Lancet. 2008 Jun 7;371(9628):1955-69.


Polderman KH.

Department of Intensive Care, University Medical Center Utrecht, Utrecht,
Netherlands. This email address is being protected from spambots. You need JavaScript enabled to view it.

Increasing evidence suggests that induction of mild hypothermia (32-35 degrees C)
in the first hours after an ischaemic event can prevent or mitigate permanent
injuries. This effect has been shown most clearly for postanoxic brain injury,
but could also apply to other organs such as the heart and kidneys. Hypothermia
has also been used as a treatment for traumatic brain injury, stroke, hepatic
encephalopathy, myocardial infarction, and other indications. Hypothermia is a
highly promising treatment in neurocritical care; thus, physicians caring for
patients with neurological injuries, both in and outside the intensive care unit,
are likely to be confronted with questions about temperature management more
frequently. This Review discusses the available evidence for use of controlled
hypothermia, and also deals with fever control. Besides discussing the evidence,
the aim is to provide information to help guide treatments more effectively with
regard to timing, depth, duration, and effective management of side-effects. In
particular, the rate of rewarming seems to be an important factor in establishing
successful use of hypothermia in the treatment of neurological injuries.