Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois.
Departments of Pediatrics and Neurology, University of Michigan, Ann Arbor, Michigan.
Pediatr Neurol. 2018 Nov;88:12-24. doi: 10.1016/j.pediatrneurol.2018.07.004. Epub 2018 Jul 21.
Targeted temperature management encompasses a range of clinical interventions to regulate systemic temperature, and includes both induction of varying degrees of hypothermia and fever prevention ("targeted normothermia"). Targeted temperature management plays a key role in the contemporary management of critically ill neonates and children with acute brain injury. Yet, many unanswered questions remain regarding optimal temperature management in pediatric neurocritical care. The introduction highlights experimental studies that have evaluated the neuroprotective efficacy of therapeutic hypothermia and explored possible mechanisms of action in several brain injury models. The next section focuses on three major clinical conditions in which therapeutic hypothermia has been evaluated in randomized controlled trials in pediatric populations: neonatal hypoxic-ischemic encephalopathy, postcardiac arrest encephalopathy, and traumatic brain injury. Clinical implications of targeted temperature management in pediatric neurocritical care are also discussed. The final section examines some of the factors that may underlie the limited neuroprotective efficacy of hypothermia that has been observed in several major pediatric clinical trials, and outlines important directions for future research.
目标温度管理涵盖了一系列用于调节全身温度的临床干预措施，包括诱导不同程度的低温和预防发热（“目标正常体温”）。目标温度管理在重症新生儿和急性脑损伤儿童的现代治疗中起着关键作用。然而，关于儿科神经重症监护中的最佳温度管理，仍有许多未解决的问题。引言部分重点介绍了评估治疗性低温的神经保护疗效的实验研究，并在几种脑损伤模型中探索了可能的作用机制。下一节重点介绍了在儿科人群中进行的三项随机对照试验中评估治疗性低温的三种主要临床情况：新生儿缺氧缺血性脑病、心搏骤停后脑病和创伤性脑损伤。还讨论了目标温度管理在儿科神经重症监护中的临床意义。最后一节探讨了可能导致在几项主要儿科临床试验中观察到的低温神经保护疗效有限的一些因素，并概述了未来研究的重要方向。
