TY - JOUR

T1 - Effect and feasibility of controlled rewarming after moderate hypothermia in stroke patients with malignant infarction of the middle cerebral artery.

AU - Steiner, Thorsten

AU - Friede, Tim

AU - Aschoff, Alfred

AU - Schellinger, Peter Dieter

AU - Schwab, Stefan

AU - Hacke, Werner

PY - 2001/12

Y1 - 2001/12

N2 - Background and Purpose-: Moderate hypothermia has been found to reduce intracranial pressure (ICP) significantly in patients who have severe middle cerebral artery infarction. However, during passive rewarming, ICP continuously rises and some patients suffer transtentorial herniation. Methods-: We investigated the question of whether slower rewarming leads to slower increase in ICP and slower decrease in cerebral perfusion pressure (CPP). Furthermore, we studied feasibility of slow, controlled rewarming. ICP, CPP, and core body temperature were monitored continuously. Achievement of rewarming protocol was assessed by hit rate of temperature target intervals. Side effects of hypothermia were assessed. Results-: Rates of change of both ICP and CPP were correlated significantly with increase in temperature (ICP r =0.62, P =0.002; CPP r =-0.50, P =0.017). In feasibility analysis of 13 controlled rewarmed patients, hit rate of temperature target intervals was 63% (median; range 48% to 81%); hit rate within the target interval or below was 79% (median; range 62% to 94%). Conclusions-: Slow, controlled rewarming is feasible and may be used for ICP and CPP control after moderate hypothermia for space-occupying infarction.

AB - Background and Purpose-: Moderate hypothermia has been found to reduce intracranial pressure (ICP) significantly in patients who have severe middle cerebral artery infarction. However, during passive rewarming, ICP continuously rises and some patients suffer transtentorial herniation. Methods-: We investigated the question of whether slower rewarming leads to slower increase in ICP and slower decrease in cerebral perfusion pressure (CPP). Furthermore, we studied feasibility of slow, controlled rewarming. ICP, CPP, and core body temperature were monitored continuously. Achievement of rewarming protocol was assessed by hit rate of temperature target intervals. Side effects of hypothermia were assessed. Results-: Rates of change of both ICP and CPP were correlated significantly with increase in temperature (ICP r =0.62, P =0.002; CPP r =-0.50, P =0.017). In feasibility analysis of 13 controlled rewarmed patients, hit rate of temperature target intervals was 63% (median; range 48% to 81%); hit rate within the target interval or below was 79% (median; range 62% to 94%). Conclusions-: Slow, controlled rewarming is feasible and may be used for ICP and CPP control after moderate hypothermia for space-occupying infarction.

KW - stroke

KW - ischemic • brain edema • intracranial pressure • hypothermia

U2 - 10.1161/hs1201.99511

DO - 10.1161/hs1201.99511

M3 - Journal article

VL - 32

SP - 2833

EP - 2835

JO - Stroke

JF - Stroke

SN - 1524-4628

IS - 12

ER -