Critically evaluate the use of therapeutic hypothermia in intensive care practice.
Maintenance of a target temperature to provide neuroprotection. A range of different temperatures employed with ‘mild hypothermia’ traditionally 32-34oC; more recently 36oC post TTM trial.
Hypothermia may lessen the brain injury through a number of mechanisms:
Clinical utility and evidence:
Post cardiac arrest:
Traumatic brain injury:
Other potential uses
Candidates mentioned detail that was not requested, such as methods of cooling. Candidates also showed poor breadth of knowledge related to the potential use of hypothermia in conditions such as TBI / SAH / CVA.
Rationale for therapeutic hypothermia:
Advantages of therapeutic hypothermia
Evidence for use in cardiac arrest:
Evidence for use in traumatic brain injury
Therapeutic hypothermia in cooling of a hyperthermic patient
Therapeutic hypothermia for subarachnoid haemorrhage
Therapeutic hypothermia for super-refractory status epilepticus
Therapeutic hypothermia for severe sepsis
Therapeutic hypothermia for meningitis
Therapeutic hypothermia for neonatal asphyxia
Therapeutic hypothermia for stroke
Therapeutic hypothermia for acute hepatic encephalopathy
Therapeutic hypothermia in ARDS :
Intraoperative therapeutic hypothermia
Suspended animation for delayed resuscitation
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