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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2008 July-August;74(7-8):425-30
Hypothermia in adult neurocritical patients: a very “hot” strategy not to be hibernated yet!
Abate M. G. 1,2, Cadore B. 1, Citerio G. 1
1 Neuroanesthesia and NeuroIntensive Care Unit, Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza, Milan, Italy;
2 Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
Therapeutic moderate hypothermia (32-34°C) is currently recommended for patients with out-of-hospital cardiac arrest (OHCA) and for newborns exhibiting neonatal hypoxic/ischemic encephalopathy. Hypothermia as neuroprotective strategy has been extensively studied in other scenarios, mainly for traumatic brain injury. Despite a negative result reported by a multicenter trial conducted in 2001 by Clifton et al. regarding the use of hypothermia on head injury patients, several studies in both clinical and laboratory settings have continued to report positive outcomes with hypothermia use in neurocritical care. To date, no adequate consensus has been reached. Though the topic is still under debate, emerging data suggest that there may not be a clear-cut answer as to whether hypothermia is beneficial. However, new research may indicate what target populations can benefit most from this therapy. Furthermore, issues of timing (when and for how long hypothermia is applied) seem to be the primary drivers of the most unambiguous findings in this matter. For the time being, we conclude that further studies are needed to assess how to better administer this possibly beneficial therapy, and who might benefit most from the technique.