Therapeutic hypothermia for adult viral meningoencephalitis.
BACKGROUND
Despite the advances in critical care, severe viral meningoencephalitis continues to impose high rates of morbidity and mortality. Consequently, new treatment strategies are needed and we present therapeutic hypothermia (TH) as one of the possible efficacious treatment tools.


METHODS
We present the case series in an adult intensive care unit of a tertiary care hospital. Eleven patients suffering from severe viral meningoencephalitis were treated with hypothermia. The major indication for TH was severely impaired consciousness associated with carbon dioxide reactivity loss assessed by Transcranial Doppler. Besides from the established treatment, all the patients underwent TH. Mild hypothermia (rectal temperature of 32-34°C) was maintained with continuous veno-venous hemofiltration.


RESULTS
Median Glasgow coma scale score in our patients at admission was 8 (3-10) and median Acute Physiology and Chronic Health Evaluation score was 24 (12-32). The overall mortality rate was 9% (1/11). Among survivors, the outcome was favorable in five patients [Glasgow Outcome Scale score (GOS) 4-5]. Remaining five patients had severe residual neurological deficit (GOS 3). Median GCS at discharge was 15 (8-15). With respect to disease severity, the outcome in presented patients was generally satisfactory.


CONCLUSIONS
Our results suggest that use of mild hypothermia in selected adult patients with viral meningoencephalitis could be a promising treatment tool.
School of Medicine, University of Zagreb, Zagreb, Croatia. marko.kutlescha@gmail.com
Marko
M
Kutleša
Bruno
B
Baršić
Dragan
D
Lepur
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
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