Hypothermie thérapeutique après arrêt cardio-respiratoire en 2017 – revue pour le praticien
Abstract
Zusammenfassung. Die therapeutische Hypothermie oder gezieltes Temperaturmanagement ist eine wirksame und einfache neuroprotektive Technik. Der Haupteffekt ist eine Milderung der Nebenhirnschädigungen, die mit dem Ischämie-Reperfusions-Phänomen nach einem Herzstillstand auftreten. Die therapeutische Hypothermie hat sich auch für die Neugeborenen-Hypoxie als wirksam erwiesen. Die modernen und automatisierten Geräte erlauben eine sehr strenge Temperaturkontrolle. In diesem Review werden die verschiedenen Aspekte der therapeutische Hypothermie diskutiert und die jüngsten veröffentlichten Empfehlungen und Ergebnisse zusammengefasst.
Abstract. Therapeutic hypothermia or targeted temperature management is an effective neuroprotective strategy mostly used to attenuate the secondary cerebral insults associated with ischemia-reperfusion injury consecutive to cardiac arrest. This technique is also successfully applied in neonatal hypoxic-ischemic encephalopathy. Automated devices have greatly evolved over the last years, allowing a strict control of patient body temperature. In this review, we will discuss indications and technical issues related to temperature management and summarize updated recommendations on therapeutic hypothermia.
Résumé. L’hypothermie thérapeutique (HT) ou contrôle ciblé de la température [CCT, targeted temperature management (TTM) en anglais] est un traitement neuroprotecteur efficace et simple d’application dont l’effet principal est d’atténuer les lésions cérébrales secondaires liées au phénomène d’ischémie-reperfusion après arrêt cardio-respiratoire (ACR). Cette technique a aussi été appliquée avec succès dans de nombreuses études randomisées dans l’encéphalopathie hypoxique néonatale. Les techniques utilisées pour atteindre la température cible se sont perfectionnées et permettent actuellement de maintenir une température au dixième de degré près. Dans cette revue, nous discutons ces différents aspects tout en rappelant les dernières recommandations et évidences publiées dans ce domaine.
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