title: Therapeutic hypothermia: benefits, mechanisms and potential clinical applications in neurological, cardiac and kidney injury.
abstract: Therapeutic hypothermia involves the controlled reduction of core temperature to attenuate the secondary organ damage which occurs following a primary injury. Clinicians have been increasingly using therapeutic hypothermia to prevent or ameliorate various types of neurological injury and more recently for some forms of cardiac injury. In addition, some recent evidence suggests that therapeutic hypothermia may also provide benefit following acute kidney injury. In this review we will examine the potential mechanisms of action and current clinical evidence surrounding the use of therapeutic hypothermia. We will discuss the ideal methodological attributes of future studies using hypothermia to optimise outcomes following organ injury, in particular neurological injury. We will assess the importance of target hypothermic temperature, time to achieve target temperature, duration of cooling, and re-warming rate on outcomes following neurological injury to gain insights into important factors which may also influence the success of hypothermia in other organ injuries, such as the heart and the kidney. Finally, we will examine the potential of therapeutic hypothermia as a future kidney protective therapy.
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Elizabeth.moore@monash.edu
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Moore
authors.forename: Alistair D
authors.initials: AD
authors.lastname: Nichol
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Bernard
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification / Q000517:prevention & control / Q000628:therapy*; D000328:Adult; D000818:Animals; D001481:Basal Metabolism / Q000502:physiology; D001831:Body Temperature / Q000502:physiology*; D001930:Brain Injuries / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D002545:Brain Ischemia / Q000150:complications; D002986:Clinical Trials as Topic; D003422:Critical Care / Q000379:methods / Q000639:trends*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D002534:Hypoxia, Brain / Q000150:complications / Q000378:metabolism; D015201:Meta-Analysis as Topic; D017202:Myocardial Ischemia / Q000150:complications; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000628:therapy; D018743:Perinatal Care / Q000379:methods; D019990:Perioperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D051381:Rats; D015427:Reperfusion Injury / Q000150:complications*; D017694:Rewarming / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000517:prevention & control