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Vol. 48. Issue 6.
Pages 341-355 (June 2024)
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Vol. 48. Issue 6.
Pages 341-355 (June 2024)
Review article
Temperature management in acute brain injury: A narrative review
Control térmico en el daño cerebral agudo: revisión narrativa
Visits
17
Eva Esther Tejerina Álvareza,b,
Corresponding author
, José Ángel Lorente Balanzaa,b,c,d
a Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Getafe, Madrid, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
c Departamento de Bioingeniería, Universidad Carlos III de Madrid, Leganés, Madrid, Spain
d Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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Tables (4)
Table 1. Summary of recommendations from major clinical practice guidelines on thermal control.
Table 2. Summary of the evidence on the thermal control in patients with post-cardiac arrest hypoxic-ischemic injury.
Table 3. Summary of evidence on thermal control in patients with acute ischemic stroke (AIS).
Table 4. Summary of evidence on thermal control in patients with severe traumatic brain injury (TBI).
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Abstract

Temperature management has been used in patients with acute brain injury resulting from different conditions, such as post-cardiac arrest hypoxic-ischaemic insult, acute ischaemic stroke, and severe traumatic brain injury. However, current evidence offers inconsistent and often contradictory results regarding the clinical benefit of this therapeutic strategy on mortality and functional outcomes. Current guidelines have focused mainly on active prevention and treatment of fever, while therapeutic hypothermia (TH) has fallen into disuse, although doubts persist as to its effectiveness according to the method of application and appropriate patient selection. This narrative review presents the most relevant clinical evidence on the effects of TH in patients with acute neurological damage, and the pathophysiological concepts supporting its use.

Keywords:
Targeted temperature management
Induced hypothermia
Therapeutic hypothermia
Hypoxic-ischemic encephalopathy
Brain hypoxia-ischemia
Postcardiac arrest syndrome
Acute brain injury
Traumatic brain injury
Acute ischemic stroke
Resumen

El control de la temperatura corporal se ha utilizado en pacientes con daño cerebral agudo ocasionado por distintas patologías como daño hipóxico-isquémico post-parada cardíaca, accidente cerebro vascular isquémico agudo y traumatismo craneoencefálico grave. Sin embargo, la evidencia actual ofrece resultados poco consistentes y a menudo contradictorios en cuanto al beneficio clínico de esta estrategia terapéutica sobre la mortalidad y los resultados funcionales. Las guías actuales han centrado su atención fundamentalmente en la prevención activa y el tratamiento de la fiebre, mientras que la hipotermia terapéutica (HT) ha caído en desuso, aún cuando persisten dudas sobre su efectividad de acuerdo con el modo de aplicación y la adecuada selección de pacientes. En esta revisión narrativa se presenta la evidencia clínica más relevante sobre los efectos de la HT en pacientes con daño neurológico agudo, así como de los conceptos fisiopatológicos en los que se fundamenta su uso.

Palabras clave:
Control selectivo de la temperatura
Hipotermia inducida
Hipotermia terapéutica
Lesión cerebral aguda
Encefalopatía hipóxico-isquémica
Hipoxia-isquemia cerebral
Síndrome postparada cardiaca
Daño cerebral agudo
Traumatismo craneoencefálico
Accidente cerebro vascular isquémico agudo

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