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عمومی::
هیپوترمی، هیپوترمی، هیپوترمی
The concept of targeted temperature management in neurocritical care includes therapeutic mild hypothermia, controlled normothermia, and aggressive treatment of fever.32 Although in head trauma patients, induced mild or moderate hypothermia failed to improve outcome, hypo- thermia did improve neurologic outcome in neonates with hypoxic-ischemic encephalopathy and in patients after out- of-hospital cardiac arrest.33-35 To cool patients, gel pads or intravascular temperature-modulating devices with servo- controls should be used to minimize overshoot.
Decompressive craniectomy has been a strategy to lower ICP, but unfortunately this intervention increases the number of patients surviving in a vegetative state or with severe brain damage.122,123 Prophylactic mild hypothermia was also a promising intervention to reduce ICP; however, in prospective multicenter studies, this ther- apy was not superior to normothermia.35 ICP control with high-dose steroids was shown to have an adverse effect on mortality and morbidity in a multicenter study of more than 10,000 patients with brain injury.124 Therefore, ste- roids are not recommended for control of ICP after TBI.
Many drugs have been tested for their potential neuro- protective effects; however, high-dose methylprednisolone, monosialotetrahexosylganglioside (GM-1), riluzole, fibro- blast growth factor, minocycline, or magnesium have not improved outcome after SCI in prospective, randomized, multicenter studies.141 Early mild hypothermia after SCI showed some promising results in clinical studies; however, they have to be validated by prospective, randomized, mul- ticenter studies.142
Confounders, such as hypothermia, metabolic or endo- crine compromise, and persistent sedative or neuromuscular drugs, must be corrected.
Treatment of comatose sur- vivors of out-of-hospital cardiac arrest with induced hypothermia.،The concept of targeted temperature management in neurocritical care includes therapeutic mild hypothermia, controlled normothermia, and aggressive treatment of fever.32 Although in head trauma patients, induced mild or moderate hypothermia failed to improve outcome, hypo- thermia did improve neurologic outcome in neonates with hypoxic-ischemic encephalopathy and in patients after out- of-hospital cardiac arrest.33-35 To cool patients, gel pads or intravascular temperature-modulating devices with servo- controls should be used to minimize overshoot.
Decompressive craniectomy has been a strategy to lower ICP, but unfortunately this intervention increases the number of patients surviving in a vegetative state or with severe brain damage.122,123 Prophylactic mild hypothermia was also a promising intervention to reduce ICP; however, in prospective multicenter studies, this ther- apy was not superior to normothermia.35 ICP control with high-dose steroids was shown to have an adverse effect on mortality and morbidity in a multicenter study of more than 10,000 patients with brain injury.124 Therefore, ste- roids are not recommended for control of ICP after TBI.
Many drugs have been tested for their potential neuro- protective effects; however, high-dose methylprednisolone, monosialotetrahexosylganglioside (GM-1), riluzole, fibro- blast growth factor, minocycline, or magnesium have not improved outcome after SCI in prospective, randomized, multicenter studies.141 Early mild hypothermia after SCI showed some promising results in clinical studies; however, they have to be validated by prospective, randomized, mul- ticenter studies.142
Confounders, such as hypothermia, metabolic or endo- crine compromise, and persistent sedative or neuromuscular drugs, must be corrected.
Treatment of comatose sur- vivors of out-of-hospital cardiac arrest with induced hypothermia.،
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