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Targeted Temperature Management for Subarachnoid Hemorrhage: Excellent Outcome After Severe Vasospasm-A Case Series.
- Source :
-
Therapeutic hypothermia and temperature management [Ther Hypothermia Temp Manag] 2019 Sep; Vol. 9 (3), pp. 216-221. Date of Electronic Publication: 2019 Mar 26. - Publication Year :
- 2019
-
Abstract
- Targeted temperature management (TTM) might improve outcome of patients with severe subarachnoid hemorrhage (SAH) in which vasospasm, delayed cerebral ischemia (DCI), and increased intracranial pressure (ICP) are frequent and severe complications. A series of patients ( n = 3) with severe aneurysmatic SAH were treated by TTM if they developed ICP crisis and/or severe vasospasm diagnosed by angiography. Once these complications were detected, body core temperature (BCT) was rapidly decreased to 35°C or 33°C, if necessary. BCT induced and maintained by surface cooling remained at the desired level for at least 72 hours. Rewarming was performed by 1°C, only if the target parameters ICP and velocities in the serial Doppler sonography indicating macrovascular vasospasm improved to regular levels. In case of increase of ICP or middle cerebral arteries velocities BCT was decreased again to the last effective level. The patients developed vasospasm between days 6 and 12 after SAH. All aneurysms were treated by coiling. BCT was reduced between days 6 and 12 after SAH. Total duration of BCT <36.5°C was between 5.5 and 8 days. It remained <35°C for 4-6 days, and at 33°C for 3 days on average. ICP could be sufficiently controlled in all patients, because no ICP crisis was observed during TTM and after rewarming. Two patients developed minor DCI. Side effects of prolonged ventilation of 7-18 days included pneumonia for two patients that could be treated sufficiently. Other complications were one case of ventriculitis and two temporary deliriums. Outcome of the patients was good because no focal neurological symptoms could be detected after rehabilitation. TTM represents a promising treatment approach for severe SAH in which standard treatment is often limited and experimental. It deserves further clinical investigation in a larger cohort.
- Subjects :
- Brain blood supply
Brain diagnostic imaging
Female
Humans
Male
Middle Aged
Treatment Outcome
Hypothermia, Induced
Subarachnoid Hemorrhage complications
Subarachnoid Hemorrhage diagnostic imaging
Subarachnoid Hemorrhage therapy
Vasospasm, Intracranial diagnostic imaging
Vasospasm, Intracranial etiology
Vasospasm, Intracranial therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2153-7933
- Volume :
- 9
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Therapeutic hypothermia and temperature management
- Publication Type :
- Academic Journal
- Accession number :
- 30912704
- Full Text :
- https://doi.org/10.1089/ther.2018.0049