Document Detail


Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm.
MedLine Citation:
PMID:  19050656     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the feasibility and safety of mild hypothermia treatment in patients with aneurysmal subarachnoid hemorrhage (SAH) who are experiencing intracranial hypertension and/or cerebral vasospasm (CVS). METHODS: Of 441 consecutive patients with SAH, 100 developed elevated intracranial pressure and/or symptomatic CVS refractory to conventional treatment. Hypothermia (33-34 degrees C) was induced and maintained until intracranial pressure normalized, CVS resolved, or severe side effects occurred. RESULTS: Thirteen patients were treated with hypothermia alone, and 87 were treated with hypothermia in combination with barbiturate coma. Sixty-six patients experienced poor-grade SAH (Hunt and Hess Grades IV and V) and 92 had Fisher Grade 3 and 4 bleedings. The mean duration of hypothermia was 169 +/- 104 hours, with a maximum of 16.4 days. The outcome after 1 year was evaluated in 90 of 100 patients. Thirty-two patients (35.6%) survived with good functional outcome (Glasgow Outcome Scale [GOS] score, 4 and 5), 14 (15.5%) were severely disabled (GOS score, 3), 1 (1.1%) was in a vegetative state (GOS score, 2), and 43 (47.8%) died (GOS score, 1). The most frequent side effects were electrolyte disorders (77%), pneumonia (52%), thrombocytopenia (47%), and septic shock syndrome (40%). Of 93 patients with severe side effects, 6 (6.5%) died as a result of respiratory or multi-organ failure. CONCLUSION: Prolonged systemic hypothermia may be considered as a last-resort option for a carefully selected group of SAH patients with intracranial hypertension or CVS resistant to conventional treatment. However, complications associated with hypothermia require elaborate protocols in general intensive care unit management.
Authors:
Martin A Seule; Carl Muroi; Susanne Mink; Yasuhiro Yonekawa; Emanuela Keller
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  64     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-15     Completed Date:  2009-03-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  86-92; discussion 92-3     Citation Subset:  IM    
Affiliation:
Neurointensive Care Unit, Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland. martin.seule@kssg.ch
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Barbiturates
Coma
Female
Glasgow Outcome Scale
Humans
Hypothermia, Induced* / adverse effects
Intracranial Aneurysm / complications,  therapy*
Intracranial Hypertension / etiology,  therapy
Male
Middle Aged
Subarachnoid Hemorrhage / complications,  therapy*
Treatment Outcome
Vasospasm, Intracranial / etiology,  therapy
Chemical
Reg. No./Substance:
0/Barbiturates

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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