Targeted temperature management (TTM) as a neuroptotective strategy is applied in a number of scenarios; post-ROSC in cardiac arrest, neonatal asphyxia, traumatic brain injury, to name some. The Neurocritical Care Society have taken it upon themselves to formulate an evidence-based guideline to the implementation and practical management of TTM in a number of settings. Although… Continue reading TTM – New Guidelines from NCS
Summer is in its last month so it’s time to get back to the NeuroScand grind. And we do so with this article by Zoerle and colleagues (among whom we can count Dr. Nino Stocchetti), published in July in Frontiers in Neurology. “Rethinking Neuroprotection in Severe Traumatic Brain Injury: Toward Bedside Neuroprotection” starts off by… Continue reading Rethinking Neuroprotection in Severe Traumatic Brain Injury: Toward Bedside Neuroprotection
Results from the HYBERNATUS trial were just published in the New England Journal of Medicine by Legriel et al. This study recruited 270 patients with convulsive status epilepticus, randomized to either therapeutic hypothermia (32-34 C) or normothermia. All patients were intubated and on controlled ventilation when included. All received standard antiepileptic pharmacological treatment. Primary outcome… Continue reading HYBERNATUS Trial: Hypothermia Not Associated With Better Outcomes in Status Epilepticus
The long-awaited Eurotherm trial was published in NEJM in autumn 2015. The premise of the study was to examine the impact of induced hypothermia on outcomes after traumatic brain injury. In a multi center randomized controlled trial patients were allocated to either therapeutic hypothermia (32-35 degrees) or the control group (standard care, normothermia). The study… Continue reading Eurotherm 3235 Trial
Excellent talk by Manoj Saxena on traumatic brain injury and temperature control. A useful overview of the available evidence. From SMACC Chicago 2015.
Just off the press: Cochrane Collaboration Review of the use of therapeutic hypothermia after cardiopulmonary resuscitation. “Evidence of moderate quality suggests that conventional cooling methods provided to induce mild therapeutic hypothermia improve neurological outcome after cardiac arrest, specifically with better outcomes than occur with no temperature management” The updated Cochrane review goes a long way… Continue reading Cochrane Review – Hypothermia for Neuroprotection after Cardiac Arrest
“There was no difference in the incidence of impairment between hypothermic and normothermic groups” Abstract: Effects of intraoperative hypothermia on neuropsychological outcomes after intracranial aneurysm surgery. Ann Neurol 2006. Anderson et al.
Free full-text via PubMed at: Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) Investigators. Mild intraoperative hypothermia during surgery for intracranial aneurysm. Todd et al. NEJM 2005. “Intraoperative hypothermia did not improve the neurologic outcome after craniotomy among good-grade patients with aneurysmal subarachnoid haemorrhage”
“The evidence of benefit of current strategies remains sparse.” Zwerus et al, The Netherlands. Current Opinions in Anesthesiology, 2015 Aug. Read abstract from the article here.
“…PEEP has no significant effect on cerebral and systemic hemodynamics…” Interesting reading about the effects of peep ! Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. Caricato et al, Italy. The Journal of Trauma, 2005 Mar. Abstract available here.