| Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm. | |
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MedLine Citation:
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PMID: 19050656 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Martin A Seule; Carl Muroi; Susanne Mink; Yasuhiro Yonekawa; Emanuela Keller |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 64 ISSN: 1524-4040 ISO Abbreviation: Neurosurgery Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2009-01-15 Completed Date: 2009-03-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: 86-92; discussion 92-3 Citation Subset: IM |
Affiliation:
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Neurointensive Care Unit, Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland. martin.seule@kssg.ch |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Barbiturates |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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