Temperature management in neurological and neurosurgical intensive care units.
Temperature management in neurological and neurosurgical intensive care units.
复制标题
神经科和神经外科重症监护病房的温度管理。
DOI：
10.1089/ther.2014.1504
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发表时间：
2014
影响因子：
1.2
通讯作者：
N. Badjatia
中科院分区：
文献类型：
--
作者：
K. Polderman;K. Lockhart;N. Badjatia
在神经和神经外科重症监护病房（ICU）中使用温度管理已获得认可，并在某些患者人群中获得了更好的结局。在院外心脏骤停以及创伤性脑损伤的各种研究中，ICU中的定向温度管理方案已导致许多严重损伤患者发生的反应性高热期减少。此外，将温度降低到各种低温水平似乎也可以减少继发性损伤机制、颅内压水平和水肿形成。然而，在我们应该冷却的患者人群以及在神经系统环境中最合适的冷却水平方面存在争议。在迈阿密举行的2014年治疗性低温和温度管理会议上，一系列最先进的讲座汇集了治疗性低温和温度管理策略领域的专家，共同讨论这一重要话题。Kees Polderman博士，宾夕法尼亚州匹兹堡市匹兹堡大学医学院重症监护系，提供了关于冷却患者的原因和冷却清醒患者的新策略的新信息，这是一个重要的临床问题。在清醒状态下，患者会颤抖，这可能会对有效降低温度和使患者舒适产生障碍。明尼苏达州明尼阿波利斯市雅培西北医院内科的Kelley Lockhart博士强调了发热对各种患者人群的潜在有害影响，包括蛛网膜下腔出血。特别是在这些患者中，70%在前10天内出现发热。虽然很难确定温度升高的根本原因，但体温过高仍然是一个风险因素，可以通过有针对性的温度管理加以控制。位于医学博士巴尔的摩的马里兰州医学院神经病学系的Neeraj Badjatia博士描述了监测患者人群颤抖程度的新方法。继续的研究是为了了解颤抖的临床相关性以及抗颤抖的策略，可能会允许冷却引入清醒的受试者。很明显，随着治疗性低温和温度管理策略越来越多地被许多护理人员使用，这些类型的问题对于定义和提供更好结果的合适策略变得越来越重要。
The use of temperature management in neurological and neurosurgical intensive care units (ICU) has gained acceptance and resulted in better outcomes in some patient populations. In various studies of out-of-hospital cardiac arrest as well as traumatic brain injury, directed temperature management protocols in the ICU have led to reductions in periods of reactive hyperthermia that occur in many patients with severe injuries. In addition, lowering the temperature to various levels of hypothermia also appears to reduce secondary injury mechanisms, intracranial pressure levels, and edema formation. Nevertheless, controversies exist in what patient population we should cool and what level of cooling is most appropriate in neurological settings. A series of stateof-the-art lectures presented at the 2014 Therapeutic Hypothermia and Temperature Management meeting in Miami brought together experts in the field of therapeutic hypothermia and temperature management strategies to discuss this important topic. Dr. Kees Polderman, Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, provided new information regarding the reasons to cool patients and new strategies for cooling awake patients, which is an important clinical question. In the awake state, patients shiver and this can produce barriers to reducing temperature effectively and making the patient comfortable. Dr. Kelley Lockhart, Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, MN, emphasized the potentially detrimental effects of fever in various patient populations, including subarachnoid hemorrhage. In these patients specifically, 70% develop fever during the first 10 days. Although it is difficult to determine causes underlying elevations in temperature, hyperthermia continues to be a risk factor that may be controlled by targeted temperature management. Dr. Neeraj Badjatia, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, described novel approaches to monitor degrees of shivering in patient populations. Continuing studies are directed toward understanding the clinical relevance of shivering as well as antishivering strategies that may allow cooling to be introduced in the awake subject. It is clear that as therapeutic hypothermia and temperature management strategies are increasingly used by many caregivers, these types of questions are becoming more and more important to define and provide suitable strategies for better outcomes.