
Steiner
T
T
Department of Neurology, University of Heidelberg, Heidelberg, Germany. thorsten_steiner@med.uni-heidelberg.de
Friede
T
T
Aschoff
A
A
Schellinger
P D
PD
Schwab
S
S
Hacke
W
W
D001831:Body Temperature; D005240:Feasibility Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D019586:Intracranial Hypertension / Q000209:etiology / Q000517:prevention & control; D012044:Regression Analysis; D017694:Rewarming / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome