Author: Padmaja Durga, Additional Professor, Department of Anesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, A.P., India. Abstract:
Therapeutic hypothermia has been advocated for neuroprotection in cardiac arrest-induced encephalopathy, neonatal hypoxic-ischemic encephalopathy, traumatic brain injury, stroke, hepatic encephalopathy, and spinal cord injury, and as an adjunct to aneurysm surgery. In this review, we address physiological mechanism of hypothermia to mitigate neurological injury, the trials that have been performed for each of these indications, the strength of the evidence to support treatment with mild/moderate hypothermia. Evidence is strongest for prehospital cardiac arrest and neonatal hypoxic-ischemic encephalopathy. For traumatic brain injury, a recent meta-analysis suggests that cooling may increase the likelihood of a good outcome, but does not change mortality rates. For many of the other indications, such as stroke and spinal cord injury, trials are ongoing, but the data is insufficient to recommend routine use of hypothermia at this time. Although induced hypothermia appears to be a highly promising treatment, it should be emphasized that it is associated with a number of potentially serious side effects, which may negate some or all of its potential benefits. Prevention and/or early treatment of these complications are the key to successful use of hypothermia in clinical practice. Key words: Therapeutic Hypothermia, mechanism, clinical application, evidence, cooling methods, practical aspects.
Mechanisms underlying neuroprotective effects of Hypothermia Potential clinical applications of hypothermia
Physiological, Metabolic and cellular effects of hypothermia Practical Aspects of TH
Hypothermia has been used for medicinal purposes since ancient times. It has been used to provide...