[Hypothermia for intracranial hypertension].
There is a large body of experimental evidence showing benefits of deliberate mild hypothermia (33-35 degrees C) on the injured brain as well as an improvement of neurological outcome after cardiac arrest in humans. However, the clinical evidence of any benefit of hypothermia following stroke, brain trauma and neonatal asphyxia is still lacking. Controversial results have been published in patients with brain trauma or neonatal asphyxia. Hypothermia can reduce the elevation of intracranial pressure, through mechanisms not completely understood. Hypothermia-induced hypocapnia should have a role on the reduction of intracranial pressure. The temperature target is unknown but no additional benefit was found below 34 degrees C. The duration of deliberate hypothermia for the treatment of elevated intracranial pressure might be at least 48 hours, and the subsequent rewarming period must be very slow to prevent adverse effects.
Service d'anesthésie et de réanimation, CHU de la Timone-Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex, France. nicolas.bruder@ap-hm.fr
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Codaccioni
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001238:Asphyxia Neonatorum / Q000150:complications / Q000503:physiopathology; D001925:Brain Damage, Chronic / Q000517:prevention & control*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D004198:Disease Susceptibility; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D016857:Hypocapnia / Q000503:physiopathology; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology; D019586:Intracranial Hypertension / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015201:Meta-Analysis as Topic; D011183:Postoperative Complications / Q000503:physiopathology; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D013927:Thrombosis / Q000209:etiology; D014883:Water-Electrolyte Imbalance / Q000209:etiology