Advertisement

Cooling Therapies after Neuronal Injury: Direct Brain Cooling and Systemic Hypothermia

  • P. J. D. Andrews
  • E. L. Anderson
  • M. Saxena

Abstract

Acute brain injury is a frequent cause of disability and death worldwide. Common forms of acute brain injury include perinatal birth asphyxia, traumatic brain injury (TBI), stroke, and out-of-hospital cardiac arrest. These conditions affect patients with a wide age range from the young to the elderly. Interruption of cerebral oxygen and nutrient delivery by cardio-respiratory insufficiency or by a vascular lesion may precipitate cerebral ischemia. The initial pathology may not induce immediate cell death, but can precipitate a complex biochemical cascade leading to delayed neuronal loss, the end result being death or disability (Fig. 1). This chapter reviews the current evidence on temperature reduction after neuronal injury.

Keywords

Traumatic Brain Injury Acute Ischemic Stroke Neuronal Injury Therapeutic Hypothermia Brain Temperature 
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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Furuse M, Ohta T, Ikenaga T, et al (2003) Effects of intravascular perfusion of cooled crystalloid solution on cold-induced brain injury using an extracorporeal cooling-filtration system. Acta Neurochir (Wien) 145:983–992CrossRefGoogle Scholar
  2. 2.
    Polderman KH, Rijnsburger ER, Peerdeman SM, Girbes ARJ (2005) Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med 33:2744–2751CrossRefPubMedGoogle Scholar
  3. 3.
    Bernard SA, Buist M (2003) Induced hypothermia in critical care medicine: A review. Crit Care Med 31:2041–2051CrossRefPubMedGoogle Scholar
  4. 4.
    Polderman KH, Girbes AR (2004) Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study. Crit Care 8:R459–R466CrossRefPubMedGoogle Scholar
  5. 5.
    Bernard SA, Gray TW, Buist MD, et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563CrossRefPubMedGoogle Scholar
  6. 6.
    Holzer M, Sterz F, Hypothermia After Cardiac Arrest Study Group (2003) Therapeutic hypothermia after cardiopulmonary resuscitation. Expert Rev Cardiovasc Ther 1:317–325CrossRefPubMedGoogle Scholar
  7. 7.
    Hypothermia After Cardiac Arrest Study Group (2002): Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556CrossRefGoogle Scholar
  8. 8.
    Gunn AJ, Thoresen M (2006) Hypothermic neuroprotection. NeuroRx 3:154–169CrossRefPubMedGoogle Scholar
  9. 9.
    Lin ZL, Yu HM, Lin J, Chen SQ, Liang ZQ, Zhang ZY (2006) Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: An experience from a single neonatal intensive care unit. J Perinatol 26:180–184CrossRefPubMedGoogle Scholar
  10. 10.
    Harris OA, Colford JM Jr, Good MC, Matz PG (2002) The role of hypothermia in the management of severe brain injury: a meta-analysis. Arch Neurol 59:1077–1083CrossRefPubMedGoogle Scholar
  11. 11.
    Henderson WR, Dhingra VK, Chittock DR, Fenwick JC, Ronco JJ (2003) Hypothermia in the management of traumatic brain injuryA systematic review and meta-analysis. Intensive Care Med 29:1637–1644CrossRefPubMedGoogle Scholar
  12. 12.
    Alderson P, Gadkary C, Signorini DF (2004) Therapeutic hypothermia for head injury. Cochrane Database Syst Rev: CD001048Google Scholar
  13. 13.
    McIntyre LA, Fergusson DA, Hèbert PC, Moher D, Hutchison JS (2003) Prolonged therapeutic hypothermia after traumatic brain injury in adults: A systematic review. JAMA 289: 2992–2999CrossRefPubMedGoogle Scholar
  14. 14.
    Liu WG, Qiu WS, Zhang Y, Wang WM, Lu F, Yang XF (2000) Effects of selective brain cooling in patients with several traumatic brain injury: a preliminary study. J Int Med Res 34:58–64Google Scholar
  15. 15.
    Correia M, Silva M, Veloso M (2000) Cooling therapy for acute stroke. Cochrane Database Syst Rev: CD001247Google Scholar
  16. 16.
    Gelman B, Schleien CL, Lohe A, Kuluz JW (1996) Selective brain cooling in infant piglets after cardiac arrest and resuscitation. Crit Care Med 24:1009–1017CrossRefPubMedGoogle Scholar
  17. 17.
    Hagioka S, Takeda Y, Takata K, Morita K (2003) Nasopharyngeal cooling selectively and rapidly decreases brain temperature and attenuates neuronal damage, even if initiated at the onset of cardiopulmonary resuscitation in rats. Crit Care Med 31:2502–2508CrossRefPubMedGoogle Scholar
  18. 18.
    Laptook AR, Shalak L, Corbett RJ (2001) Differences in brain temperature and cerebral blood flow during selective head versus whole-body cooling. Pediatrics 108:1103–1110CrossRefPubMedGoogle Scholar
  19. 19.
    Laptook AR, Corbett RJ (2002) The effects of temperature on hypoxic-ischemic brain injury. Clin Perinatol 29:623–649CrossRefPubMedGoogle Scholar
  20. 20.
    Mustafa S, Thulesius O (2002) Cooling-induced carotid artery dilatation: An experimental study in isolated vessels. Stroke 33:256–260CrossRefPubMedGoogle Scholar
  21. 21.
    Mustafa S, Thulesius O, Ismael HN (2004): Hyperthermia-induced vasoconstriction of the carotid artery, a possible causative factor of heatstroke. J Appl Physiol 96:1875–1878CrossRefPubMedGoogle Scholar
  22. 22.
    Mustafa SMD, Thulesius O (2001) Cooling is a potent vasodilator of deep vessels in the rat. Can J Physiol Pharmacol 79:899–904CrossRefPubMedGoogle Scholar
  23. 23.
    Diao C, Zhu L, Wang H (2003) Cooling and rewarming for brain ischemia or injury: theoretical analysis. Ann Biomed Eng 31:346–353CrossRefPubMedGoogle Scholar
  24. 24.
    Maloney SK, Mitchell G (1997) Selective brain cooling: role of angularis oculi vein and nasal thermoreception. Am J Physiol 273:R1108–R1116PubMedGoogle Scholar
  25. 25.
    Nagasaka T, Brinnel H, Hales JR, Ogawa T (1998) Selective brain cooling in hyperthermia: the mechanisms and medical implications. Med Hypotheses 50:203–211CrossRefPubMedGoogle Scholar
  26. 26.
    Andrews PJD, Harris B, Murray GD (2005) Randomized controlled trial of effects of the airflow through the upper respiratory tract of intubated braininjured patients on brain temperature and selective brain cooling. Br J Anaesth 94:330–335CrossRefPubMedGoogle Scholar
  27. 27.
    Harris BA, Andrews PJD, Murray GM (2007) Enhanced upper respiratory tract airflow and head fanning reduce brain temperature, without selective brain cooling, in brain-injured, mechanically ventilated patients: a randomized, crossover, factorial trial. Br J Anaesth 98: 93–99CrossRefPubMedGoogle Scholar
  28. 28.
    Cabanac M, White M (1997): Heat loss from the upper airways and selective brain cooling in humans. Ann N Y Acad Sci 813:613–616CrossRefPubMedGoogle Scholar
  29. 29.
    Cabanac M (1998) Selective brain cooling and thermoregulatory set-point. J Basic Clin Physiol Pharmacol 9:3–13PubMedGoogle Scholar
  30. 30.
    Gomis P, Rousseaux P, Jolly D, Graftieaux JP (1994) Initial prognostic factors of aneurysmal subarachnoid hemorrhages. Neurochirurgie 40:18–30PubMedGoogle Scholar
  31. 31.
    Rousseaux P, Gomis P, Bazin A, et al (1993) Aneurysmal subarachnoid hemorrhage with and without Nimodipine. A comparative study with an analysis of the temperature curve. Neurochirurgie 39:157–165PubMedGoogle Scholar
  32. 32.
    Kammersgaard LP, Jorgensen HS, Rungby JA, et al (2002) Admission body temperature predicts long-term mortality after acute stroke: The Copenhagen Stroke Study. Stroke 33:1759–1762CrossRefPubMedGoogle Scholar
  33. 33.
    Reith J, Jorgensen HS, Pedersen PM, et al (1996) Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet 347:422–425CrossRefPubMedGoogle Scholar
  34. 34.
    Dippel DW, van Breda EJ, van Gemert HM, et al (2001) Effect of paracetamol (acetaminophen) on body temperature in acute ischemic stroke: a double-blind, randomized phase II clinical trial. Stroke 32:1607–1612PubMedGoogle Scholar
  35. 35.
    Dippel DW, van Breda EJ, van der Worp HB, et al (2003) Timing of the effect of acetaminophen on body temperature in patients with acute ischemic stroke. Neurology 61:677–679PubMedGoogle Scholar
  36. 36.
    Hajat C, Hajat S, Sharma P (2000) Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke 31:410–414PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • P. J. D. Andrews
    • 1
  • E. L. Anderson
    • 1
  • M. Saxena
    • 1
  1. 1.Department of Anesthesia, Intensive Care and Pain ManagementWestern General HospitalEdinburghUK

Personalised recommendations