Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium Faculty of Medicine, University Hasselt, Hasselt, Belgium.
Curr Opin Anaesthesiol. 2010 Apr;23(2):258-62. doi: 10.1097/ACO.0b013e328336ea44.
Therapeutic hypothermia after traumatic brain injury (TBI)? For the last 10 years, no topic has been more popular and more controversial among neurointensivists. This article reviews the most current findings (experimental, clinical, adult and pediatric TBI), as well as the clinical management of therapeutic hypothermia.
Despite ample experimental evidence, the clinical utility of therapeutic hypothermia has still to be conclusively demonstrated in terms of reduced mortality or improved functional recovery after TBI (even in pediatric TBI). Current findings support that hypothermia should be initiated as soon as possible, for at least 48 h duration, and that outcome is worse when barbiturates are part of ICU management. Currently, available cooling techniques, including prehospital cooling protocols, expand and improve clinical management of therapeutic hypothermia.
Taking into consideration all results from clinical hypothermia TBI studies discussion has to be focused around the possibility that a better outcome could be achieved if protocols for therapeutic hypothermia are reviewed. It is possible that the negative effects of the cooling and the rewarming procedure currently overshadow the neuroprotective effects.
创伤性脑损伤（TBI）后的治疗性低温？在过去的 10 年中，没有哪个话题能像神经重症医学领域的治疗性低温那样热门和具有争议性。本文综述了治疗性低温的最新发现（实验、临床、成人和儿童 TBI），以及治疗性低温的临床管理。
尽管有大量的实验证据，但治疗性低温对 TBI 后死亡率降低或功能恢复的临床效果仍有待明确证实（即使在儿科 TBI 中也是如此）。目前的研究结果支持，低温应尽快开始，持续至少 48 小时，而 ICU 管理中使用巴比妥类药物会导致预后更差。目前，可用的冷却技术，包括院前冷却方案，扩大和改善了治疗性低温的临床管理。
考虑到所有临床低温 TBI 研究的结果，讨论必须集中在审查治疗性低温方案是否可能获得更好的结果。目前，冷却和复温过程的负面影响可能超过了神经保护作用。
