Nebenwirkungen der Hypothermie

Die therapeutische Hypothermie ist eine vielversprechende neuroprotektive Strategie, die durch ihre multimodale Wirkweise eine Reihe pathophysiologischer Prozesse drosseln kann, die nach Hypoxie, Trauma oder Blutung auftreten und so zu sekundärer Schädigung des Gehirns führen [1]. Die Anwendung dieser Therapie in der klinischen Praxis setzt die gute Kenntnis unerwünschter Wirkungen der Hypothermie und ihrer Behandlung voraus.

Das Kältezittern (im englischen Sprachgebrauch „Shivering“) ist ein integrierter thermoregulatorischer Reflex, der bei einer Absenkung der Körperkerntemperatur unter dem hypothalamischen Sollwert auftritt und aus einer kutanen Vasokonstriktion sowie Muskeloszillationen besteht [2].

• Literatur

• 1 Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 2009; 37: S186-202
• 2 Sessler DI. Defeating normal thermoregulatory defenses: Induction of therapeutic hypothermia. Stroke 2009; 40: e614-621
• 3 Badjatia N, Strongilis E, Gordon E et al. Metabolic impact of shivering during therapeutic temperature modulation: The bedside shivering assessment scale. Stroke 2008; 39: 3242-3247
• 4 Oddo M, Frangos S, Maloney-Wilensky E et al. Effect of shivering on brain tissue oxygenation during induced normothermia in patients with severe brain injury. Neurocrit Care 2010; 12: 10-16
• 5 Mokhtarani M, Mahgoub AN, Morioka N et al. Buspirone and meperidine synergistically reduce the shivering threshold. Anesthesia and analgesia 2001; 93: 1233-1239
• 6 Frank SM, Satitpunwaycha P, Bruce SR et al. Increased myocardial perfusion and sympathoadrenal activation during mild core hypothermia in awake humans. Clin Sci (Lond) 2003; 104: 503-508
• 7 Badjatia N, Strongilis E, Prescutti M et al. Metabolic benefits of surface counter warming during therapeutic temperature modulation. Crit Care Med 2009; 37: 1893-1897
• 8 Lenhardt R, Orhan-Sungur M, Komatsu R et al. Suppression of shivering during hypothermia using a novel drug combination in healthy volunteers. Anesthesiology 2009; 111: 110-115
• 9 Hemmen TM, Raman R, Guluma KZ et al. Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ictus-l): Final results. Stroke 2010; 41: 2265-2270
• 10 Piironen K, Tiainen M, Mustanoja S et al. Mild hypothermia after intravenous thrombolysis in patients with acute stroke: A randomized controlled trial. Stroke 2014; 45: 486-491
• 11 Wan YH, Nie C, Wang HL et al. Therapeutic hypothermia (different depths, durations, and rewarming speeds) for acute ischemic stroke: A meta-analysis. J Stroke Cerebrovasc Dis 2014; 23: 2736-2747
• 12 Schubert A. Side effects of mild hypothermia. J Neurosurg Anesthesiol 1995; 7: 139-147
• 13 Post H, Schmitto JD, Steendijk P et al. Cardiac function during mild hypothermia in pigs: Increased inotropy at the expense of diastolic dysfunction. Acta physiologica (Oxford, England) 2010; 199: 43-52
• 14 Kim F, Nichol G, Maynard C et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: A randomized clinical trial. JAMA 2014; 311: 45-52
• 15 Muller A, Lorenz A, Seifert B et al. Risk of thromboembolic events with endovascular cooling catheters in patients with subarachnoid hemorrhage. Neurocrit Care 2014; 21: 207-210
• 16 Brinkman AC, Ten Tusscher BL, de Waard MC et al. Minimal effects on ex vivo coagulation during mild therapeutic hypothermia in post cardiac arrest patients. Resuscitation 2014; 85: 1359-1363
• 17 Gong P, Zhang MY, Zhao H et al. Effect of mild hypothermia on the coagulation-fibrinolysis system and physiological anticoagulants after cardiopulmonary resuscitation in a porcine model. PloS one 2013; 8: e67476
• 18 Nielsen N, Wetterslev J, Cronberg T et al. Targeted temperature management at 33 degrees c versus 36 degrees c after cardiac arrest. N Engl J Med 2013; 369: 2197-2206
• 19 Berger C, Xia F, Kohrmann M et al. Hypothermia in acute stroke--slow versus fast rewarming an experimental study in rats. Exp Neurol 2007; 204: 131-137
• 20 Povlishock JT, Wei EP. Posthypothermic rewarming considerations following traumatic brain injury. J Neurotrauma 2009; 26: 333-340
• 21 Schwab S, Georgiadis D, Berrouschot J et al. Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 2001; 32: 2033-2035
• 22 Schwab S, Schwarz S, Spranger M et al. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 1998; 29: 2461-2466
• 23 Clifton GL, Valadka A, Zygun D et al. Very early hypothermia induction in patients with severe brain injury (the national acute brain injury study: Hypothermia ii): A randomised trial. Lancet Neurol 2011; 10: 131-139
• 24 Kollmar R, Staykov D, Dorfler A et al. Hypothermia reduces perihemorrhagic edema after intracerebral hemorrhage. Stroke 2010; 41: 1684-1689
• 25 Staykov D, Wagner I, Volbers B et al. Mild prolonged hypothermia for large intracerebral hemorrhage. Neurocrit Care 2013; 18: 178-183
• 26 Andrews PJ, Sinclair HL, Battison CG et al. European society of intensive care medicine study of therapeutic hypothermia (32–35 degrees c) for intracranial pressure reduction after traumatic brain injury (the eurotherm3235trial). Trials 2011; 12: 18