[Therapeutic hypothermia after traumatic brain injury or subarachnoid hemorrhage. Current practices of German anaesthesia departments in intensive care].
BACKGROUND
We aimed to explore current practices in use of therapeutic hypothermia after traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH) in intensive care of adults.


METHODS
Questionnaires were sent to anaesthesia department chairs in German hospitals with neurosurgical care in January 2004 with a survey focussing on cooling procedures, temperature measurement, depth and duration of hypothermia, and rewarming after therapy.


RESULTS
99 (67%) questionnaires on TBI and 95 (64%) on SAH could be analysed. Hypothermia was used in 39% after TBI and 18% after SAH. Its aims were neuroprotection in approximately 45% and control of refractory intracranial hypertension in approximately 50%. However, in most cases (69% TBI, 59% SAH) hypothermia was used in less than a quarter of patients treated. A criterion for hypothermia was severe disease in approximately 40% and refractory intracranial hypertension in approximately 50%. Temperatures were targeted to 36-34 degrees C in 77% after TBI and 88% after SAH. In more than 80%, bladder temperatures were measured. For induction of hypothermia, surface cooling was applied in approximately 90%. The duration of hypothermia was 24-48 h in 62% after TBI and 29% after SAH. Cooling was orientated at the intracranial pressure (ICP) in 31% after TBI and 47% after SAH, and was used for more than 48 h in approximately 25%. After hypothermia was stopped, a rewarming rate of 0.5 degrees C/h was applied in 38% after TBI and 53% after SAH. In approximately 35%, rewarming was orientated at the ICP, and in 33% after TBI and 24% after SAH, it was performed over 24 h. After SAH, spontaneous rewarming was used in 24%.


CONCLUSIONS
Therapeutic hypothermia is used in 39% after TBI and 18% after SAH in the intensive care of German anaesthesia departments. There is no standard in management, and there is wide variation in practices of duration of cooling and rewarming. For patients' benefit, evidence-based recommendations on therapeutic hypothermia should be published by the appropriate medical societies in the German language.
Himmelseher
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Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München. s.himmelseher@lrz.tu-muenchen.de
Werner
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C
D000328:Adult; D000761:Anesthesia Department, Hospital; D001831:Body Temperature / Q000502:physiology; D001930:Brain Injuries / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D007036:Hypothermia, Induced; D013345:Subarachnoid Hemorrhage / Q000628:therapy*; D011795:Surveys and Questionnaires