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Surani S, Varon J. The expanded use of targeted temperature management: Time for reappraisal. Resuscitation 2016; 108:A8-A9. [PMID: 27618758 DOI: 10.1016/j.resuscitation.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Salim Surani
- Texas A&M University, USA; University of North Texas, USA
| | - Joseph Varon
- The University of Texas Health Science Center at Houston, USA; The University of Texas Medical Branch at Galveston, USA; Foundation Surgical Hospital, Houston, TX, USA.
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52
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Therapeutic hypothermia after cardiac arrest is not associated with favorable neurological outcome: a meta-analysis. J Clin Anesth 2016; 33:225-32. [DOI: 10.1016/j.jclinane.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/07/2016] [Indexed: 11/24/2022]
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53
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Tu Y, Miao XM, Yi TL, Chen XY, Sun HT, Cheng SX, Zhang S. Neuroprotective effects of bloodletting at Jing points combined with mild induced hypothermia in acute severe traumatic brain injury. Neural Regen Res 2016; 11:931-6. [PMID: 27482221 PMCID: PMC4962590 DOI: 10.4103/1673-5374.184491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Bloodletting at Jing points has been used to treat coma in traditional Chinese medicine. Mild induced hypothermia has also been shown to have neuroprotective effects. However, the therapeutic effects of bloodletting at Jing points and mild induced hypothermia alone are limited. Therefore, we investigated whether combined treatment might have clinical effectiveness for the treatment of acute severe traumatic brain injury. Using a rat model of traumatic brain injury, combined treatment substantially alleviated cerebral edema and blood-brain barrier dysfunction. Furthermore, neurological function was ameliorated, and cellular necrosis and the inflammatory response were lessened. These findings suggest that the combined effects of bloodletting at Jing points (20 μL, twice a day, for 2 days) and mild induced hypothermia (6 hours) are better than their individual effects alone. Their combined application may have marked neuroprotective effects in the clinical treatment of acute severe traumatic brain injury.
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Affiliation(s)
- Yue Tu
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao-Mei Miao
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tai-Long Yi
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Xu-Yi Chen
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Hong-Tao Sun
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Shi-Xiang Cheng
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Sai Zhang
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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54
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Scantling D, Frank B, Pontell ME, Medinilla S. Inducing Therapeutic Hypothermia in Cardiac Arrest Caused by Lightning Strike. Wilderness Environ Med 2016; 27:401-4. [PMID: 27451005 DOI: 10.1016/j.wem.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
Only limited clinical scenarios are grounds for induction of therapeutic hypothermia. Its use in traumatic cardiac arrests, including those from lightning strikes, is not well studied. Nonshockable cardiac arrest rhythms have only recently been included in resuscitation guidelines. We report a case of full neurological recovery with therapeutic hypothermia after a lightning-induced pulseless electrical activity cardiac arrest in an 18-year-old woman. We also review the important pathophysiology of lightning-induced cardiac arrest and neurologic sequelae, elaborate upon the mechanism of therapeutic hypothermia, and add case-based evidence in favor of the use of targeted temperature management in lightning-induced cardiac arrest.
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Affiliation(s)
- Dane Scantling
- Department of General Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA(Drs Scantling and Pontell)?>.
| | - Brian Frank
- Department of Surgery and Critical Care, Christiana Care Health System, Newark, DE
| | - Mathew E Pontell
- Department of General Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA(Drs Scantling and Pontell)?>
| | - Sandra Medinilla
- Department of Surgery and Critical Care, Christiana Care Health System, Newark, DE
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55
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Xia J, Li R, Yang R, Zhang L, Sun B, Feng Y, Jin J, Huang L, Zhan Q. Mild hypothermia attenuate kidney injury in canines with oleic acid-induced acute respiratory distress syndrome. Injury 2016; 47:1445-51. [PMID: 27180146 DOI: 10.1016/j.injury.2016.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/18/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hypothermia may attenuate ventilator induced-lung injury in acute respiratory distress syndrome (ARDS). However, the impact of hypothermia on extra-pulmonary organ injury in ARDS remains unclear. The purpose of this study was to investigate whether hypothermia affects extra-pulmonary organ injury in a canine ARDS model induced by oleic acid. OBJECTIVES Twelve anesthetized canines with oleic acid-induced ARDS were randomly divided (n=6 per group) into a hypothermia group (core temperature of 33±1°C, HT group) and a normothermia group (core temperature of 38±1°C, NT group) and treated for four hours. The liver, small intestine and kidney were assessed by evaluating biochemical parameters, plasma and tissue cytokine levels, and tissue histopathological injury scores. RESULTS The HT group showed a lower plateau pressure, lung elastance and pulmonary vascular resistance. Hypothermia was associated with lower oxygen consumption (138.4±55.0mlmin(-1)vs. 72.0±11.2mlmin(-1), P<0.05) and higher oxygen saturation of mixed venous blood (62.8%±8.0% vs. 77.5%±10.1%, P<0.05). Both groups had similar levels of tumour necrosis factor-α in the plasma and extra-pulmonary organ, however, plasma interleukin-10 (97.1±25.0pgml(-1)vs. 131.4±27.0pgml(-1), P<0.05) was higher in the HT group. Further, the animals in the HT group had a lower levels of plasma creatinine (54.6±19.1UL(-1)vs. 29.1±8.0UL(-1), P<0.05), and lower renal histopathological injury scores [4.0(3.5;7.0) vs. 1.5(0.8;3.0), P<0.05]. Hypothermia did not affect the histopathological injury of the liver and small intestine. CONCLUSIONS Short-term mild hypothermia can reduce lung elastance and pulmonary vascular resistance, increase the systemic anti-inflammatory response and attenuate kidney histopathological injury in a canine ARDS model induced by oleic acid.
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Affiliation(s)
- Jingen Xia
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, PR China.
| | - Ran Li
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
| | - Rui Yang
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
| | - Li Zhang
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
| | - Bing Sun
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
| | - Yingying Feng
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, PR China.
| | - Jingjing Jin
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
| | - Linna Huang
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
| | - Qingyuan Zhan
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, PR China.
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56
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Fukuda T. Targeted temperature management for adult out-of-hospital cardiac arrest: current concepts and clinical applications. J Intensive Care 2016; 4:30. [PMID: 27123306 PMCID: PMC4847228 DOI: 10.1186/s40560-016-0139-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/04/2016] [Indexed: 11/25/2022] Open
Abstract
Targeted temperature management (TTM) (primarily therapeutic hypothermia (TH)) after out-of-hospital cardiac arrest (OHCA) has been considered effective, especially for adult-witnessed OHCA with a shockable initial rhythm, based on pathophysiology and on several clinical studies (especially two randomized controlled trials (RCTs) published in 2002). However, a recently published large RCT comparing TTM at 33 °C (TH) and TTM at 36 °C (normothermia) showed no advantage of 33 °C over 36 °C. Thus, this RCT has complicated the decision to perform TH after cardiac arrest. The results of this RCT are sometimes interpreted fever control alone is sufficient to improve outcomes after cardiac arrest because fever control was not strictly performed in the control groups of the previous two RCTs that showed an advantage for TH. Although this may be possible, another interpretation that the optimal target temperature for TH is much lower than 33 °C may be also possible. Additionally, there are many points other than target temperature that are unknown, such as the optimal timing to initiate TTM, the period between OHCA and initiating TTM, the period between OHCA and achieving the target temperature, the duration of maintaining the target temperature, the TTM technique, the rewarming method, and the management protocol after rewarming. RCTs are currently underway to shed light on several of these underexplored issues. In the present review, we examine how best to perform TTM after cardiac arrest based on the available evidence.
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Affiliation(s)
- Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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57
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Laux C, Guanci MM, Figueroa SA, Francis KE, Livesay SL, Mathiesen C. Clinical Q & A: Translating Therapeutic Temperature Management from Theory to Practice. Ther Hypothermia Temp Manag 2016; 6:52-6. [PMID: 26866958 DOI: 10.1089/ther.2016.29009.mkb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Chris Laux
- 2 Harborview Medical Center , Seattle, Washington
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58
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Dietrich WD, Bramlett HM. Therapeutic hypothermia and targeted temperature management in traumatic brain injury: Clinical challenges for successful translation. Brain Res 2015; 1640:94-103. [PMID: 26746342 DOI: 10.1016/j.brainres.2015.12.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 12/20/2022]
Abstract
The use of therapeutic hypothermia (TH) and targeted temperature management (TTM) for severe traumatic brain injury (TBI) has been tested in a variety of preclinical and clinical situations. Early preclinical studies showed that mild reductions in brain temperature after moderate to severe TBI improved histopathological outcomes and reduced neurological deficits. Investigative studies have also reported that reductions in post-traumatic temperature attenuated multiple secondary injury mechanisms including excitotoxicity, free radical generation, apoptotic cell death, and inflammation. In addition, while elevations in post-traumatic temperature heightened secondary injury mechanisms, the successful implementation of TTM strategies in injured patients to reduce fever burden appear to be beneficial. While TH has been successfully tested in a number of single institutional clinical TBI studies, larger randomized multicenter trials have failed to demonstrate the benefits of therapeutic hypothermia. The use of TH and TTM for treating TBI continues to evolve and a number of factors including patient selection and the timing of the TH appear to be critical in successful trial design. Based on available data, it is apparent that TH and TTM strategies for treating severely injured patients is an important therapeutic consideration that requires more basic and clinical research. Current research involves the evaluation of alternative cooling strategies including pharmacologically-induced hypothermia and the combination of TH or TTM approaches with more selective neuroprotective or reparative treatments. This manuscript summarizes the preclinical and clinical literature emphasizing the importance of brain temperature in modifying secondary injury mechanisms and in improving traumatic outcomes in severely injured patients. This article is part of a Special Issue entitled SI:Brain injury and recovery.
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Affiliation(s)
- W Dalton Dietrich
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Helen M Bramlett
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
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59
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Milde therapeutische Hypothermie. Med Klin Intensivmed Notfmed 2015; 110:597-601. [DOI: 10.1007/s00063-015-0023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 02/16/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
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60
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Hunter BR, Ellender TJ. Targeted temperature management in emergency medicine: current perspectives. Open Access Emerg Med 2015; 7:69-77. [PMID: 27147892 PMCID: PMC4806809 DOI: 10.2147/oaem.s71279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Landmark trials in 2002 showed that therapeutic hypothermia (TH) after out-of-hospital cardiac arrest due to ventricular tachycardia or ventricular fibrillation resulted in improved likelihood of good neurologic recovery compared to standard care without TH. Since that time, TH has been frequently instituted in a wide range of cardiac arrest patients regardless of initial heart rhythm. Recent evidence has evaluated how, when, and to what degree TH should be instituted in cardiac arrest victims. We outline early evidence, as well as recent trials, regarding the use of TH or targeted temperature management in these patients. We also provide evidence-based suggestions for the institution of targeted temperature management/TH in a variety of emergency medicine settings.
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Affiliation(s)
- Benton R Hunter
- Department of Emergency Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Timothy J Ellender
- Department of Emergency Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA; Department of Critical Care Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
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61
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Kim DK, Hyun DK. Therapeutic Hypothermia in Traumatic Brain injury; Review of History, Pathophysiology and Current Studies. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.3.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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62
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Sato-Numata K, Numata T, Okada Y. Temperature sensitivity of acid-sensitive outwardly rectifying (ASOR) anion channels in cortical neurons is involved in hypothermic neuroprotection against acidotoxic necrosis. Channels (Austin) 2015; 8:278-83. [PMID: 24476793 DOI: 10.4161/chan.27748] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The acid-sensitive outwardly rectifying (ASOR) anion channel has been found in non-neuronal cell types and was shown to be involved in acidotoxic death of epithelial cells. We have recently shown that the ASOR channel is sensitive to temperature. Here, we extend those results to show that temperature-sensitive ASOR anion channels are expressed in cortical neurons and involved in acidotoxic neuronal cell death. In cultured mouse cortical neurons, reduction of extracellular pH activated anionic currents exhibiting phenotypic properties of the ASOR anion channel. The neuronal ASOR currents recorded at pH 5.25 were augmented by warm temperature, with a threshold temperature of 26 °C and the Q(10) value of 5.6. After 1 h exposure to acidic solution at 37 °C, a large population of neurons suffered from necrotic cell death which was largely protected not only by ASOR channel blockers but also by reduction of temperature to 25 °C. Thus, it is suggested that high temperature sensitivity of the neuronal ASOR anion channel provides, at least in part, a basis for hypothermic neuroprotection under acidotoxic situations associated with a number of pathological brain states.
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63
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Léon K, Pichavant-Rafini K, Ollivier H, Monbet V, L'Her E. Does Induction Time of Mild Hypothermia Influence the Survival Duration of Septic Rats? Ther Hypothermia Temp Manag 2015; 5:85-8. [DOI: 10.1089/ther.2014.0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karelle Léon
- Laboratory Mouvement, Sport, Santé, Université de Brest, Brest, France
- Laboratory ORPHY, Université de Brest, Brest, France
| | | | | | - Valérie Monbet
- Laboratory IRMAR (VM), Université de Rennes, Rennes, France
| | - Erwan L'Her
- Réanimation Médicale (ELH), Pôle ARSIBOU, CHRU de Brest, Brest, France
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64
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Reis C, Wang Y, Akyol O, Ho WM, Ii RA, Stier G, Martin R, Zhang JH. What's New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. Int J Mol Sci 2015; 16:11903-65. [PMID: 26016501 PMCID: PMC4490422 DOI: 10.3390/ijms160611903] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible. Tracking and monitoring TBI with neuroimaging technologies, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and high definition fiber tracking (HDFT) show increasing sensitivity and specificity. Classical electrophysiological monitoring, together with newly established brain-on-chip, cerebral microdialysis techniques, both benefit TBI. First generation molecular biomarkers, based on genomic and proteomic changes following TBI, have proven effective and economical. It is conceivable that TBI-specific biomarkers will be developed with the combination of systems biology and bioinformation strategies. Advances in treatment of TBI include stem cell-based and nanotechnology-based therapy, physical and pharmaceutical interventions and also new use in TBI for approved drugs which all present favorable promise in preventing and reversing TBI.
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Affiliation(s)
- Cesar Reis
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Yuechun Wang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Physiology, School of Medicine, University of Jinan, Guangzhou 250012, China.
| | - Onat Akyol
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
| | - Wing Mann Ho
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, University Hospital Innsbruck, Tyrol 6020, Austria.
| | - Richard Applegate Ii
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Gary Stier
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Robert Martin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - John H Zhang
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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65
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Fintl C, Hudson NPH, Handel I, Pearson GT. The effect of temperature changes onin vitroslow wave activity in the equine ileum. Equine Vet J 2015; 48:218-23. [DOI: 10.1111/evj.12401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/17/2014] [Indexed: 12/19/2022]
Affiliation(s)
- C. Fintl
- Norwegian University of Life Sciences; Faculty of Veterinary Medicine and Biosciences; Oslo Norway
| | - N. P. H. Hudson
- Royal (Dick) School of Veterinary Studies and Roslin Institute; University of Edinburgh; Roslin Midlothian UK
| | - I. Handel
- Royal (Dick) School of Veterinary Studies and Roslin Institute; University of Edinburgh; Roslin Midlothian UK
| | - G. T. Pearson
- Royal (Dick) School of Veterinary Studies and Roslin Institute; University of Edinburgh; Roslin Midlothian UK
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66
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Lim ETS, Wong ASL, Ahmad NSB, Tan KBK, Ong MEH, Tan JWC. Review of the Clinical Evidence and Controversies in Therapeutic Hypothermia for Survivors of Sudden Cardiac Death. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/201010581502400107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sudden cardiac arrest constitutes a major public health burden in both developed and developing countries. In those successfully resuscitated from cardiac arrest, subsequent mortality is still high (∼75%) and is due to a combination of ischaemia and reperfusion injury. The purpose of this review is to describe the experimental and clinical evidence supporting therapeutic hypothermia in survivors of sudden cardiac arrest. We also discuss controversies and unresolved issues in therapeutic hypothermia, including the optimum target temperature for therapeutic hypothermia, and the role of pre-hospital induction of hypothermia. We conclude with a perspective on therapeutic hypothermia as it applies to the Singapore context.
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Affiliation(s)
| | - Aaron Sung Lung Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | | | | | - Marcus Eng Hock Ong
- Duke-NUS Graduate Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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67
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Newmyer R, Mendelson J, Pang D, Fink EL. Targeted Temperature Management in Pediatric Central Nervous System Disease. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2015; 1:38-47. [PMID: 26042193 PMCID: PMC4450147 DOI: 10.1007/s40746-014-0008-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute central nervous system conditions due to hypoxic-ischemic encephalopathy, traumatic brain injury (TBI), status epilepticus, and central nervous system infection/inflammation, are a leading cause of death and disability in childhood. There is a critical need for effective neuroprotective therapies to improve outcome targeting distinct disease pathology. Fever, defined as patient temperature > 38°C, has been clearly shown to exacerbate brain injury. Therapeutic hypothermia (HT) is an intervention using targeted temperature management that has multiple mechanisms of action and robust evidence of efficacy in multiple experimental models of brain injury. Prospective clinical evidence for its neuroprotective efficacy exists in narrowly-defined populations with hypoxic-ischemic injury outside of the pediatric age range while trials comparing hypothermia to normothermia after TBI have failed to demonstrate a benefit on outcome but consistently demonstrate potential use in decreasing refractory intracranial pressure. Data in children from prospective, randomized controlled trials using different strategies of targeted temperature management for various outcomes are few but a large study examining HT versus controlled normothermia to improve neurological outcome in cardiac arrest is underway.
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Affiliation(s)
- Robert Newmyer
- Children's Hospital of Pittsburgh of UPMC (Pittsburgh, PA USA)
| | - Jenny Mendelson
- Children's Hospital of Pittsburgh of UPMC (Pittsburgh, PA USA)
| | - Diana Pang
- Children's Hospital of Pittsburgh of UPMC (Pittsburgh, PA USA)
| | - Ericka L Fink
- Children's Hospital of Pittsburgh of UPMC (Pittsburgh, PA USA)
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68
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van Eps AW, Orsini JA. A comparison of seven methods for continuous therapeutic cooling of the equine digit. Equine Vet J 2015; 48:120-4. [PMID: 25385194 DOI: 10.1111/evj.12384] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/06/2014] [Indexed: 11/27/2022]
Abstract
REASONS FOR PERFORMING STUDY Digital hypothermia may be effective for laminitis prophylaxis and therapy, but the efficacy of cooling methods used in clinical practice requires evaluation. OBJECTIVES To use hoof wall surface temperature (HWST) to compare several cooling methods used in clinical practice. STUDY DESIGN Experimental crossover design with a minimum washout period of 72 h. METHODS Seven cooling methods (commercially available ice packs, wraps and boots) and one prototypical dry-sleeve device were applied to a single forelimb in 4 horses for 8 h, during which HWST of the cooled forelimb and the uncooled (control) forelimb was recorded hourly. Results were analysed descriptively. RESULTS The median (range) HWST from 2-8 h was lowest for the ice and water immersion methods that included the foot and extended proximally to at least include the pastern: 5.2°C (range: 4.8-7.8°C) for the fluid bag and 2.7°C (2.4-3.4°C) for the ice boot. An ice boot that included the distal limb but not the foot resulted in a median HWST of 25.7°C (20.6-27.2°C). Dry interface applications (ice packs) confined to the foot only resulted in a median HWST of 21.5°C (19.5-25.5°C) for the coronet sleeve and 19.8°C (17.6-23°C) for a commercial ice pack. For the dry interface applications that included the foot and distal limb, the median HWST was much higher for the ice pack device, 19.9°C (18.7-23.1°C), compared with the perfused cuff prototype of 5.4°C (4.2-7°C). CONCLUSIONS Immersion of the foot and at least the pastern region in ice and water achieved sustained HWST <10°C as did a prototype perfused cuff device with a dry interface. Variation between cooling methods may have a profound effect on HWST and therefore efficacy in clinical cases where laminitis prophylaxis or therapy is the goal.
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Affiliation(s)
| | - J A Orsini
- New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, USA
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Kounis NG, Kounis GN, Soufras GD, Tsigkas G, Hahalis G. Therapeutic hypothermia, stent thrombosis and the Kounis mast cell activation-associated syndrome. Int J Cardiol 2015; 179:504-6. [DOI: 10.1016/j.ijcard.2014.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/04/2014] [Indexed: 01/31/2023]
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Jo YH, Kim K, Lee JH, Rim KP, Cho IS. Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis. Clin Exp Emerg Med 2014; 1:120-125. [PMID: 27752563 PMCID: PMC5052836 DOI: 10.15441/ceem.14.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/05/2014] [Accepted: 07/17/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study was performed to investigate the effect of the rewarming rate on survival and acute lung injury in sepsis. METHODS Male Sprague-Dawley rats underwent cecal ligation and incision. After 1 hour of sepsis induction, normothermia (37°C±0.5°C, NT group) or hypothermia (32°C±0.5°C) was induced. Hypothermia was maintained for 4 hours and rats were divided into two groups according to the rewarming rate: RW1 group, 1 hour of rewarming; and RW2 group, 2 hours of rewarming. In the survival study, rats were observed for 12 hours after sepsis induction (n=6 per group). In the second experiment, rats were sacrificed 7 hours after sepsis induction, and lung tissues and plasma were harvested (n=10 per group). RESULTS In the survival study, the RW2 group survived longer than the RW1 group (P<0.05), but the RW1 and NT groups showed no significant difference in survival duration (P>0.05). The histological lung injury score and malondialdehyde concentrations in the lung tissues were significantly higher in the RW1 group than in the RW2 group (P<0.05). Plasma interleukin (IL)-6 concentration and the ratio of IL-6 to IL-10 were higher in the RW1 group than in the RW2 group (P<0.05). CONCLUSION Rapid rewarming after therapeutic hypothermia results in a shorter survival period and acute lung injury in sepsis, which could be associated with the inflammatory responses.
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Affiliation(s)
- You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Pil Rim
- Department of Emergency Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - In Soo Cho
- Department of Emergency Medicine, Kepco Medical Center, Seoul, Korea
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Popugaev KA, Savin IA, Oshorov AV, Kurdumova NV, Ershova ON, Lubnin AU, Kadashev BA, Kalinin PL, Kutin MA, Killeen T, Cesnulis E, Melieste R. Postsurgical meningitis complicated by severe refractory intracranial hypertension with limited treatment options: the role of mild therapeutic hypothermia. J Neurol Surg Rep 2014; 75:e224-9. [PMID: 25485219 PMCID: PMC4242895 DOI: 10.1055/s-0034-1387188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/03/2014] [Indexed: 12/19/2022] Open
Abstract
Intracranial hypertension is a commonly encountered neurocritical care problem. If first-tier therapy is ineffective, second-tier therapy must be initiated. In many cases, the full arsenal of established treatment options is available. However, situations occasionally arise in which only a narrow range of options is available to neurointensivists. We present a rare clinical scenario in which therapeutic hypothermia was the only available method for controlling intracranial pressure and that demonstrates the efficacy and safety of the Thermogard (Zoll, Chelmsford, Massachusetts, United States) cooling system in creating and maintaining a prolonged hypothermic state. The lifesaving effect of hypothermia was overshadowed by the unfavorable neurologic outcome observed (minimally conscious state on intensive care unit discharge). These results add further evidence to support the role of therapeutic hypothermia in managing intracranial pressure and provide motivation for finding new strategies in combination with hypothermia to improve neurologic outcomes.
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Affiliation(s)
- Konstantin A. Popugaev
- Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Ivan A. Savin
- Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Andrew V. Oshorov
- Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Natalia V. Kurdumova
- Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Olga N. Ershova
- Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Andrew U. Lubnin
- Department of Neuroanesthesia, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Boris A. Kadashev
- 8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Pavel L. Kalinin
- 8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Maxim A. Kutin
- 8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Tim Killeen
- Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland
| | - Evaldas Cesnulis
- Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland
| | - Ronald Melieste
- Temperature Management Division Europe, Zoll Medical Corporation, Chelmsford, Massachusetts, United States
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Tan N, Thode HC, Singer AJ. The effect of controlled mild hypothermia on large scald burns in a resuscitated rat model. Clin Exp Emerg Med 2014; 1:56-61. [PMID: 27752553 PMCID: PMC5052816 DOI: 10.15441/ceem.14.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/07/2014] [Accepted: 08/17/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Early surface cooling of burns reduces pain, depth of injury and improves healing. We hypothesized that controlled mild hypothermia would also prolong survival in a fluid resuscitated rat model of large scald burns. METHODS Forty rats were anesthetized and a single full-thickness scald burn covering 40% of total body surface area was created on each of the rats. The rats were then randomized to hypothermia (n=20) or no hypothermia (n=20). Mild hypothermia (a reduction of 2°C) was induced with intraperitoneal 4°C normal saline and ice packs. After 2 hours of hypothermia, the rats were rewarmed back to their baseline temperature with a heating pad. The control rats received room temperature intraperitoneal saline. The difference in survival between the groups was determined using Kaplan-Meier analysis and the log-rank test. RESULTS Hypothermia was induced in all experimental rats within a mean of 22 minutes (95% confidence interval, 17 to 27). The number of normothermic and hypothermic rats that expired at each time interval were: at 1 hour, 4 vs. 0; at 10 hours, 2 from each group; at 24 hours, 0 vs. 1; at 48 hours, 2 vs. 2; at 72 hours, 1 vs. 1; and at 120 hours, 1 vs. 1 respectively. There were no differences in time to survival between the groups. CONCLUSION Induction of brief, mild hypothermia does not prolong survival in a resuscitated rat model of large scald burns.
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Affiliation(s)
- Nhi Tan
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Henry C Thode
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA
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73
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Orlowski P, McConnell FK, Payne S. A mathematical model of cellular metabolism during ischemic stroke and hypothermia. IEEE Trans Biomed Eng 2014; 61:484-90. [PMID: 24058013 DOI: 10.1109/tbme.2013.2282603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stroke is a major cause of death and disability worldwide. Therapeutic hypothermia is a potentially useful neuroprotective treatment. A mathematical model of brain metabolism during stroke is extended here to simulate the effect of hypothermia on cell survival. Temperature decreases were set to reduce chemical reaction rates and slow diffusion through ion channels according to the Q10 rule. Heat delivery to tissues was set to depend on metabolic heat generation rate and perfusion. Two cooling methods, scalp and vascular, were simulated to approximate temperature variation in the brain during treatment. Cell death was assumed to occur at continued cell membrane depolarization. Simulations showed that hypothermia to 34.5 °C induced within 1-1.5 h of stroke onset could extend cell survival time by at least 5 h in tissue with perfusion reduced by 80% of normal. There was good agreement between simulated metabolite dynamics and those reported in rat model studies.
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Lee JH, Wei L, Gu X, Wei Z, Dix TA, Yu SP. Therapeutic effects of pharmacologically induced hypothermia against traumatic brain injury in mice. J Neurotrauma 2014; 31:1417-30. [PMID: 24731132 DOI: 10.1089/neu.2013.3251] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Preclinical and clinical studies have shown therapeutic potential of mild-to-moderate hypothermia for treatments of stroke and traumatic brain injury (TBI). Physical cooling in humans, however, is usually slow, cumbersome, and necessitates sedation that prevents early application in clinical settings and causes several side effects. Our recent study showed that pharmacologically induced hypothermia (PIH) using a novel neurotensin receptor 1 (NTR1) agonist, HPI-201 (also known as ABS-201), is efficient and effective in inducing therapeutic hypothermia and protecting the brain from ischemic and hemorrhagic stroke in mice. The present investigation tested another second-generation NTR1 agonist, HPI-363, for its hypothermic and protective effect against TBI. Adult male mice were subjected to controlled cortical impact (CCI) (velocity=3 m/sec, depth=1.0 mm, contact time=150 msec) to the exposed cortex. Intraperitoneal administration of HPI-363 (0.3 mg/kg) reduced body temperature by 3-5°C within 30-60 min without triggering a shivering defensive reaction. An additional two injections sustained the hypothermic effect in conscious mice for up to 6 h. This PIH treatment was initiated 15, 60, or 120 min after the onset of TBI, and significantly reduced the contusion volume measured 3 days after TBI. HPI-363 attenuated caspase-3 activation, Bax expression, and TUNEL-positive cells in the pericontusion region. In blood-brain barrier assessments, HPI-363 ameliorated extravasation of Evans blue dye and immunoglobulin G, attenuated the MMP-9 expression, and decreased the number of microglia cells in the post-TBI brain. HPI-363 decreased the mRNA expression of tumor necrosis factor-α and interleukin-1β (IL-1β), but increased IL-6 and IL-10 levels. Compared with TBI control mice, HPI-363 treatments improved sensorimotor functional recovery after TBI. These findings suggest that the second generation NTR-1 agonists, such as HPI-363, are efficient hypothermic-inducing compounds that have a strong potential in the management of TBI.
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Affiliation(s)
- Jin Hwan Lee
- 1 Department of Anesthesiology, Emory University School of Medicine , Atlanta, Georgia
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75
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Karnatovskaia LV, Wartenberg KE, Freeman WD. Therapeutic hypothermia for neuroprotection: history, mechanisms, risks, and clinical applications. Neurohospitalist 2014; 4:153-63. [PMID: 24982721 DOI: 10.1177/1941874413519802] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The earliest recorded application of therapeutic hypothermia in medicine spans about 5000 years; however, its use has become widespread since 2002, following the demonstration of both safety and efficacy of regimens requiring only a mild (32°C-35°C) degree of cooling after cardiac arrest. We review the mechanisms by which hypothermia confers neuroprotection as well as its physiological effects by body system and its associated risks. With regard to clinical applications, we present evidence on the role of hypothermia in traumatic brain injury, intracranial pressure elevation, stroke, subarachnoid hemorrhage, spinal cord injury, hepatic encephalopathy, and neonatal peripartum encephalopathy. Based on the current knowledge and areas undergoing or in need of further exploration, we feel that therapeutic hypothermia holds promise in the treatment of patients with various forms of neurologic injury; however, additional quality studies are needed before its true role is fully known.
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Affiliation(s)
| | - Katja E Wartenberg
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Germany
| | - William D Freeman
- Departments of Neurology, Neurosurgery, Critical Care, Mayo Clinic, Jacksonville, FL, USA
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Idris Z, Zenian MS, Muzaimi M, Hamid WZWA. Better Glasgow outcome score, cerebral perfusion pressure and focal brain oxygenation in severely traumatized brain following direct regional brain hypothermia therapy: A prospective randomized study. Asian J Neurosurg 2014; 9:115-23. [PMID: 25685201 PMCID: PMC4323894 DOI: 10.4103/1793-5482.142690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Induced hypothermia for treatment of traumatic brain injury is controversial. Since many pathways involved in the pathophysiology of secondary brain injury are temperature dependent, regional brain hypothermia is thought capable to mitigate those processes. The objectives of this study are to assess the therapeutic effects and complications of regional brain cooling in severe head injury with Glasgow coma scale (GCS) 6-7. MATERIALS AND METHODS A prospective randomized controlled pilot study involving patients with severe traumatic brain injury with GCS 6 and 7 who required decompressive craniectomy. Patients were randomized into two groups: Cooling and no cooling. For the cooling group, analysis was made by dividing the group into mild and deep cooling. Brain was cooled by irrigating the brain continuously with cold Hartmann solution for 24-48 h. Main outcome assessments were a dichotomized Glasgow outcome score (GOS) at 6 months posttrauma. RESULTS A total of 32 patients were recruited. The cooling-treated patients did better than no cooling. There were 63.2% of patients in cooling group attained good GOS at 6 months compared to only 15.4% in noncooling group (P = 0.007). Interestingly, the analysis at 6 months post-trauma disclosed mild-cooling-treated patients did better than no cooling (70% vs. 15.4% attained good GOS, P = 0.013) and apparently, the deep-cooling-treated patients failed to be better than either no cooling (P = 0.074) or mild cooling group (P = 0.650). CONCLUSION Data from this pilot study imply direct regional brain hypothermia appears safe, feasible and maybe beneficial in treating severely head-injured patients.
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Affiliation(s)
- Zamzuri Idris
- Center for Neuroscience Service and Research, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Sofan Zenian
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mustapha Muzaimi
- Center for Neuroscience Service and Research, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Zuraida Wan Abdul Hamid
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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78
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Perman SM, Goyal M, Neumar RW, Topjian AA, Gaieski DF. Clinical applications of targeted temperature management. Chest 2014; 145:386-393. [PMID: 24493510 DOI: 10.1378/chest.12-3025] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Targeted temperature management (TTM) has been investigated experimentally and used clinically for over 100 years. The initial rationale for the clinical application of TTM, historically referred to as therapeutic hypothermia, was to decrease the metabolic rate, allowing the injured brain time to heal. Subsequent research demonstrated the temperature dependence of diverse cellular mechanisms including endothelial dysfunction, production of reactive oxygen species, and apoptosis. Consequently, modern use of TTM centers on neuroprotection following focal or global neurologic injury. Despite a solid basic science rationale for applying TTM in a variety of disease processes, including cardiac arrest, traumatic brain injury, ischemic stroke, neonatal ischemic encephalopathy, sepsis-induced encephalopathy, and hepatic encephalopathy, human efficacy data are limited and vary greatly from disease to disease. Ten years ago, two landmark investigations yielded high-quality data supporting the application of TTM in comatose survivors of out-of-hospital cardiac arrest. Additionally, TTM has been demonstrated to improve outcomes for neonatal patients with anoxic brain injury secondary to hypoxic ischemic encephalopathy. Trials are currently under way, or have yielded conflicting results in, examining the utility of TTM for the treatment of ischemic stroke, traumatic brain injury, and acute myocardial infarction. In this review, we place TTM in historic context, discuss the pathophysiologic rationale for its use, review the general concept of a TTM protocol for the management of brain injury, address some of the common side effects encountered when lowering human body temperature, and examine the data for its use in diverse disease conditions with in-depth examination of TTM for postarrest care and pediatric applications.
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Affiliation(s)
- Sarah M Perman
- Department of Emergency Medicine, Center for Resuscitation Science, Children's Hospital of Philadelphia; Department of Emergency Medicine, Children's Hospital of Philadelphia; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Munish Goyal
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert W Neumar
- Department of Emergency Medicine, Medstar Health System, Washington Hospital Healthcare System, Washington, DC
| | - Alexis A Topjian
- Department of Pediatric Critical Care Medicine, Children's Hospital of Philadelphia
| | - David F Gaieski
- Department of Emergency Medicine, Center for Resuscitation Science, Children's Hospital of Philadelphia; Department of Emergency Medicine, Children's Hospital of Philadelphia.
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Crossley S, Reid J, McLatchie R, Hayton J, Clark C, MacDougall M, Andrews PJD. A systematic review of therapeutic hypothermia for adult patients following traumatic brain injury. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R75. [PMID: 24742169 PMCID: PMC4056614 DOI: 10.1186/cc13835] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/03/2014] [Indexed: 12/16/2022]
Abstract
Introduction Research into therapeutic hypothermia following traumatic brain injury has been characterised by small trials of poor methodological quality, producing variable results. The Cochrane review, published in 2009, now requires updating. The aim of this systematic review is to assess the effectiveness of the application of therapeutic hypothermia to reduce death and disability when administered to adult patients who have been admitted to hospital following traumatic brain injury. Methods Two authors extracted data from each trial. Unless stated in the trial report, relative risks and 95% confidence intervals (CIs) were calculated for each trial. We considered P < 0 · 05 to be statistically significant. We combined data from all trials to estimate the pooled risk ratio (RR) with 95% confidence intervals for death, unfavourable outcome, and pneumonia. All statistical analyses were performed using RevMan 5.1 (Cochrane IMS, Oxford, UK) and Stata (Intercooled Version 12.0, StataCorp LP). Pooled RRs were calculated using the Mantel-Haenszel estimator. The random effects model of DerSimonian and Laird was used to estimate variances for the Mantel-Haenszel and inverse variance estimators. Results Twenty studies are included in the review, while 18 provided mortality data. When the results of 18 trials that evaluated mortality as one of the outcomes were statistically aggregated, therapeutic hypothermia was associated with a significant reduction in mortality and a significant reduction in poor outcome. There was a lack of statistical evidence for an association between use of therapeutic hypothermia and increased onset of new pneumonia. Conclusions In contrast to previous reviews, this systematic review found some evidence to suggest that therapeutic hypothermia may be of benefit in the treatment of traumatic brain injury. The majority of trials were of low quality, with unclear allocation concealment. Low quality trials may overestimate the effectiveness of hypothermia treatment versus standard care. There remains a need for more, high quality, randomised control trials of therapeutic hypothermia after traumatic brain injury. PROSPERO Systematic Review Registration Number 2012:
CRD42012002449.
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McMahon D. Editorial comment. J Urol 2014; 191:1584-5. [PMID: 24679867 DOI: 10.1016/j.juro.2013.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dan McMahon
- Akron Children's Hospital, Northeast Ohio Medical University, Rootstown, Ohio
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81
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Synergistic interaction between ketamine and magnesium in lowering body temperature in rats. Physiol Behav 2014; 127:45-53. [DOI: 10.1016/j.physbeh.2014.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/20/2013] [Accepted: 01/14/2014] [Indexed: 11/19/2022]
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82
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Bader EBMK. Clinical Q & A: Translating Therapeutic Temperature Management from Theory to Practice. Ther Hypothermia Temp Manag 2014. [DOI: 10.1089/ther.2014.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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83
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Factors associated with pneumonia in post–cardiac arrest patients receiving therapeutic hypothermia. Am J Emerg Med 2014; 32:150-5. [DOI: 10.1016/j.ajem.2013.10.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/11/2013] [Accepted: 10/14/2013] [Indexed: 11/20/2022] Open
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Scantling D, Klonoski E, Valentino DJ. Use of therapeutic hypothermia in cocaine-induced cardiac arrest: further evidence. Am J Crit Care 2014; 23:89-92. [PMID: 24382622 DOI: 10.4037/ajcc2014299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Therapeutic hypothermia is an important and successful treatment that has been endorsed only in specific clinical settings of cardiac arrest. Inclusion criteria thus far have not embraced drug-induced cardiac arrest, but clinical evidence has been mounting that therapeutic hypothermia may be beneficial in such cases. A 59-year-old man who experienced a cocaine-induced cardiac arrest had a full neurological recovery after use of therapeutic hypothermia. The relevant pathophysiology of cocaine-induced cardiac arrest is reviewed, the mechanism and history of therapeutic hypothermia are discussed, and the clinical evidence recommending the use of therapeutic hypothermia in cocaine-induced cardiac arrest is reinforced.
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Affiliation(s)
- Dane Scantling
- Dane Scantling is a fourth year medical student at The Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Emily Klonoski is an internal medicine resident a St Luke’s University Health Network in Bethlehem, Pennsylvania. Dominic J. Valentino III is the medical director of critical care at Mercy Fitzgerald Hospital in Darby, Pennsylvania
| | - Emily Klonoski
- Dane Scantling is a fourth year medical student at The Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Emily Klonoski is an internal medicine resident a St Luke’s University Health Network in Bethlehem, Pennsylvania. Dominic J. Valentino III is the medical director of critical care at Mercy Fitzgerald Hospital in Darby, Pennsylvania
| | - Dominic J. Valentino
- Dane Scantling is a fourth year medical student at The Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Emily Klonoski is an internal medicine resident a St Luke’s University Health Network in Bethlehem, Pennsylvania. Dominic J. Valentino III is the medical director of critical care at Mercy Fitzgerald Hospital in Darby, Pennsylvania
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Chang JY, Hong JH, Jeong JH, Nam SJ, Jang JH, Bang JS, Han MK. Therapeutic Hypothermia after Decompressive Craniectomy in Malignant Cerebral Infarction. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jun Young Chang
- Department of Interdisciplinary Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jin-Heon Jeong
- Department of Interdisciplinary Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Jin Nam
- Department of Interdisciplinary Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji-Hwan Jang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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Heparin dosing in critically ill patients undergoing therapeutic hypothermia following cardiac arrest. Resuscitation 2013; 85:533-7. [PMID: 24361456 DOI: 10.1016/j.resuscitation.2013.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/15/2013] [Accepted: 12/06/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine the effects of anticoagulation with intravenous unfractionated heparin (IVUH) during therapeutic hypothermia (TH) post-cardiac arrest. METHODS Single-center, retrospective, observational trial in the intensive care units of two hospitals within the Detroit Medical Center. Unresponsive survivors of cardiac arrest, receiving treatment doses of IVUH during TH were included. Patients were required to have at least 1 measured activated partial thromboplastin time (aPTT) during TH. Coagulation parameters were collected at 3 distinct temperature phases: baseline, TH, and post-re-warming (±37 °C) target aPTT defined as 1.5-2 times baseline. RESULTS Forty-six patients received IVUH during TH, with 211 aPTTs. Heparin starting rate was 13±4 units/kg/h. Average baseline, TH and post-TH aPTT were 34±12, 142±48, and 56±17 s, respectively. Using standard dosing strategies, initial aPTT was above the target range in 89% of patients. After re-warming, aPTT significantly decreased (142±48s vs. 56±17 s, p=0.005), and heparin dose significantly increased (7.9±3 vs. 9±4 units/kg/h, p<0.001). There was a significant difference between aPTT among all three groups, and heparin dose between TH and post-TH even after correcting for age, sex, body mass index, heparin rate, and APACHE II score (p<0.001). Three patients experienced a major bleeding event. CONCLUSIONS Current dosing protocols for IVUH should not be utilized during TH. Heparin requirements are drastically reduced during TH and prolonged interruptions may be required to allow for adequate clearance of UH.
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Oxidative stress and antioxidant activity in hypothermia and rewarming: can RONS modulate the beneficial effects of therapeutic hypothermia? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2013; 2013:957054. [PMID: 24363826 PMCID: PMC3865646 DOI: 10.1155/2013/957054] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 10/21/2013] [Indexed: 12/12/2022]
Abstract
Hypothermia is a condition in which core temperature drops below the level necessary to maintain bodily functions. The decrease in temperature may disrupt some physiological systems of the body, including alterations in microcirculation and reduction of oxygen supply to tissues. The lack of oxygen can induce the generation of reactive oxygen and nitrogen free radicals (RONS), followed by oxidative stress, and finally, apoptosis and/or necrosis. Furthermore, since the hypothermia is inevitably followed by a rewarming process, we should also consider its effects. Despite hypothermia and rewarming inducing injury, many benefits of hypothermia have been demonstrated when used to preserve brain, cardiac, hepatic, and intestinal function against ischemic injury. This review gives an overview of the effects of hypothermia and rewarming on the oxidant/antioxidant balance and provides hypothesis for the role of reactive oxygen species in therapeutic hypothermia.
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Jha MK, Seo M, Kim JH, Kim BG, Cho JY, Suk K. The secretome signature of reactive glial cells and its pathological implications. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2013; 1834:2418-28. [PMID: 23269363 DOI: 10.1016/j.bbapap.2012.12.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/23/2012] [Accepted: 12/12/2012] [Indexed: 12/12/2022]
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Ferreira Da Silva IR, Frontera JA. Targeted Temperature Management in Survivors of Cardiac Arrest. Cardiol Clin 2013; 31:637-55, ix. [DOI: 10.1016/j.ccl.2013.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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91
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Marblestone AH, Zamft BM, Maguire YG, Shapiro MG, Cybulski TR, Glaser JI, Amodei D, Stranges PB, Kalhor R, Dalrymple DA, Seo D, Alon E, Maharbiz MM, Carmena JM, Rabaey JM, Boyden ES, Church GM, Kording KP. Physical principles for scalable neural recording. Front Comput Neurosci 2013; 7:137. [PMID: 24187539 PMCID: PMC3807567 DOI: 10.3389/fncom.2013.00137] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 09/23/2013] [Indexed: 12/20/2022] Open
Abstract
Simultaneously measuring the activities of all neurons in a mammalian brain at millisecond resolution is a challenge beyond the limits of existing techniques in neuroscience. Entirely new approaches may be required, motivating an analysis of the fundamental physical constraints on the problem. We outline the physical principles governing brain activity mapping using optical, electrical, magnetic resonance, and molecular modalities of neural recording. Focusing on the mouse brain, we analyze the scalability of each method, concentrating on the limitations imposed by spatiotemporal resolution, energy dissipation, and volume displacement. Based on this analysis, all existing approaches require orders of magnitude improvement in key parameters. Electrical recording is limited by the low multiplexing capacity of electrodes and their lack of intrinsic spatial resolution, optical methods are constrained by the scattering of visible light in brain tissue, magnetic resonance is hindered by the diffusion and relaxation timescales of water protons, and the implementation of molecular recording is complicated by the stochastic kinetics of enzymes. Understanding the physical limits of brain activity mapping may provide insight into opportunities for novel solutions. For example, unconventional methods for delivering electrodes may enable unprecedented numbers of recording sites, embedded optical devices could allow optical detectors to be placed within a few scattering lengths of the measured neurons, and new classes of molecularly engineered sensors might obviate cumbersome hardware architectures. We also study the physics of powering and communicating with microscale devices embedded in brain tissue and find that, while radio-frequency electromagnetic data transmission suffers from a severe power-bandwidth tradeoff, communication via infrared light or ultrasound may allow high data rates due to the possibility of spatial multiplexing. The use of embedded local recording and wireless data transmission would only be viable, however, given major improvements to the power efficiency of microelectronic devices.
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Affiliation(s)
- Adam H. Marblestone
- Biophysics Program, Harvard UniversityBoston, MA, USA
- Wyss Institute for Biologically Inspired Engineering at Harvard UniversityBoston, MA, USA
| | | | - Yael G. Maguire
- Department of Genetics, Harvard Medical SchoolBoston, MA, USA
- Plum Labs LLCCambridge, MA, USA
| | - Mikhail G. Shapiro
- Division of Chemistry and Chemical Engineering, California Institute of TechnologyPasadena, CA, USA
| | | | - Joshua I. Glaser
- Interdepartmental Neuroscience Program, Northwestern UniversityChicago, IL, USA
| | - Dario Amodei
- Department of Radiology, Stanford UniversityPalo Alto, CA, USA
| | | | - Reza Kalhor
- Department of Genetics, Harvard Medical SchoolBoston, MA, USA
| | - David A. Dalrymple
- Biophysics Program, Harvard UniversityBoston, MA, USA
- NemaloadSan Francisco, CA, USA
- Media Laboratory, Massachusetts Institute of TechnologyCambridge, MA, USA
| | - Dongjin Seo
- Department of Electrical Engineering and Computer Sciences, University of California at BerkeleyBerkeley, CA, USA
| | - Elad Alon
- Department of Electrical Engineering and Computer Sciences, University of California at BerkeleyBerkeley, CA, USA
| | - Michel M. Maharbiz
- Department of Electrical Engineering and Computer Sciences, University of California at BerkeleyBerkeley, CA, USA
| | - Jose M. Carmena
- Department of Electrical Engineering and Computer Sciences, University of California at BerkeleyBerkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California at BerkeleyBerkeley, CA, USA
| | - Jan M. Rabaey
- Department of Electrical Engineering and Computer Sciences, University of California at BerkeleyBerkeley, CA, USA
| | - Edward S. Boyden
- Media Laboratory, Massachusetts Institute of TechnologyCambridge, MA, USA
- Departments of Brain and Cognitive Sciences and Biological Engineering, Massachusetts Institute of TechnologyCambridge, MA, USA
| | - George M. Church
- Biophysics Program, Harvard UniversityBoston, MA, USA
- Wyss Institute for Biologically Inspired Engineering at Harvard UniversityBoston, MA, USA
- Department of Genetics, Harvard Medical SchoolBoston, MA, USA
| | - Konrad P. Kording
- Departments of Physical Medicine and Rehabilitation and of Physiology, Northwestern University Feinberg School of MedicineChicago, IL, USA
- Sensory Motor Performance Program, The Rehabilitation Institute of ChicagoChicago, IL, USA
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Moler FW, Silverstein FS, Meert KL, Clark AE, Holubkov R, Browning B, Slomine BS, Christensen JR, Dean JM. Rationale, timeline, study design, and protocol overview of the therapeutic hypothermia after pediatric cardiac arrest trials. Pediatr Crit Care Med 2013; 14:e304-15. [PMID: 23842585 PMCID: PMC3947631 DOI: 10.1097/pcc.0b013e31828a863a] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the rationale, timeline, study design, and protocol overview of the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials. DESIGN Multicenter randomized controlled trials. SETTING Pediatric intensive care and cardiac ICUs in the United States and Canada. PATIENTS Children from 48 hours to 18 years old, who have return of circulation after cardiac arrest, who meet trial eligibility criteria, and whose guardians provide written consent. INTERVENTIONS Therapeutic hypothermia or therapeutic normothermia. MEASUREMENTS AND MAIN RESULTS From concept inception in 2002 until trial initiation in 2009, 7 years were required to plan and operationalize the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials. Two National Institute of Child Health and Human Development clinical trial planning grants (R21 and R34) supported feasibility assessment and protocol development. Two clinical research networks, Pediatric Emergency Care Applied Research Network and Collaborative Pediatric Critical Care Research Network, provided infrastructure resources. Two National Heart Lung Blood Institute U01 awards provided funding to conduct separate trials of in-hospital and out-of-hospital cardiac arrest. A pilot vanguard phase that included half the clinical sites began on March 9, 2009, and this was followed by full trial funding through 2015. CONCLUSIONS Over a decade will have been required to plan, design, operationalize, and conduct the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials. Details described in this report, such as participation of clinical research networks and clinical trial planning grants utilization, may be of utility for individuals who are planning investigator-initiated, federally supported clinical trials.
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Affiliation(s)
- Frank W Moler
- 1Department of Pediatrics, University of Michigan, Ann Arbor, MI. 2Department of Pediatrics, Wayne State University, Detroit, MI. 3Department of Pediatrics, University of Utah, Salt Lake City, UT. 4Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD. 5Department of Pediatric Rehabilitation Medicine, Kennedy Krieger Institute, Baltimore, MD
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Ning MM, Lopez M, Sarracino D, Cao J, Karchin M, McMullin D, Wang X, Buonanno FS, Lo EH. Pharmaco-proteomics opportunities for individualizing neurovascular treatment. Neurol Res 2013; 35:448-56. [PMID: 23711324 PMCID: PMC4153693 DOI: 10.1179/1743132813y.0000000213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Neurovascular disease often involves multi-organ system injury. For example, patent foramen ovale (PFO) related ischemic strokes involve not just the brain, but also the heart, the lung, and the peripheral vascular circulation. For higher-risk but high-reward systemic therapy (e.g., thrombolytics, therapeutic hypothermia (TH), PFO closure) to be implemented safely, very careful patient selection and close monitoring of disease progression and therapeutic efficacy are imperative. For example, more than a decade after the approval of therapeutic hypothermic and intravenous thrombolysis treatments, they both remain extremely under-utilized, in part due to lack of clinical tools for patient selection or to follow therapeutic efficacy. Therefore, in understanding the complexity of the global effects of clinical neurovascular diseases and their therapies, a systemic approach may offer a unique perspective and provide tools with clinical utility. Clinical proteomic approaches may be promising to monitor systemic changes in complex multi-organ diseases - especially where the disease process can be 'sampled' in clinically accessible fluids such as blood, urine, and CSF. Here, we describe a 'pharmaco-proteomic' approach to three major challenges in translational neurovascular research directly at bedside - in order to better stratify risk, widen therapeutic windows, and explore novel targets to be validated at the bench - (i) thrombolytic treatment for ischemic stroke, (ii) therapeutic hypothermia for post-cardiac arrest syndrome, and (iii) treatment for PFO related paradoxical embolic stroke. In the future, this clinical proteomics approach may help to improve patient selection, ensure more precise clinical phenotyping for clinical trials, and individualize patient treatment.
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Affiliation(s)
- MM Ning
- Clinical Proteomics Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School; Boston, MA
- Neuroprotection Research Laboratory, Department of Neurology and Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - M Lopez
- Thermo-Fisher BRIMS, Cambridge, MA
| | | | - J Cao
- Clinical Proteomics Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School; Boston, MA
| | - M Karchin
- Clinical Proteomics Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School; Boston, MA
| | - D McMullin
- Clinical Proteomics Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School; Boston, MA
| | - X Wang
- Neuroprotection Research Laboratory, Department of Neurology and Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - FS Buonanno
- Clinical Proteomics Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School; Boston, MA
- Neuroprotection Research Laboratory, Department of Neurology and Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - EH Lo
- Clinical Proteomics Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School; Boston, MA
- Neuroprotection Research Laboratory, Department of Neurology and Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Heart Rate and Arterial Pressure Changes during Whole-Body Deep Hypothermia. ISRN PEDIATRICS 2013; 2013:140213. [PMID: 23691350 PMCID: PMC3649319 DOI: 10.1155/2013/140213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/18/2013] [Indexed: 11/17/2022]
Abstract
Whole-body deep hypothermia (DH) could be a new therapeutic strategy for asphyxiated newborn. This retrospective study describes how DH modified the heart rate and arterial blood pressure if compared to mild hypothermia (MH). Fourteen in DH and 17 in MH were cooled within the first six hours of life and for the following 72 hours. Hypothermia criteria were gestational age ≥36 weeks; birth weight ≥1800 g; clinical signs of moderate/severe hypoxic-ischemic encephalopathy. Rewarming was obtained in the following 6-12 hours (0.5°C/h) after cooling. Heart rates were the same between the two groups; there was statistically significant difference at the beginning of hypothermia and during rewarming. Three babies in the DH group and 2 in the MH group showed HR < 80 bpm and QTc > 520 ms. Infant submitted to deep hypothermia had not bradycardia or Qtc elongation before cooling and after rewarming. Blood pressure was significantly lower in DH compared to MH during the cooling, and peculiar was the hypotension during rewarming in DH group. Conclusion. The deeper hypothermia is a safe and feasible, only if it is performed by a well-trained team. DH should only be associated with a clinical trial and prospective randomized trials to validate its use.
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96
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Gierman JL, Shutze WP, Pearl GJ, Foreman ML, Hohmann SE, Shutze WP. Thermoregulatory catheter-associated inferior vena cava thrombus. Proc (Bayl Univ Med Cent) 2013; 26:100-2. [PMID: 23543961 DOI: 10.1080/08998280.2013.11928929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The use of thermoregulatory catheters (TRCs) in critically ill patients has become increasingly popular. TRCs have been shown to be effective in regulating patient body temperature with improved outcomes. Critically ill patients, especially multitrauma patients and those with femoral catheters, are at high risk for deep vein thrombosis (DVT). Among patients for whom chemical DVT prophylaxis is not an option, inferior vena cava (IVC) filters are often placed prophylactically. The development of intravascular ultrasound (IVUS) has allowed placement of IVC filters at the bedside for patients who are too ill for transport to the operating room or cardiac catheterization lab. After encountering several patients with occult DVT of the IVC during bedside IVC filter placement, we performed a retrospective review to determine the incidence of DVT or pulmonary embolus (PE) in patients who had been treated with a TRC at Baylor University Medical Center at Dallas. Since 2008, IVC filters have been deployed at the bedside with the use of IVUS at Baylor University Medical Center. During that same time period, 83 patients had a TRC placed for either intravascular warming or cooling during their resuscitation. Forty-seven out of 83 patients who had a TRC placed survived their injuries. Ten of 47 patients (21%) were diagnosed with DVT or PE, and 6 of these 10 (60%) were found to have caval thrombus. We present this case series as evidence that undiagnosed IVC thrombus associated with TRCs may be higher than previously suspected, given that 5 out of 10 patients who had IVUS of their IVC for prophylactic IVC filter placement, as well as one patient diagnosed with PE, were found to have caval thrombus.
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Affiliation(s)
- Joshua L Gierman
- Department of Surgery (Gierman, Shutze Sr., Pearl, Foreman, Hohmann), Baylor University Medical Center at Dallas; and Texas Vascular Associates, Dallas, Texas (Shutze Jr.)
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Abstract
Summer invites activities and sports that are unique to this time of year. Although safety is a priority, there are commonly accidents and incidents that occur while individuals are participating in these activities. The prevalence and incidence of several types of injuries and trauma related to water activities, camping, caving, backpacking, and hiking are discussed. Treatment of nonfatal drowning is discussed, along with the pathophysiologic process that must be corrected for optimal outcomes. Summer is a time for outdoor cooking, campfires, and the traditional Fourth of July firework pastimes, which can result in admissions to critical care areas.
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Affiliation(s)
- Stephen D Krau
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN 37240, USA.
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Khadrawy YA, AboulEzz HS, Ahmed NA, Mohammed HS. The Anticonvulant Effect of Cooling in Comparison to α-Lipoic Acid: A Neurochemical Study. Neurochem Res 2013; 38:906-15. [DOI: 10.1007/s11064-013-0995-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 01/28/2013] [Accepted: 01/31/2013] [Indexed: 11/29/2022]
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Nadeau M, Micheau P, Robert R, Avoine O, Tissier R, Germim PS, Walti H. Control of rapid hypothermia induction by total liquid ventilation: preliminary results. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:3757-3760. [PMID: 24110548 DOI: 10.1109/embc.2013.6610361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Mild therapeutic hypothermia (MTH) consists in cooling the body temperature of a patient to between 32 and 34 °C. This technique helps to preserve tissues and neurological functions in multi-organ failure by preventing ischemic injury. Total liquid ventilation (TLV) ensures gas exchange in the lungs with a liquid, typically perfluorocarbon (PFC). A liquid ventilator is responsible for ensuring cyclic renewal of tidal volume of oxygenated and temperature-controlled PFC. Hence, TLV using the lung as a heat exchanger and PFC as a heat carrier allows ultra fast cooling of the whole body which can help improve outcome after ischemic injuries. The present study was aimed to evaluate the control performance and safety of automated ultrarapid MTH induction by TLV. Experimentation was conducted using the Inolivent-5.0 liquid ventilator equipped with a PFC treatment unit that allows PFC cooling and heating from the flow of energy carrier water inside a double wall installed on an oxygenator. A water circulating bath is used to manage water temperature. A feedback controller was developed to modulate inspired PFC temperature and control body temperature. Such a controller is important since, with MTH induction, heart temperature should not reach 28 °C because of a high risk of fibrillation. The in vivo experimental protocol was conducted on a male newborn lamb of 4.7 kg which, after anesthetization, was submitted to conventional gas ventilation and instrumented with temperature sensors at the femoral artery, oesophagus, right ear drum and rectum. After stabilization, TLV was initiated with fast automated MTH induction to 33.5 °C until stabilization of all temperatures. MTH could be reached safely in 3 minutes at the femoral artery, in 3.6 minutes at the esophagus, in 7.7 minutes at the eardrum and in 15 minutes at the rectum. All temperatures were stable at 33.5 ± 0.5 °C within 15 minutes. The present results reveal that ultra-fast MTH induction by TLV with Inolivent-5.0 is safe for the heart while maintaining esophageal and arterial temperature over 32.6 °C.
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100
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Shaikh N, Malmstrom M. Protective hypothermia: An old therapy with a new prospective. Qatar Med J 2012; 2012:81-4. [PMID: 25003047 PMCID: PMC3991035 DOI: 10.5339/qmj.2012.2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 12/01/2012] [Indexed: 11/09/2022] Open
Abstract
Therapeutic hypothermia (protective hypothermia) has been known to have beneficial effects since ancient times but interest was renewed after two land mark publication a decade ago. The survival as well as quality of life of post cardiac arrest patients depends on neurological outcome. Mild induced hypothermia is recommended for improving the neurological status of these patients. All acute care physician, nurses and emergency medical services personals should be aware of this approach. We report a case of post cardiac arrest that displayed improved neurological status with mild therapeutic hypothermia. Case: A young, female patient experienced perioperative cardiac arrest. Immediate resuscitation lead to return of spontaneous circulation in six minutes. Her post resuscitation Glasgow Coma score (GCS) was five. We induced therapeutic hypothermia—the patient required sedation and a chemical muscle relaxant. After 24 h we began slow rewarming. On day four, her GCS improved to 14, and she was extubated on day 6. She had mild cognitive disorder but was functionally independent. She was transferred to the ward on day 11 and subsequently discharged home. Conclusion: Mild induced therapeutic hypothermia improves neurological status of post cardiac arrest patients; however, it had adverse effect of increased risk for infection, arrhythmia and electrolyte disorders.
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Affiliation(s)
- N. Shaikh
- Hamad Medical Corporation, Doha, Qatar
- Address for Correspondence: N Shaikh E-mail:
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