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Current Neurology and Neuroscience Reports

, Volume 6, Issue 6, pp 509–517 | Cite as

Therapeutic temperature modulation in neurocritical care

  • Neeraj Badjatia
Article

Abstract

The ability to effectively achieve and maintain longterm temperature control is an important goal that has been previously unachievable in the neurocritical care setting. Previous attempts have been limited by the inability to overcome physiologic defense mechanisms, short duration of action, or significant adverse effects. Recent advances in technology have made therapeutic temperature modulation feasible. In this review, current concepts of therapeutic temperature modulation are presented. New advances in technology may provide an important breakthrough in the ability to reduce fever-associated morbidity in neurocritically ill patients. What remains to be seen is whether the advantages of these technologies will outweigh the risks associated with therapeutic temperature modulation.

Keywords

Dexmedetomidine Therapeutic Hypothermia Mild Hypothermia Neurocritical Care Acute Brain Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Fay T: Observations on generalized refrigeration in cases of severe cerebral trauma. Assoc Res Nerv Ment Dis Proc 1945, 24:611–619.Google Scholar
  2. 2.
    Clifton GL, Miller ER, Choi SC, et al.: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001, 344:556–563.PubMedCrossRefGoogle Scholar
  3. 3.
    Kilpatrick R, Megan M, Lowry DW, et al.: Hyperthermia in the Neurosurgical Intensive Care Unit. Neurosurgery 2000, 47:850–856.PubMedCrossRefGoogle Scholar
  4. 4.
    Mackowiak PA: Concepts of fever. Arch Intern Med 1998, 158:1870–1881.PubMedCrossRefGoogle Scholar
  5. 5.
    Koennecke HC, Leistner S: Prophylactic antipyretic treatment with acetaminophen in acute ischemic stroke: a pilot study. Neurology 2001, 57:2301–2303.PubMedGoogle Scholar
  6. 6.
    Kasner SE, Wein T, Piriyawat P, et al..: Acetaminophen for altering body temperature in acute stroke: a randomized clinical trial. Stroke 2002, 33:130–135.PubMedCrossRefGoogle Scholar
  7. 7.
    Dippel DW, van Breda EJ, van Gemert HM, et al.: Effect of paracetamol (acetaminophen) on body temperature in acute ischemic stroke: a double-blind, randomized phase II clinical trial. Stroke 2001, 32:1607–1612.PubMedGoogle Scholar
  8. 8.
    Dippel DW, van Breda EJ, van der Worp HB, et al.: Effect of paracetamol (acetaminophen) and ibuprofen on body temperature in acute ischemic stroke PISA, a phase II double-blind, randomized, placebo-controlled trial. BMC Cardiovasc Disord 2003, 3:2.PubMedCrossRefGoogle Scholar
  9. 9.
    van Breda EJ, van der Worp BH, van Gemert MH, et al.: PAIS: paracetamol (acetaminophen) in stroke; protocol for a randomized, double blind clinical trial. BMC Cardiovasc Disord 2005, 5:24. Important study.PubMedCrossRefGoogle Scholar
  10. 10.
    Polderman KH: Application of therapeutic hypothermia in the intensive care unit. Intensive Care Med 2004, 30:757–769.PubMedCrossRefGoogle Scholar
  11. 11.
    Wyndham CH, Strydom NB, Cooke HM, et al.: Methods of cooling subjects with hyperpyrexia. J Appl Physiol 1959, 14:771–776.PubMedGoogle Scholar
  12. 12.
    Steele RW, Tanaka PT, Lara RP, Bass JW: Evaluation of sponging and of oral antipyretic therapy to reduce fever. J Pediatr 1970, 77:824 -829.PubMedCrossRefGoogle Scholar
  13. 13.
    Mayer SA, Commichau C, Scarmeas N, et al.: Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients. Neurology 2001, 56:292–298.PubMedGoogle Scholar
  14. 14.
    Morgan SP: A comparison of three methods of managing fever in the neurologic patient. J Neurosci Nurs 1990, 22:19–24.PubMedGoogle Scholar
  15. 15.
    Poblette B, Romand JA, Pichard C, et al.: Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients. Br J Anaesth 1997, 78:123–127.Google Scholar
  16. 16.
    O’Donnell J, Axelrod P, Fisher C, Lorber B: Use and effectiveness of hypothermia blankets for febrile patients in the intensive care unit. Clin Infect Dis 1997, 24:1208–1213.PubMedGoogle Scholar
  17. 17.
    Mayer SA, Kowalski RG, Presciutti M, et al.: Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med 2004, 32:2508–2515.PubMedCrossRefGoogle Scholar
  18. 18.
    Rajek A, Grief R, Sessler DI, et al.: Core cooling by central venous infusion of ice-cold (4 degrees Celcius or 20 degrees Celcius) fluid: isolation of core and peripheral thermal compartments. Anaesthesiology 2000, 93:629–637.CrossRefGoogle Scholar
  19. 19.
    Bernard S, Buist M, Monteiro O, Smith K: Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 2003, 56:9–13.PubMedCrossRefGoogle Scholar
  20. 20.
    Badjatia, N, Vijayappa, M, Guanci M, Rordorf G A: Cold saline infusion as an adjunct to conventional treatment for refractory fever. Crit Care Med 2004, 32(Suppl):A103.Google Scholar
  21. 21.
    Steinberg GK, Ogilvy CS, Shuer LM, et al.: Comparison of endovascular cooling to surface cooling during unruptured cerebral aneurysm repair. Neurosurgery 2003, 55:307–315.Google Scholar
  22. 22.
    Badjatia N, O’Donnell J, Baker JR, et al.: Achieving normothermia in patients with febrile subarachnoid hemorrhage: feasibility and safety of a novel intravascular cooling catheter. Neurocritical Care 2002, 1:145–156.CrossRefGoogle Scholar
  23. 23.
    Schmutzhard E, Engelhardt K, Beer R, et al.: Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study. Crit Care Med 2002, 30:2481–2488.PubMedCrossRefGoogle Scholar
  24. 24.
    Diringer MN, for the Neurocritical Care Fever Reduction Trial Group: Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 2004, 32:559–564.PubMedCrossRefGoogle Scholar
  25. 25.
    Oliveira-Filho J, Ezzeddine MA, Segal AZ, et al.: Fever in subarachnoid hemorrhage: relationship to vasospasm and outcome. Neurology 2001, 56:1299–1304.PubMedGoogle Scholar
  26. 26.
    Jiang JY, Gao GY, Li WP, et al.: Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 2002, 19:869–874.PubMedCrossRefGoogle Scholar
  27. 27.
    Schwarz S, Hafner K, Aschoff A, Schwab S: Incidence and prognostic significance of fever following intracerebral hemorrhage. Neurology 2000, 54:354–361.PubMedGoogle Scholar
  28. 28.
    McIntyre LA, Fergusson DA, Hebert PC, et al.: Prolonged therapeutic hypothermia after traumatic brain injury in adults. JAMA 2003, 289:2992–2999.PubMedCrossRefGoogle Scholar
  29. 29.
    Polderman KH, Tjong Tjin, Joe R, et al.: Effects of artificially induced hypothermia on intracranial pressure and outcome in patients with severe traumatic head injury. Intensive Care Med 2002, 28:1563–1567.PubMedCrossRefGoogle Scholar
  30. 30.
    Jiang J, Yu M, Zhu C: Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg 2000, 93:546–549.PubMedGoogle Scholar
  31. 31.
    De Georgia MA, Krieger DW, Abou-Chebl A, et al.: Cooling for acute ischemic brain damage (COOL AID): a feasibility trial of endovascular cooling. Neurology 2004, 63:312–317.PubMedGoogle Scholar
  32. 32.
    Negovsky VA: Postresuscitation disease. Crit Care Med 1988, 16:942–946.PubMedCrossRefGoogle Scholar
  33. 33.
    Benson DW, Williams GR, Spencer FC: The use of hypothermia after cardiac arrest. Anesth Analg 1958, 38:423–428.Google Scholar
  34. 34.
    The Hypothermia After Cardiac Arrest (HACA) study group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002, 346:549–556.CrossRefGoogle Scholar
  35. 35.
    Bernard SA, Gray TW, Buist MD, et al.: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002, 346:557–563.PubMedCrossRefGoogle Scholar
  36. 36.
    Thome C, Schubert G, Piepgras A, et al.: Hypothermia reduces acute vasospasm following SAH in rats. Acta Neurochir Suppl 2001, 77:255–258.PubMedGoogle Scholar
  37. 37.
    Piepgras A, Elste V, Frietsch T, et al.: Effect of moderate hypothermia on experimental severe subarachnoid hemorrhage, as evaluated by apparent diffusion coefficient changes. Neurosurgery 2001, 48:1128–1135.PubMedCrossRefGoogle Scholar
  38. 38.
    Nagao S, Irie K, Kawai N, et al.: Protective effect of mild hypothermia on symptomatic vasospasm: a preliminary report. Acta Neurochir Suppl 2000, 76:547–550.PubMedGoogle Scholar
  39. 39.
    Nagao S, Irie K, Kawai N, et al.: The use of mild hypothermia for patients with severe vasospasm: a preliminary report. J Clin Neurosci 2003, 10:208–212.PubMedCrossRefGoogle Scholar
  40. 40.
    Oliveira-Filho J, Ezzeddine MA, Segal AZ, et al.: Fever in subarachnoid hemorrhage: relationship to vasospasm and outcome. Neurology 2001, 56:1299–1304.PubMedGoogle Scholar
  41. 41.
    Badjatia N, O’Donnell J, Baker JR, et al.: Achieving normothermia in patients with febrile subarachnoid hemorrhage: feasibility and safety of a novel intravascular cooling catheter. Neurocrit Care 2002, 1:145–156.CrossRefGoogle Scholar
  42. 42.
    Valeri CR, Feingold H, Cassidy G, et al.: Hypothermiainduced reversible platelet dysfunction. Ann Surg 1987, 205:175–181;PubMedCrossRefGoogle Scholar
  43. 43.
    Watts DD, Trask A, Soeken K, et al.: Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function and fibrinolytic activity. J Trauma 1998, 44:846–854.PubMedGoogle Scholar
  44. 44.
    Valeri CR, MacGregor H, Cassidy G, et al.: Effects of temperature on bleeding time and clotting time in normal male and female volunteers. Crit Care Med 1995, 23:698–704.PubMedCrossRefGoogle Scholar
  45. 45.
    Resnick DK, Marion DW, Darby JM: The effect of hypothermia on the incidence of delayed traumatic intracerebral hemorrhage. Neurosurgery 1994, 34:352–356.CrossRefGoogle Scholar
  46. 46.
    Schwab S, Georgiadis D, Berrouschot J, et al.: Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 2001, 32:2033–2035.PubMedGoogle Scholar
  47. 47.
    Marion DW, Penrod LE, Kelsey SF, et al.: Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 1997, 336:540 -546.PubMedCrossRefGoogle Scholar
  48. 48.
    Hammel HH, Fusco JD: Thermoregulatory responses to hypothalamic cooling in unanesthetized dogs. Am J Physiol 1960, 198:481–486.PubMedGoogle Scholar
  49. 49.
    Horvath SS, Hutt GB, Hamilton BK: Metabolic cost of shivering. J Appl Physiol 1956, 8:595–602.PubMedGoogle Scholar
  50. 50.
    Just BD, Camus E, Lienhart Y: Oxygen reuptake during recovery following naloxone. Anesthesiology 1992, 76:60–64.PubMedCrossRefGoogle Scholar
  51. 51.
    Ciofolo MC, Devilliers F, Ben-Ammar C, et al.: Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology 1989, 70:737–741.PubMedCrossRefGoogle Scholar
  52. 52.
    De Witte J, Sessler DI: Perioperative shivering: physiology and pharmacology. Anesthesiology 2002, 96:467–484.PubMedCrossRefGoogle Scholar
  53. 53.
    Polderman KH, Peerdeman SM, Girbes AR: Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 2001, 94:697–705.PubMedCrossRefGoogle Scholar
  54. 54.
    Zweifier RM, Voorhees ME, Mahmood MA, Parnell M: Magnesium sulfate increases the rate of hypothermia via surface cooling and improves comfort. Stroke 2004, 35:2331–2334.CrossRefGoogle Scholar
  55. 55.
    Sessler DI: Complications and treatment of mild hypothermia. Anesthesiology 2001, 95:531–543.PubMedCrossRefGoogle Scholar
  56. 56.
    Kollmar R, Frietsch T, Georgiadis D, et al.: Early effects of acid-base management during hypothermia on cerebral infarct volume, edema, and cerebral blood flow in acute focal cerebral ischemia in rats. Anesthesiology 2002, 97:868–874.PubMedCrossRefGoogle Scholar
  57. 57.
    Clifton GL, Miller ER, Choi SC, et al.: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001, 344:556–563.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2006

Authors and Affiliations

  1. 1.Neurological InstituteNew YorkUSA

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