mild hypothermia for neuroprotection

[epidural man]

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When I was a resident, I remember reading something about the IHAST II trial - and although mod hypothermia (33C) did not greatly increase neuroprotection, I remember reading somewhere that a target of 34-35C was optimal. Hypothermia does give protection, but the increase in morbidity (like bacteremia in the IHAST trial) doesn't justify the increased benefit. However, the argument was that 34-35C likely affords some protection, but mitigates the morbidity (or lessens it).

However, maybe I dreamt that - because I can't find ANYTHING that discusses this (now several years later).

Anyone have any references that say that 34-35C is a good target for a neuroprotective strategy?

 

[IMGASMD]

Brain trauma foundation 2016 guideline.



Level I and II A
• There was insufficient evidence to support a Level I or II A recommendation for this
topic.
Level II B
• Early (within 2.5 hours), short-term (48 hours post-injury) prophylactic hypothermia is not recommended to improve outcomes in patients with diffuse injury.

It’s more for TBI I believe. HTH.
https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf

 

[epidural man]

Let me clarify -

There is a LOT of stuff discussing hypothermia and neuroprotection.

What I can't find is anything that specifically talks about 35C being useful and a good target.

 

[IMGASMD]

If you look at the document. They listed two trials. Both were done in China. But both showed better outcome.... there may be more.

 

[deleted697535]

What context do you mean? ICU? Post rosc? Tbi? In the or?

For post rosc see neilsen 2013 ttm trial. The Europeans just this month released an updated trial on this that I haven't fully read yet that shows a slightly different result

 

[epidural man]

What context do you mean? ICU? Post rosc? Tbi? In the or?

For post rosc see neilsen 2013 ttm trial. The Europeans just this month released an updated trial on this that I haven't fully read yet that shows a slightly different result

The IHAST trial was with focal iscemia, or something like that (surgical aneurysm treatment).

 

[epidural man]

If you look at the document. They listed two trials. Both were done in China. But both showed better outcome.... there may be more.

OH thanks. I'm checking it out now.

 

[vector2]

Hypothermia likely isn't all that beneficial. The real benefit is likely that all the pts getting the protocols in these trials had continuous monitoring of temperature and rigorous avoidance of fever, which we know is quite deleterious post-cardiac arrest.

PulmCrit- Hypothermia for non-shockable arrest: let’s not get hot-headed about this

background Fever is harmful in post-arrest patients. This creates confusion in studies of hypothermia in post-arrest patients: is the benefit

emcrit.org

 

[deleted171991]

Let me clarify -

There is a LOT of stuff discussing hypothermia and neuroprotection.

What I can't find is anything that specifically talks about 35C being useful and a good target.

36C is a good target. There have been studies of 33 vs 36, and 33 did not have better outcomes, just more side effects.

The key is to have not just cooling, but a system that proactively adjusts cooling (to keep the temperature swings at a minimum). That's why ICUs use stuff like Arctic Sun.

 

[Iso4ane]

With regards to TBI, I recall seeing that it’s not the hypothermia that is important, it’s the avoidance of hyperthermia. That’s why there was minimal differences between 36C vs 33C.