Timing of Rewarming

  • Nariyuki Hayashi
  • Dalton W. Dietrich


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].


Brain Edema Brain Damage Metabolic Shift Brain Injured Patient Albumin Ratio 
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  1. 1.
    Hayashi N (2000) Enhanced neuronal damage in severely brain injured patients by hypothalamus, pituitary, and adrenal axis neuro-hormonal changes. In: Hayashi N (ed) Brain hypothermia. Springer, Berlin Heidelberg New York Tokyo, pp 3-26CrossRefGoogle Scholar
  2. 2.
    Hayashi N (2000) The clinical issue and effectiveness of brain hypothermia treatment for severe brain injured patients. In: Hayashi N (ed) Brain hypothermia. Springer, Berlin Heidelberg New York Tokyo, pp 121–151CrossRefGoogle Scholar

Copyright information

© Springer Japan 2004

Authors and Affiliations

  • Nariyuki Hayashi
    • 1
    • 2
  • Dalton W. Dietrich
    • 3
    • 4
  1. 1.Nihon University Emergency Medical CenterTokyoJapan
  2. 2.Department of Emergency and Critical Care MedicineNihon University School of MedicineTokyoJapan
  3. 3.Department of Neurological Surgery, Neurology and Cell Biology and AnatomyUniversity of Miami School of MedicineMiamiUSA
  4. 4.The Miami Project to Cure ParalysisMiamiUSA

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