Mechanisms of action, physiological effects, and complications of hypothermia

作者：Kees H. Polderman · 发表于：Critical Care Medicine · 年份：2009 · DOI：10.1097/ccm.0b013e3181aa5241 · 被引用次数：1182 · 研究领域：Thermal Regulation in Medicine、Cardiac Arrest and Resuscitation、Thermoregulation and physiological responses

Background: Mild to moderate hypothermia (32–35°C) is the first treatment with proven efficacy for postischemic neurological injury. In recent years important insights have been gained into the mechanisms underlying hypothermia's protective effects; in addition, physiological and pathophysiological changes associated with cooling have become better understood. Objective: To discuss hypothermia's mechanisms of action, to review (patho)physiological changes associated with cooling, and to discuss potential side effects. Design: Review article. Interventions: None. Main Results: A myriad of destructive processes unfold in injured tissue following ischemia–reperfusion. These include excitotoxicty, neuroinflammation, apoptosis, free radical production, seizure activity, blood–brain barrier disruption, blood vessel leakage, cerebral thermopooling, and numerous others. The severity of this destructive cascade determines whether injured cells will survive or die. Hypothermia can inhibit or mitigate all of these mechanisms, while stimulating protective systems such as early gene activation. Hypothermia is also effective in mitigating intracranial hypertension and reducing brain edema. Side effects include immunosuppression with increased infection risk, cold diuresis and hypovolemia, electrolyte disorders, insulin resistance, impaired drug clearance, and mild coagulopathy. Targeted interventions are required to effectively manage these side effects. Hypothermia does not decrease myoca...