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Hypothermie und Targeted Temperature Management (TTM) als Therapiekonzept

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NeuroIntensiv

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Zusammenfassung

Die Körper- und damit auch Gehirntemperatur beeinflusst tierexperimentell und klinisch das Ausmaß der zerebralen Schädigung sowie das funktionelle Outcome und die Mortalität nach akuter Hirnschädigung. Fieber verschlechtert experimentell und klinisch das Outcome. Bei therapeutischer Beeinflussung der Körper- oder Gehirntemperatur sind zu unterscheiden das sog. Targeted Temperature Management (TTM), bei dem eine bestimmte Temperatur Ziel der Interventionen ist – also auch Fiebertherapie –, von der sog. induzierten Hypothermie, bei der Körper- oder Gehirntemperatur unter den Normalwert gesenkt werden. Als physikalische Maßnahme greift induzierte Hypothermie im Gegensatz zu pharmakologischen Substanzen mit einem spezifischen Wirkmechanismus an nahezu allen Stellen der pathophysiologischen Kaskade nach akuter Hirnschädigung an. Die zunehmende Erfahrung in der Hypothermiebehandlung, Ergebnisse klinischer Studien und neue Verfahren zur Induktion/Aufrechterhaltung von Hypothermie sowie die Therapie von Nebenwirkungen führten zu neuen klinischen Studien auf nahezu allen Gebieten der akuten Hirnschädigung.

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Literatur

  1. Arrich J et al (2009) Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane database of systematic reviews CD004128

    Google Scholar 

  2. Bernard SA et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563

    Article  PubMed  Google Scholar 

  3. Bro-Jeppesen J, Hassager C, Wanscher M et al (2013) Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest. Resuscitation 84:1734–1740

    Article  PubMed  Google Scholar 

  4. Busch H-J et al (2010) Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest. Resuscitation 81:943–949

    Article  PubMed  Google Scholar 

  5. Clifton GL et al (2001) Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 344:556–563

    Article  CAS  PubMed  Google Scholar 

  6. Clifton GL et al (2011) Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol 10:131–139

    Article  PubMed  Google Scholar 

  7. De Georgia MA et al (2004) Cooling for Acute Ischemic Brain Damage (COOL AID): a feasibility trial of endovascular cooling. Neurology 63:312–317

    Article  PubMed  Google Scholar 

  8. Drennan IR, Lin S, Thorpe KE, Morrison LJ (2014) The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest. Resuscitation 08

    Google Scholar 

  9. Enerbäck S (2010) Human brown adipose tissue. Cell Metab 11:248–252

    Article  PubMed  Google Scholar 

  10. Esposito E, Ebner M, Ziemann U, Poli S (2014) In cold blood: intraarteral cold infusions for selective brain cooling in stroke. J Cereb Blood Flow Metab 34:743–752

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fingas M, Clark DL, Colbourne F (2007) The effects of selective brain hypothermia on intracerebral hemorrhage in rats. Exp Neurol 208:277–284

    Article  PubMed  Google Scholar 

  12. Georgiadis D et al (2001) Endovascular cooling for moderate hypothermia in patients with acute stroke: first results of a novel approach. Stroke 32:2550–2553

    Article  CAS  PubMed  Google Scholar 

  13. Gillies MA et al (2010) Therapeutic hypothermia after cardiac arrest: A retrospective comparison of surface and endovascular cooling techniques. Resuscitation 81:1117–1122

    Article  PubMed  Google Scholar 

  14. HACA (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556

    Article  Google Scholar 

  15. Hemmen TM et al (2010) Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ICTuS-L): final results. Stroke 41:2265–2270

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hemmen TM, Rapp K, Raman R et al (2012) Phase 2/3 study of intravenous thrombolysis and hypothermia for acute treatment of ischemic stroke (ICTuS 2/3). Crit Care 16(Suppl 2):A13

    PubMed Central  Google Scholar 

  17. ILCOR (2005) International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 4: Advanced life support. Resuscitation 67:213–247

    Article  Google Scholar 

  18. Jacobs S et al (2007) Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane database of systematic reviews (Online) CD003311

    Google Scholar 

  19. Jordan JD, Carhuapoma JR (2007) Hypothermia: comparing technology. J Neurol Sci 261:35–38

    Article  PubMed  Google Scholar 

  20. Kawai N et al (2001) Effects of hypothermia on thrombin-induced brain edema formation. Brain Res 895:50–58

    Article  CAS  PubMed  Google Scholar 

  21. Kawai N, Nakamura T, Nagao S (2002) Effects of brain hypothermia on brain edema formation after intracerebral hemorrhage in rats. Acta Neurochir (Suppl) 81:233–235

    CAS  Google Scholar 

  22. Kim F et al (2007) Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation 115:3064–3070

    Article  PubMed  Google Scholar 

  23. Kollmar R, Schwab S (2010) Therapeutic hypothermia in neurological critical care. Dtsch Med Wochenschr 135:2361–2365

    Article  CAS  PubMed  Google Scholar 

  24. Kollmar R et al (2009) Ice-cold saline for the induction of mild hypothermia in patients with acute ischemic stroke: a pilot study. Stroke 40:1907–1979

    Article  CAS  PubMed  Google Scholar 

  25. Kollmar R et al (2010) Hypothermia Reduces Perihemorrhagic Edema After Intracerebral Hemorrhage. Stroke 41:1684–1689

    Article  PubMed  Google Scholar 

  26. Kollmar R, Juettler E, Huttner HB, Dörfler A, Staykov D, Kallmuenzer B, Schmutzhard E, Schwab S, Broessner G, CINCH investigators (2012) Cooling in intracerebral hemorrhage (CINCH) trial: protocol of a randomized German-Austrian clinical trial. Int J Stroke 7:168–172

    Article  PubMed  Google Scholar 

  27. Kranke P et al (2004) Single-dose parenteral pharmacological interventions for the prevention of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg 99:718–727 (table of contents)

    Article  CAS  PubMed  Google Scholar 

  28. Liu L, Yenari (2007) Therapeutic hypothermia: neuroprotective mechanisms. Front Biosci 12:816–825

    Article  CAS  PubMed  Google Scholar 

  29. MacLellan CL et al (2006) The influence of hypothermia on outcome after intracerebral hemorrhage in rats. Stroke 37:1266–1270

    Article  PubMed  Google Scholar 

  30. Mahmood MA, Zweifler RM (2007) Progress in shivering control. J Neurol Sci 26:47–54

    Article  Google Scholar 

  31. Marion DW et al (1997) Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 336:540–546

    Article  CAS  PubMed  Google Scholar 

  32. Morrison LJ et al (2010) Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 122(16 Suppl 2):345–421

    Article  Google Scholar 

  33. Mourvillier B, Tubac F, van de Beek D (2013) Induced Hypothermia in Severe Bacterial Meningitis. A Randomized Clinical Trial. JAMA 310:2174–2183

    Article  CAS  PubMed  Google Scholar 

  34. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M et al (2013) Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. New Engl J Med 369:2197–2206

    Article  CAS  PubMed  Google Scholar 

  35. O’Collins VE et al (2006) 1,026 experimental treatments in acute stroke. AnnNneurol 59:467–477

    Google Scholar 

  36. Peterson K, Carson S, Carney N (2008) Hypothermia treatment for traumatic brain injury: a systematic review and meta-analysis. J Neurotrauma 25:62–71

    Article  PubMed  Google Scholar 

  37. Piironen K, Tiainen M, Mustanoja S (2014) Mild Hypothermia After Intravenous Thrombolysis in Patients With Acute Stroke: A Randomized Controlled Trial. Stroke 45:486–491

    Article  CAS  PubMed  Google Scholar 

  38. Polderman KH (2004) Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence. Intensive Care Med 30:556–575

    Article  PubMed  Google Scholar 

  39. Polderman KH (2004) Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality – Part 2: Practical aspects and side effects. Intensive Care Med 30:757–769

    Article  PubMed  Google Scholar 

  40. Polderman KH (2009) Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 37(7 Suppl):186–202

    Article  Google Scholar 

  41. Poli S, Purrucker J, Priglinger M et al (2013) Induction of cooling with a passive head and neck cooling device: effects on brain temperature after stroke. Stroke 44:708–713

    Article  PubMed  Google Scholar 

  42. Poli S, Purrucker J, Priglinger M et al (2014) Safety evaluation of nasopharyngeal cooling (RhinoChill(R)) in stroke patients: an observational study. Neurocrit Care 20:98–105

    Article  PubMed  Google Scholar 

  43. Poli S, Purrucker J, Priglinger M et al (2014) Rapid Induction of COOLing in Stroke Patients (iCOOL1): A randomised pilot study comparing cold infusions with nasopharyngeal cooling. Crit Care (accepted)

    Google Scholar 

  44. Rutherford MA et al (2005) Mild hypothermia and the distribution of cerebral lesions in neonates with hypoxic-ischemic encephalopathy. Pediatrics 116:1001–1006

    Article  PubMed  Google Scholar 

  45. Saini M et al (2009) Effect of hyperthermia on prognosis after acute ischemic stroke. Stroke 40:3051–3059

    Article  PubMed  Google Scholar 

  46. Schwab S et al (1998) Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 29:2461–2466

    Article  CAS  PubMed  Google Scholar 

  47. Schwab S et al (2001) Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 32:2033–2035

    Article  CAS  PubMed  Google Scholar 

  48. Sena ES, et al. The impact of pethidine on the neuroprotective effects of hypothermia, in European Stroke Conference 2009; Stockholm, Sweden

    Google Scholar 

  49. Sessler DI (2009) Defeating normal thermoregulatory defenses: induction of therapeutic hypothermia. Stroke 40:e614–621

    Article  CAS  PubMed  Google Scholar 

  50. Sessler DI (2009) Thermoregulatory defense mechanisms. Crit Care Med 37(7 Suppl):S203–210

    Article  CAS  PubMed  Google Scholar 

  51. Seule MA, Muroi C, Mink S, Yonekawa Y, Keller E (2009) Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm. Neurosurgery 64:86–92

    Article  PubMed  Google Scholar 

  52. Seule M, Muroi C, Sikorski C et al (2014) Therapeutic hypothermia reduces middle cerebral artery flow velocity in patients with severe aneurysmal subarachnoid hemorrhage. Neurocrit Care 20:255–262

    Article  CAS  PubMed  Google Scholar 

  53. Springborg JB, Springborg KK, Romner B (2013) First clinical experience with intranasal cooling for hyperthermia in brain-injured patients. Neurocrit Care 18:400–405

    Article  PubMed  Google Scholar 

  54. Staykov D, Schwab S, Dörfler A, Kollmar R (2011) Hypothermia reduces perihemorrhagic edema after intracerebral hemorrhage: but does it influence functional outcome and mortality? Ther Hypothermia Temp Manag 1:105–106

    Article  PubMed  Google Scholar 

  55. Staykov D, Wagner I, Volbers B et al (2013) Mild prolonged hypothermia for large intracerebral hemorrhage. Neurocrit Care 18:178–183

    Article  PubMed  Google Scholar 

  56. Thoresen M et al (2001) Twenty-four hours of mild hypothermia in unsedated newborn pigs starting after a severe global hypoxic-ischemic insult is not neuroprotective. Pediatr Res 50:405–411

    Article  CAS  PubMed  Google Scholar 

  57. Todd MM et al (2005) Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med 352:135–145

    Article  CAS  PubMed  Google Scholar 

  58. Tømte O et al (2011) A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors. Crit Care Med 39:443–449

    Article  PubMed  Google Scholar 

  59. van der Worp HB et al (2007) Hypothermia in animal models of acute ischaemic stroke: a systematic review and meta-analysis. Brain 130(Pt 12):3063–3074

    Article  PubMed  Google Scholar 

  60. van der Worp HB, Macleod MR, Bath PM et al (2014) EuroHYP-1: European multicenter, randomized, phase III clinical trial of therapeutic hypothermia plus best medical treatment vs. best medical treatment alone for acute ischemic stroke. Int J Stroke 9:642–645

    Article  PubMed  Google Scholar 

  61. Wagner KR et al (2006) Delayed profound local brain hypothermia markedly reduces interleukin-1beta gene expression and vasogenic edema development in a porcine model of intracerebral hemorrhage. Acta Neurochir (Suppl) 96:177–182

    Article  CAS  Google Scholar 

  62. Winters SA, Wolf KH, Kettinger SA et al (2013) Assessment of risk factors for post-rewarming ″rebound hyperthermia″ in cardiac arrest patients undergoing therapeutic hypothermia. Resuscitation 84:1245–1249

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Klinik für Neurologie und Neurogeriatrie, Klinikum Darmstadt, Grafenstrasse 9, 64283, Darmstadt, Deutschland

    Rainer Kollmar Prof. Dr.

  2. Neurologie mit Schwerpunkt neurovaskuläre Erkrankungen, Universität Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    Sven Poli Dr.

Authors
  1. Rainer Kollmar Prof. Dr.
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  2. Sven Poli Dr.
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Correspondence to Rainer Kollmar Prof. Dr. .

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Editors and Affiliations

  1. Neurologische Klinik, Universitätklinikum Erlangen, Erlangen, Germany

    Stefan Schwab

  2. Neurologische Klinik und Geriatrie, Johannes Wesling Klinikum Minden, Minden, Germany

    Peter Schellinger

  3. Klinik für Anästhesiologie, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Germany

    Christian Werner

  4. Neurochirurgische Klinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany

    Andreas Unterberg

  5. Neurologische Klinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany

    Werner Hacke

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Kollmar, R., Poli, S. (2015). Hypothermie und Targeted Temperature Management (TTM) als Therapiekonzept. In: Schwab, S., Schellinger, P., Werner, C., Unterberg, A., Hacke, W. (eds) NeuroIntensiv. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46500-4_15

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  • DOI: https://doi.org/10.1007/978-3-662-46500-4_15

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