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HACA,
2002

Bernard,
2002
Idrissi,
2001
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1-Clinical Study of Mild Hypothermia Treatment for


Severe Traumatic Brain Injury
Ji-Yao Jiang
J.Neurotrauma 2009

2-Current and future role of therapeutic hypothermia


D. Marion

J Neurotrauma 2009

3-Therapeutic hypothermia and controlled


normothermia
in the intensive care unit
K. Polderman

Crit Care Med 2009

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(32-35 C) ++++
(28-32C)
( 28C)

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-
:


(++++)
a


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2. ?

1. ?
1

3. ?

4
3 4. ?

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Anesth. Analg. 1959

50

1990
2 2002 (JM )
2003.

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01/2009
Fire Department and Emergency
Medical Service
New York-Seattle Miami Boston

( -4 C)


New York : * 7500 /
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.


10

4
normothermic control

0
0 6

18

72
Abella et al, 2004

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2003



(32-34C),

12 24

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Recommandations canadiennes
Can J Emerg Med, 2006;8(2):107-8

2 (grade A)

8 KRPA
(grade B)
+ (grade B)
(grade A)

(grade C)
(grade D)
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: !




> 39.5 C

( ): !

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37

41
36
40
35
41

34
39

33
38
32
37
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(Don Marion 2009)

>38 C

:
:
:
:
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73%
91%
68%
61%
14

International Guidelines
- American Assn of Neurological Surgeons
- American Stroke Association
- European Stroke Initiative



ICP
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:
ICP

3

= 39,1 C- ICP = 25
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= 35 C ICP = 8
.

= 37,2 C ICP =1610


Merchant R M, CCM, 2006, 34:1935-40
2248 (Internet)


?
USA

USA

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?
As soon as possible
!

(Vandenhoek et al, 2000; Abella et al, 2004)

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: ?

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Coolgard

NaCl 0.9% 4C
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Bruel C, Crit Care, 2008, 12:R31

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FDA approuved 09/2003


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5 mm

-8.5 or 9.3 Fr
-.032 guidewire (Seldinger technique)
-22 cm long

4 mm

Heat
exchange
balloons

-Duraflo (Heparin) coated


-Radiopaque

-Insertion Kit

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.
: 2006 03/2009
70

:
: 104 ( 65
5 )
: 51
: 54

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12

18

19

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< 32 C

>38,5

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36

: 9
:

18

: 2

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(
)
30
25


()

20
15

10
5
0
1

9 10 11 12 13

: 0 - 28
2 - 8
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38

18
16
14
12

10
8

6
4
2
0
1

11

13

15

: 0-17
: 5 - 8

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(:
1/64 =1.5%)
( 66%):
(2) : 19%
(1) : 47%

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()
11%

6%

ACINETOBACTER
6%

PROTEUS

6%
6%

16%

6%
6%
16%

PS. AEROGUINOSA
KLEBSIELLA PN
PSEUDOMONAS
STAPH AUREUS
STAPH EPID
STAPH HAEMOLITICUM

21%

BACCILUS SPP
ENTEROCOCCUS

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Effects of hypothermia
Levels of evidence (2009)
Class I
Class I for ICP lowering
Class II A for fever
Fever
Class II B
Stroke
Class III
Intra operative Class III
CPR
TBI

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1
Coolgard

Serum sal 4C

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Bruel C, Crit Care, 2008, 12:R31

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