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.
Fink
Ericka L
EL
Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA. finkel@ccm.upmc.edu
Kochanek
Patrick M
PM
Clark
Robert S B
RS
Bell
Michael J
MJ
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