Drew Kelly L, Bhowmick Saurav, Laughlin Bernard W, Goropashnaya Anna V, Tøien Øivind, Sugiura M Hoshi, Wong Ardy, Pourrezaei Kambiz, Barati Zeinab, Chen Chao-Yin
Center for Transformative Research in Metabolism, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, United States.
Drexel University School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, United States.
Front Neurol. 2023 Jan 27;14:1009718. doi: 10.3389/fneur.2023.1009718. eCollection 2023.
Targeted temperature management (TTM) is standard of care for neonatal hypoxic ischemic encephalopathy (HIE). Prevention of fever, not excluding cooling core body temperature to 33°C, is standard of care for brain injury post cardiac arrest. Although TTM is beneficial, HIE and cardiac arrest still carry significant risk of death and severe disability. Mammalian hibernation is a gold standard of neuroprotective metabolic suppression, that if better understood might make TTM more accessible, improve efficacy of TTM and identify adjunctive therapies to protect and regenerate neurons after hypoxic ischemia brain injury. Hibernating species tolerate cerebral ischemia/reperfusion better than humans and better than other models of cerebral ischemia tolerance. Such tolerance limits risk of transitions into and out of hibernation torpor and suggests that a barrier to translate hibernation torpor may be human vulnerability to these transitions. At the same time, understanding how hibernating mammals protect their brains is an opportunity to identify adjunctive therapies for TTM. Here we summarize what is known about the hemodynamics of hibernation and how the hibernating brain resists injury to identify opportunities to translate these mechanisms for neurocritical care.
目标温度管理（TTM）是新生儿缺氧缺血性脑病（HIE）的护理标准。预防发热，包括将核心体温降至33°C，是心脏骤停后脑损伤的护理标准。尽管TTM有益，但HIE和心脏骤停仍有显著的死亡和严重残疾风险。哺乳动物冬眠是神经保护性代谢抑制的黄金标准，如果能更好地理解，可能会使TTM更容易实现，提高TTM的疗效，并确定缺氧缺血性脑损伤后保护和再生神经元的辅助治疗方法。冬眠物种比人类以及其他脑缺血耐受模型更能耐受脑缺血/再灌注。这种耐受性限制了进入和退出冬眠蛰伏状态的风险，并表明将冬眠蛰伏状态转化应用的一个障碍可能是人类对这些转变的易感性。与此同时，了解冬眠哺乳动物如何保护其大脑为确定TTM的辅助治疗方法提供了契机。在此，我们总结了关于冬眠血流动力学的已知信息，以及冬眠大脑如何抵抗损伤，以确定将这些机制转化应用于神经危重症护理的机会。
