Timing of Rewarming

Abstract

The major issues of rewarming during intensive care unit (ICU) management of brain hypothermia are the metabolic shift from lipid to glucose, increasing serum lactate, induction of proinflammatory cytokines, vascular engorgement, heat production, alteration of blood-brain barrier (BBB) function, bloodflowmetabolic gap, hyperdynamic microcirculation, and increasing serum catecholamine levels. However, in cases of short duration of mild brain hypothermia (24 h at 34°–35°C), the rewarming clinical issues as described above are not serious [2]. Complication at the rewarming stage is more frequently observed in prolonged brain hypothermia treatment. Complication at the rewarming stage is variable and depends on the duration and severity of hypothermia, the degree of control of hypothalamus-pituitary-adrenal (HPA) axis neurohormonal dysfunction, presence of hyperglycemia and hemoglobin dysfunction, complication of pneumonia, degree of recovery from brain damage, and the progression of the brain injury mechanism [2].