MedStar Authors catalog › Details for: Clinical applications of targeted temperature management. [Review]
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Clinical applications of targeted temperature management. [Review]

by Goyal, Munish.
Citation: Chest. 145(2):386-93, 2014 Feb..Journal: Chest.ISSN: 0012-3692.Full author list: Perman SM; Goyal M; Neumar RW; Topjian AA; Gaieski DF.UI/PMID: 24493510.Subject(s): Brain Injuries/th [Therapy] | Disease Management | History, 20th Century | History, 21st Century | Humans | *Hypothermia, Induced/hi [History] | *Hypothermia, Induced/mt [Methods] | Myocardial Infarction/th [Therapy] | Stroke/th [Therapy] | Treatment OutcomeInstitution(s): MedStar Washington Hospital CenterDepartment(s): Emergency MedicineActivity type: Journal Article.Medline article type(s): Historical Article | Journal Article | ReviewOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1378/chest.12-3025 (Click here) Abbreviated citation: Chest. 145(2):386-93, 2014 Feb.Local Holdings: Available online from MWHC library: 1935 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Targeted temperature management (TTM) has been investigated experimentally and used clinically for over 100 years. The initial rationale for the clinical application of TTM, historically referred to as therapeutic hypothermia, was to decrease the metabolic rate, allowing the injured brain time to heal. Subsequent research demonstrated the temperature dependence of diverse cellular mechanisms including endothelial dysfunction, production of reactive oxygen species, and apoptosis. Consequently, modern use of TTM centers on neuroprotection following focal or global neurologic injury. Despite a solid basic science rationale for applying TTM in a variety of disease processes, including cardiac arrest, traumatic brain injury, ischemic stroke, neonatal ischemic encephalopathy, sepsis-induced encephalopathy, and hepatic encephalopathy, human efficacy data are limited and vary greatly from disease to disease. Ten years ago, two landmark investigations yielded high-quality data supporting the application of TTM in comatose survivors of out-of-hospital cardiac arrest. Additionally, TTM has been demonstrated to improve outcomes for neonatal patients with anoxic brain injury secondary to hypoxic ischemic encephalopathy. Trials are currently under way, or have yielded conflicting results in, examining the utility of TTM for the treatment of ischemic stroke, traumatic brain injury, and acute myocardial infarction. In this review, we place TTM in historic context, discuss the pathophysiologic rationale for its use, review the general concept of a TTM protocol for the management of brain injury, address some of the common side effects encountered when lowering human body temperature, and examine the data for its use in diverse disease conditions with in-depth examination of TTM for postarrest care and pediatric applications.

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