How I cool children in neurocritical care.
Brain injury is the leading cause of death in our pediatric ICU [Au et al. Crit Care Med 36:A128, 2008]. Clinical care for brain injury remains largely supportive. Therapeutic hypothermia has been shown to be effective in improving neurological outcome after adult ventricular-arrhythmia-induced cardiac arrest and neonatal asphyxia, and is under investigation as a neuroprotectant after cardiac arrest and traumatic brain injury in children in our ICU and other centers. To induce hypothermia in children comatose after cardiac arrest we target 32-34 degrees C using cooling blankets and intravenous iced saline as primary methods for induction, for 24-72 h duration with vigilant re-warming. The objective of this article is to share our hypothermia protocol for cooling children with acute brain injury.
Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA. finkel@ccm.upmc.edu
Ericka L
EL
Fink
Patrick M
PM
Kochanek
Robert S B
RS
Clark
Michael J
MJ
Bell
D000328:Adult; D001238:Asphyxia Neonatorum / Q000150:complications* / Q000628:therapy*; D001831:Body Temperature; D001925:Brain Damage, Chronic / Q000517:prevention & control*; D001930:Brain Injuries / Q000628:therapy*; D002648:Child; D003128:Coma / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016032:Randomized Controlled Trials as Topic; D017694:Rewarming / Q000379:methods