Terapijska hipotermija nakon ozljede mozga

master's thesis

• Title (english): Therapeutic hypothermia after brain injury
• Author: Ida Penzar
• Mentor: Ante Sekulić (mentor)
• Committee member: Mladen Perić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Ante Sekulić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Ovaj rad donosi pregled literature o liječenju traumatske ozljede mozga induciranom hipotermijom. Ozljede mozga važan su uzrok invalidnosti i smrti diljem svijeta, pa tako i u Hrvatskoj. Inicijalno nastala ozljeda obično se u prvim danima nakon traumatskog događaja širi i pogoršava zbog razvoja ishemije i upale. Intenzivna njega bolesnika fokusirana je na prevenciju nastanka sekundarnog neurološkog oštećenja.
Hipotermija se već standardno koristi kao sredstvo neuroprotekcije nakon srčanog aresta i u neonatalnoj hipoksično-ishemijskoj encefalopatiji, a njen učinak na ishod traumatske ozljede mozga istražuje se u kliničkim ispitivanjima. Kritički su uspoređene dosadašnje meta-analize kliničkih pokusa: brojne su naznake o mogućoj koristi pothlađivanja, ali rezultati velikim dijelom potječu iz manjih ili metodološki slabijih istraživanja. Poznato je da hipotermija pomaže snižavanju intrakranijalnog tlaka, ali nema jasnih dokaza o poboljšanom preživljenju ili boljem neurološkom ishodu hipotermičnih pacijenata.
Izazov predstavlja otkrivanje optimalne kombinacije ciljne temperature, trajanja hipotermije i brzine zagrijavanja. Dosadašnja iskustva upućuju da blago do umjereno snižene temperature (32-35°C), duže trajanje postupka (>48h) i sporije zagrijavanje, po mogućnosti titrirano da bi se održale fiziološke vrijednosti intrakranijalnog tlaka, vjerojatno donose najviše koristi. Za takvo 'prilagođavanje doze' hipotermije najpogodnije su metode hlađenja s aktivnom regulacijom temperature. Pobrojane su razne aktivne i pasivne metode hlađenja cijeloga tijela i selektivnog hlađenja glave. Moguće komplikacije postupka uključuju pneumoniju i druge infekcije, poremećaje koagulacije i hipovolemiju.

Abstract (english)

This article reviews the literature on induced hypothermia in the treatment of traumatic brain injury. Brain injuries are a major cause of death and disability worldwide, Croatia included. The initial lesion usually progresses due to ischaemia and inflammation in the early days following the traumatic event. Critical care of patients is focused on the prevention of secondary neurological injury.
Hypothermia has become a standard method of neuroprotection after cardiac arrest and in neonatal hypoxic-ischaemic encephalopathy, while it's effect on the outcome of traumatic brain injury is currently under clinical investigation. Present meta-analyses of clinical trials are critically appraised: there is reason to believe in the benefits of hypothermia; however, a substantial number of results come from studies of small size and lower methodological quality. Hypothermia has been shown to reduce intracranial pressure; however, there is no clear evidence of reduced mortality or improved neurological outcome among hypothermic patients.
The challenge remains to find the optimal combination of target temperature, duration of hypothermia and rate of rewarming. Present experience suggests that mildly to moderately reduced temperatures (32-35°C), longer duration of the procedure and slow rewarming, preferably titrated to maintain physiologic values of intracranial pressure, likely bring most benefit. Active temperature control methods are the best way to achieve this 'dose-adjustment' of hypothermia. The article lists various active and passive cooling methods, both for systemic cooling and selective head cooling. Possible complications of hypothermia include pneumonia and other infections, coagulation disorders, and hypovolemia.

• Keywords: ozljede mozga; intenzivna njega; inducirana hipotermija.
• Keywords (english): brain injuries; critical care; induced hypothermia.
• Language: croatian
• URN:NBN: urn:nbn:hr:105:347783
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-11-19 09:35:23