Induction of Brain Hypothermia Treatment
Mild brain hypothermia treatment (34°C) is indicated in patients with a Glasgow Coma Scalescore (GCS) of 8 or less, serum glucose concentration less than 230 mg/dl, and no clinical signs of herniation. The duration is variable at 3–7 days, and brain hypothermia should be started within 3h after insult (Fig. 28, Chap. 23). Moderate brain hypothermia (32°–33°C) is indicated in patients with a GCS of 6 or less, and serum glucose concentration less than 180 mg/dl. The duration is variable at 4–14 days. Early brain hypothermia treatment is indicated for the prevention of vegetation. A flat electroencephalogram (EEG) and no response of the auditory brain stem evoked potential (ABER), breathing arrest, and pupil dilatation are not signs of contraindication at admission (Fig. 79). This is because, despite the disappearance of cell membrane potentials shortly after brain damage, many neuronal cells remain alive. However, these critical signs suggest the contraindication of brain hypothermia treatment 3–6 h after brain trauma and stroke.
KeywordsSerum Glucose Brain Edema Disseminate Intravascular Coagulation Cerebral Perfusion Pressure Vasopressin Release
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