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J Neurol Surg Rep 2014; 75(02): e224-e229
DOI: 10.1055/s-0034-1387188
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Postsurgical Meningitis Complicated by Severe Refractory Intracranial Hypertension with Limited Treatment Options: The Role of Mild Therapeutic Hypothermia

Konstantin A. Popugaev
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Ivan A. Savin
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Andrew V. Oshorov
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Natalia V. Kurdumova
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Olga N. Ershova
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Andrew U. Lubnin
2   Department of Neuroanesthesia, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Boris A. Kadashev
3   8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Pavel L. Kalinin
3   8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Maxim A. Kutin
3   8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Tim Killeen
4   Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland
,
Evaldas Cesnulis
4   Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland
,
Ronald Melieste
5   Temperature Management Division Europe, Zoll Medical Corporation, Chelmsford, Massachusetts, United States
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Publikationsverlauf

20. März 2014

03. Juni 2014

Publikationsdatum:
21. August 2014 (online)

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Abstract

Intracranial hypertension is a commonly encountered neurocritical care problem. If first-tier therapy is ineffective, second-tier therapy must be initiated. In many cases, the full arsenal of established treatment options is available. However, situations occasionally arise in which only a narrow range of options is available to neurointensivists. We present a rare clinical scenario in which therapeutic hypothermia was the only available method for controlling intracranial pressure and that demonstrates the efficacy and safety of the Thermogard (Zoll, Chelmsford, Massachusetts, United States) cooling system in creating and maintaining a prolonged hypothermic state. The lifesaving effect of hypothermia was overshadowed by the unfavorable neurologic outcome observed (minimally conscious state on intensive care unit discharge). These results add further evidence to support the role of therapeutic hypothermia in managing intracranial pressure and provide motivation for finding new strategies in combination with hypothermia to improve neurologic outcomes.

Keywords

therapeutic hypothermia - meningitis - intracranial pressure - intracranial hypertension
 

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