Hypothermie thérapeutique en traumatologie crânienne grave

Translated title of the contribution: Therapeutic hypothermia for severe traumatic brain injury

P. Bouzat, G. Francony, M. Oddo, J. F. Payen

Research output: Contribution to journalArticle

Abstract

Therapeutic hypothermia (TH) is considered a standard of care in the post-resuscitation phase of cardiac arrest. In experimental models of traumatic brain injury (TBI), TH was found to have neuroprotective properties. However, TH failed to demonstrate beneficial effects on neurological outcome in patients with TBI. The absence of benefits of TH uniformly applied in TBI patients should not question the use of TH as a second-tier therapy to treat elevated intracranial pressure. The management of all the practical aspects of TH is a key factor to avoid side effects and to optimize the potential benefit of TH in the treatment of intracranial hypertension. Induction of TH can be achieved with external surface cooling or with intra-vascular devices. The therapeutic target should be set at a 35. °C using brain temperature as reference, and should be maintained at least during 48. hours and ideally over the entire period of elevated intracranial pressure. The control of the rewarming phase is crucial to avoid temperature overshooting and should not exceed 1. °C/day. Besides its use in the management of intracranial hypertension, therapeutic cooling is also essential to treat hyperthermia in brain-injured patients. In this review, we will discuss the benefit-risk balance and practical aspects of therapeutic temperature management in TBI patients.

Original languageFrench
Pages (from-to)787-791
Number of pages5
JournalAnnales Francaises d'Anesthesie et de Reanimation
Volume32
Issue number11
DOIs
StatePublished - Nov 2013
Externally publishedYes

Fingerprint

Induced Hypothermia
Intracranial Hypertension
Temperature
Therapeutics
Rewarming
Traumatic Brain Injury
Brain
Standard of Care
Heart Arrest
Resuscitation
Blood Vessels
Fever
Theoretical Models
Equipment and Supplies

Keywords

  • Injury
  • Intracranial pressure
  • Neuroprotection
  • Therapeutic hypothermia
  • Traumatic brain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Hypothermie thérapeutique en traumatologie crânienne grave. / Bouzat, P.; Francony, G.; Oddo, M.; Payen, J. F.

In: Annales Francaises d'Anesthesie et de Reanimation, Vol. 32, No. 11, 11.2013, p. 787-791.

Research output: Contribution to journalArticle

Bouzat, P. ; Francony, G. ; Oddo, M. ; Payen, J. F. / Hypothermie thérapeutique en traumatologie crânienne grave. In: Annales Francaises d'Anesthesie et de Reanimation. 2013 ; Vol. 32, No. 11. pp. 787-791.
@article{64e83064e9ff464ea4095c3863bd9186,
title = "Hypothermie th{\'e}rapeutique en traumatologie cr{\^a}nienne grave",
abstract = "Therapeutic hypothermia (TH) is considered a standard of care in the post-resuscitation phase of cardiac arrest. In experimental models of traumatic brain injury (TBI), TH was found to have neuroprotective properties. However, TH failed to demonstrate beneficial effects on neurological outcome in patients with TBI. The absence of benefits of TH uniformly applied in TBI patients should not question the use of TH as a second-tier therapy to treat elevated intracranial pressure. The management of all the practical aspects of TH is a key factor to avoid side effects and to optimize the potential benefit of TH in the treatment of intracranial hypertension. Induction of TH can be achieved with external surface cooling or with intra-vascular devices. The therapeutic target should be set at a 35. °C using brain temperature as reference, and should be maintained at least during 48. hours and ideally over the entire period of elevated intracranial pressure. The control of the rewarming phase is crucial to avoid temperature overshooting and should not exceed 1. °C/day. Besides its use in the management of intracranial hypertension, therapeutic cooling is also essential to treat hyperthermia in brain-injured patients. In this review, we will discuss the benefit-risk balance and practical aspects of therapeutic temperature management in TBI patients.",
keywords = "Injury, Intracranial pressure, Neuroprotection, Therapeutic hypothermia, Traumatic brain",
author = "P. Bouzat and G. Francony and M. Oddo and Payen, {J. F.}",
year = "2013",
month = "11",
doi = "10.1016/j.annfar.2013.09.004",
language = "French",
volume = "32",
pages = "787--791",
journal = "Anaesthesia, critical care & pain medicine",
issn = "0750-7658",
publisher = "Elsevier BV",
number = "11",

}

TY - JOUR

T1 - Hypothermie thérapeutique en traumatologie crânienne grave

AU - Bouzat, P.

AU - Francony, G.

AU - Oddo, M.

AU - Payen, J. F.

PY - 2013/11

Y1 - 2013/11

N2 - Therapeutic hypothermia (TH) is considered a standard of care in the post-resuscitation phase of cardiac arrest. In experimental models of traumatic brain injury (TBI), TH was found to have neuroprotective properties. However, TH failed to demonstrate beneficial effects on neurological outcome in patients with TBI. The absence of benefits of TH uniformly applied in TBI patients should not question the use of TH as a second-tier therapy to treat elevated intracranial pressure. The management of all the practical aspects of TH is a key factor to avoid side effects and to optimize the potential benefit of TH in the treatment of intracranial hypertension. Induction of TH can be achieved with external surface cooling or with intra-vascular devices. The therapeutic target should be set at a 35. °C using brain temperature as reference, and should be maintained at least during 48. hours and ideally over the entire period of elevated intracranial pressure. The control of the rewarming phase is crucial to avoid temperature overshooting and should not exceed 1. °C/day. Besides its use in the management of intracranial hypertension, therapeutic cooling is also essential to treat hyperthermia in brain-injured patients. In this review, we will discuss the benefit-risk balance and practical aspects of therapeutic temperature management in TBI patients.

AB - Therapeutic hypothermia (TH) is considered a standard of care in the post-resuscitation phase of cardiac arrest. In experimental models of traumatic brain injury (TBI), TH was found to have neuroprotective properties. However, TH failed to demonstrate beneficial effects on neurological outcome in patients with TBI. The absence of benefits of TH uniformly applied in TBI patients should not question the use of TH as a second-tier therapy to treat elevated intracranial pressure. The management of all the practical aspects of TH is a key factor to avoid side effects and to optimize the potential benefit of TH in the treatment of intracranial hypertension. Induction of TH can be achieved with external surface cooling or with intra-vascular devices. The therapeutic target should be set at a 35. °C using brain temperature as reference, and should be maintained at least during 48. hours and ideally over the entire period of elevated intracranial pressure. The control of the rewarming phase is crucial to avoid temperature overshooting and should not exceed 1. °C/day. Besides its use in the management of intracranial hypertension, therapeutic cooling is also essential to treat hyperthermia in brain-injured patients. In this review, we will discuss the benefit-risk balance and practical aspects of therapeutic temperature management in TBI patients.

KW - Injury

KW - Intracranial pressure

KW - Neuroprotection

KW - Therapeutic hypothermia

KW - Traumatic brain

UR - http://www.scopus.com/inward/record.url?scp=84888432885&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888432885&partnerID=8YFLogxK

U2 - 10.1016/j.annfar.2013.09.004

DO - 10.1016/j.annfar.2013.09.004

M3 - Article

C2 - 24138767

AN - SCOPUS:84888432885

VL - 32

SP - 787

EP - 791

JO - Anaesthesia, critical care & pain medicine

JF - Anaesthesia, critical care & pain medicine

SN - 0750-7658

IS - 11

ER -