Open Access Medical Books

THERAPEUTIC HYPOTHERMIA IN BRAIN INJURY

HYPOTHERMIA IN BRAIN INJURY

Edited by Farid Sadaka .

160 pages . 
Open Access .


This book is meant to look at the evidence behind the application of Therapeutic Hypothermia on patients with injury to the Central Nervous System, including both brain and spinal cord. Central nervous system injury includes ischemia reperfusion after cardiac arrest or asphyxiation, traumatic brain injury, acute ischemic stroke, hemorrhagic stroke, refractory intracranial hypertension, cerebral edema in acute liver failure, subarachnoid hemorrhage, as well as spinal cord injury (SCI). In the minutes to hours following injury, cascades of destructive events and pathophysiologic processes begin at the cellular level. These result in further neuronal injury and are termed the secondary injury. Cellular mechanisms of secondary injury include all of the following: apoptosis, mitochondrial dysfunction, excitotoxicity, disruption in ATP metabolism, disruption in calcium homeostasis, increase in inflammatory mediators and cells, free radical formation, DNA damage, blood-brain barrier disruption, brain glucose utilization disruption, microcirculatory dysfunction and microvascular thrombosis. All of these processes in the brain and spinal cord are temperature dependent; they are all stimulated by fever, and can all be mitigated or blocked by mild to moderate hypothermia. As a result, there has recently been extensive interest in studying the application of Therapeutic Hypothermia (TH) to brain and spinal cord injured patients. This book will discuss the mechanisms by which therapeutic hypothermia can mitigate the pathophysiologies responsible for secondary brain injury, as well as the available evidence for the use of therapeutic hypothermia in multiple neurologic injuries (stated above). Recent studies have indicated that TH with a reduction of body core temperature (T) to 32 - 34 °C for 12 to 24 hours has improved survival and neurologic outcome in comatose out-of-hospital cardiac arrest patients. In this patient population, the evidence for TH is overwhelming leading to major international associations giving it a class I recommendation. However, the evidence for its application to patients with other forms of brain injury stated above and SCI is less overwhelming and still in progress. This book will describe the clinical human evidence behind therapeutic hypothermia for all of the above mentioned brain and spinal cord injuries, as well as the basic and animal studies that led to its clinical applications. This book will also describe how to apply hypothermia to patients with brain injury in the intensive care unit (ICU), methods of cooling and technologies used to induce and maintain therapeutic hypothermia, protocol development for hospitals and ICUs, as well as timing, depth, duration, and management of side-effects.

Neuroprognostication of patients with brain injury and SCI is also significantly affected by the application of therapeutic hypothermia. This book will also describe how hypothermia can influence the ability to prognosticate these injured patients, as well as describe the current evidence to help clinicians offer the family the best and most honest discussion on prognosis of their loved ones. We will also describe how TH influences the metabolism of the most commonly used drugs in the ICU, and how this effect is also linked to prognostication of these patients with brain and spinal cord injury. It will also provide grounds for future directions in the application of and research with therapeutic hypothermia.

Farid Sadaka, MD
Clinical Associate Professor
Critical Care Medicine/ NeuroCritical Care
Medical Director, Trauma and Neuro ICU
Mercy Hospital St Louis/ St. Louis University
St. Louis,
USA
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CONTENTS :

Section 1 Therapeutic Hypothermia-General 


  1 Therapeutic Hypothermia: Adverse Events, 
Recognition, Prevention and Treatment Strategies 3 Rekha Lakshmanan, Farid Sadaka and Ashok Palagiri

Section 2 Therapeutic Hypothermia-Cardiac Arrest 


  2 Therapeutic Hypothermia for Cardiac Arrest 23 
Farid Sadaka

  3 Prehospital Therapeutic Hypothermia for Cardiac Arrest 35 
Farid Sadaka

Section 3 Therapeutic Hypothermia-Stroke / SCI 


  4 Therapeutic Hypothermia in Acute Stroke 51 
Edgar A. Samaniego

  5 Hypothermia for Intracerebral Hemorrhage, 
Subarachnoid Hemorrhage & Spinal Cord Injury 69 David E. Tannehill

Section 4 Therapeutic Hypothermia- Traumatic Brain Injury/Intracranial Hypertension 


  6 Therapeutic Hypothermia in Traumatic Brain Injury 79 
Farid Sadaka, Christopher Veremakis, Rekha Lakshmanan and Ashok Palagiri

Section 5 Therapeutic Hypothermia-Acute Liver Failure 


Chapter 7 Hypothermia in Acute Liver Failure 99 
Rahul Nanchal and Gagan Kumar

Section 6 Therapeutic Hypothermia-Neuroprognostication/Drug Metabolism 


  8 Prognostication in Post Cardiac Arrest Patients 
Treated with Therapeutic Hypothermia 113 Ashok Palagiri, Farid Sadaka and Rekha Lakshmanan

  9 Therapeutic Hypothermia: 
Implications on Drug Therapy 131 Kacey B. Anderson and Samuel M. Poloyac .





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