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Temperaturmanagement nach Schädel-Hirn-Trauma in der prähospitalen Notfallversorgung

Eine aktuelle Skizze zur Hypothermie

Temperature management after traumatic brain injury in prehospital emergency care: a current view on hypothermia

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Zusammenfassung

Für das Management der Temperatur in der präklinischen Notfallversorgung des Patienten mit Schädel-Hirn-Trauma (SHT) gibt es kaum auf der Evidenz von Studien basierende Daten. Bisher fehlen auch valide, prospektive Untersuchungen zu den Auswirkungen einer therapeutischen Hypothermie auf das Endergebnis (Outcome) nach SHT in der Notfallmedizin. Unverändert gilt deshalb das Anstreben einer normothermen Körpertemperatur als Ziel der Maßnahmen des Temperaturmanagements nach SHT in der Prähospitalphase. Eine Hyperthermie ist zu vermeiden.

Zukünftige Forschungsarbeiten werden klären, ob eine milde bis moderate präklinische Hypothermietherapie in Kombination mit einer innerklinischen Kühlbehandlung von wenigstens 24 h Dauer das Endergebnis nach isoliertem SHT bei jüngeren Patienten verbessern kann. Bei polytraumatisierten Patienten mit SHT ist zu prüfen, ob eine milde präklinische Hypothermie angesichts der geringen Temperatursenkung zu einer klinisch relevanten Beeinträchtigung der Gerinnung führt bzw. günstige Auswirkungen auf das traumatisierte Gehirn hat. Bei schädel-hirn-traumatisierten Patienten mit traumatisch-hämorrhagischer Hypotension bzw. Volumenmangelschock sollte insbesondere die für potenziell neuroprotektive Effekte benötigte Tiefe der Temperaturreduktion untersucht werden.

Abstract

Evidence-based data on temperature management in prehospital care of patients with traumatic brain injury (TBI) are scarce. Regarding the outcome after TBI, there is also as yet a lack of valid, prospective trials on the effects of therapeutic hypothermia in the field. Normothermia is therefore still regarded as the goal of preclinical measures of temperature management after TBI. Hyperthermia has to be avoided.

Future research will clarify whether mild to moderate preclinical therapeutic hypothermia combined with inner clinical cooling of at least 24-hours duration may improve the outcome of younger patients with isolated TBI. In patients with multiple injuries and TBI, it is a priority to examine whether mild preclinical hypothermia induces a clinically relevant impairment of coagulatory functions in view of the small temperature decrease, and whether it is associated with beneficial effects on the traumatized brain. In case of TBI and hemorrhagic hypotension or volume depletion shock, the depth of temperature reduction necessary for potential neuroprotective effects should be studied.

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

    C. Werner

  2. Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München

    S. Himmelseher

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  1. S. Himmelseher
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  2. C. Werner
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Correspondence to S. Himmelseher.

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Himmelseher, S., Werner, C. Temperaturmanagement nach Schädel-Hirn-Trauma in der prähospitalen Notfallversorgung. Notfall Rettungsmed 9, 179–185 (2006). https://doi.org/10.1007/s10049-006-0801-7

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  • DOI: https://doi.org/10.1007/s10049-006-0801-7

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