Hipotermia terapéutica para neuroprotección. Historia, mecanismos, riesgos y aplicaciones clínicas
Therapeutic hypothermia for neuroprotection: history, mechanisms, risks, and clinical applications.
Karnatovskaia LV1, Wartenberg KE2, Freeman WD3.
Neurohospitalist. 2014 Jul;4(3):153-63. doi: 10.1177/1941874413519802.
Abstract
The earliest recorded application of therapeutic hypothermia in medicine spans about 5000 years; however, its use has become widespread since 2002, following the demonstration of both safety and efficacy of regimens requiring only a mild (32°C-35°C) degree of cooling after cardiac arrest. We review the mechanisms by which hypothermia confers neuroprotection as well as its physiological effects by body system and its associated risks. With regard to clinical applications, we present evidence on the role of hypothermia in traumatic brain injury, intracranial pressure elevation, stroke, subarachnoid hemorrhage, spinal cord injury, hepatic encephalopathy, and neonatal peripartum encephalopathy. Based on the current knowledge and areas undergoing or in need of further exploration, we feel that therapeutic hypothermia holds promise in the treatment of patients with various forms of neurologic injury; however, additional quality studies are needed before its true role is fully known.
KEYWORDS:
clinical; clinical specialty; nervous system; neurocritical care; neurophysiology; techniques; trauma
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056415/pdf/10.1177_1941874413519802.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Therapeutic hypothermia for neuroprotection: history, mechanisms, risks, and clinical applications.
Karnatovskaia LV1, Wartenberg KE2, Freeman WD3.
Neurohospitalist. 2014 Jul;4(3):153-63. doi: 10.1177/1941874413519802.
Abstract
The earliest recorded application of therapeutic hypothermia in medicine spans about 5000 years; however, its use has become widespread since 2002, following the demonstration of both safety and efficacy of regimens requiring only a mild (32°C-35°C) degree of cooling after cardiac arrest. We review the mechanisms by which hypothermia confers neuroprotection as well as its physiological effects by body system and its associated risks. With regard to clinical applications, we present evidence on the role of hypothermia in traumatic brain injury, intracranial pressure elevation, stroke, subarachnoid hemorrhage, spinal cord injury, hepatic encephalopathy, and neonatal peripartum encephalopathy. Based on the current knowledge and areas undergoing or in need of further exploration, we feel that therapeutic hypothermia holds promise in the treatment of patients with various forms of neurologic injury; however, additional quality studies are needed before its true role is fully known.
KEYWORDS:
clinical; clinical specialty; nervous system; neurocritical care; neurophysiology; techniques; trauma
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056415/pdf/10.1177_1941874413519802.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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