The Use of Hypothermia in Head Injury

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Clinically Induced Hypothermia in the Management of Severe Head Injury: A Review of the Evidence PAGE 1. Title Page 2. Acknowledgements 3. Contents 4-5. Abstract 6-7. Introduction 8-11. Methods 9. i) Inclusion & Exclusion Criteria 10. ii) Limitations of Search 11. iii) Critical Framework 12-26. Critical Review of the Data 13. i) Study Aims & Design 19. ii) Sampling & Controls 25. iii) Results 27-36. Discussion 32. i) Implications for Practice 37-41. References 42. Appendix 1) – The Four Stages of Research 43. Appendix 2) – Database Search (Hard Copy Only) 44-49. Appendix 3) – Example (1) Using the CASP Framework 50-55. Appendix 3) – Example (2) Using the CASP…show more content…
(Sahuquillo 2007). Brain injury is normally thought of in terms of primary and secondary insults. First published in the 1970’s this remains a useful concept as it differentiates between the unavoidable irreversible primary injury and the potentially avoidable secondary one (Adams 1977). Primary brain injury occurs immediately at the time of injury, whereas secondary injury is a cascade of events that contributes to intracranial hypertension resulting in a reduction in cerebral perfusion pressure and ischaemia (Marmarou 1991). The cerebral perfusion pressure (CPP) is determined by the Monro-Kellie hypothesis. In closed head injuries, the skull has a fixed volume and the pressure within it is determined by the equilibrium between the CPP, the mean arterial pressure (MAP) and the intracranial pressure (ICP) using the equation: CPP = MAP − ICP Therefore, assuming a constant blood pressure, as ICP rises CPP must fall. Minimising the ICP, should minimise ischaemia and brain damage resulting from localised pressure thus leading to a global increase in perfusion and therefore oxygen delivery to the brain. There is class I evidence that cooling to a mild hypothermic state of ≤35oC reduces intracranial hypertension by limiting cerebral oedema. In addition it is thought that moderate hypothermia of 33oC

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