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"Emergency medicine" 2 (65) 2015

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Homeostasis Changes Induced by Artificial Therapeutic Hypothermia in Patients with Intracranial Hypertension and Intracranial Aneurism Hemorrhages

Authors: Dudukina S.O. - Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov, Neurointensive Care Unit, Ukraine

Categories: Medicine of emergency

Sections: Clinical researches

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Keywords

therapeutic hypothermia, intracranial pressure, glycemia, diures, hematocrit.

Objective: to define peculiarities of artificial hypothermia clinical course in terms of homeostasis changes in patients with intracranial hypertension while intracranial aneurism hemorrhages

Materials and methods of research:

29 patients with intracranial aneurism hemorrhages complicated by secondary brain ischemia with intracranial hypertension were included into research. In all patients therapeutic hypothermia was used aiming to treat secondary brain ischemia with intracranial hypertension. Hypothermia was undertaken with the help of Blanketrol II apparatus made by Cincinnati Sub-Zero company according to modification method Gal R. Statistical analysis was conducted with the help of program product IBM SPSS 21.

Results of research:

Average level of intracranial pressure at the hypothermia start made up 36,4 ± 1,22 millimeter mercury column and was ramping down till the minimization. With 32ºС the average level of intracranial pressure made up 24,5 ± 0,91 millimeter mercury column. During hypothermia intracranial pressure was managed to be kept in 28 patients within tolerance. From the moment of patients’ exposure to cold and virtually within the whole period of therapeutic hypothermia gradual decrease in frequency of heart contraction was observed. Within the whole period of minimization and up to the 3rd hour from the start of hypothermia process the diuresis increased, becoming higher at each stage of increase. While hypothermia the logic of changes in the diuresis wasn’t observed. Virtually at each stage of the research increase in the average of glycemic level was observed. From the start of patients’ exposure to cold and virtually within the whole period of therapeutic hypothermia gradual increase in hematocrit was observed, but its values were in the corridor of ordinary values. .

.Conclusions: changes in intracranial pressure while therapeutic hypothermia depends on the temperature with a tendency for decrease in values. The heart rate while therapeutic hypothermia depends on the hypothermia duration and gradually decreases to 39,8 ± 0,45/ min to 48 hours. From the 24th hour of therapeutic hypothermia there is a moment of blood glucose increase >10 mmol/L, which might require corrections. Diures increase while therapeutic hypothermia is observed in the period of minimal temperature and remains relatively high while hypothermia. Despite the increased level of hematocrit while therapeutic hypothermia, its values are in the corridor of best values.


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