Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Copyright © 2022 The Korean Society of Critical Care Medicine
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Cardiac arrest | Traumatic brain injury | |
---|---|---|
Evidence of therapeutic hypothermia | Effective | Not proved |
Injury mechanism | Temporary global ischemic-reperfusion brain injury | Primary mechanical disruption of brain cells and blood-brain barrier |
Secondary injury: hemorrhage, ischemia-reperfusion, excitotoxicity, inflammation, etc. | ||
Injury type | Relatively homogenous | Heterogeneous mechanism that includes focal and diffuse components |
Reversibility | Depends on the duration of ischemic time | Depends on primary injury |
Score | Type of shivering | Location |
---|---|---|
0 | None | No shivering is detected in the masseter, neck, or chest muscles |
1 | Mild | Shivering localized to neck and thorax only |
2 | Moderate | Shivering involves gross movement of upper extremities (in addition to the neck and thorax) |
3 | Severe | Shivering involves gross movement of the trunk and upper and lower extremities |
Type of system | Response to IH and potential complications | |
---|---|---|
Cardiovascular | In the early stage, increasing sympathetic tone and peripheral vasoconstriction | Hypertension |
Arrhythmia | ||
Decreased left ventricular function | Hypotension | |
Hypovolemia due to cold diuresis | ||
Immunologic | Immunosuppression | Increased risk of infection |
leukopenia | ||
Hematologic | Increased hematocrit | Mild coagulopathy |
Thrombocytopenia | Increased risk of bleeding | |
Increased prothrombin time and activated partial thromboplastin time | ||
Acid-base dysregulation & | pH elevation | |
metabolic change | Hypokalemia | Arrhythmia |
Hyperglycemia | ||
Hypomagnesemia | ||
Others | Shivering | |
Skin necrosis | ||
Changes in drug clearance/elimination |
IH: induced hypothermia.