Principles of Critical Care > Part II. General Management of the Patient > Chapter 16. Therapeutic Hypothermia Benjamin S. Abella,  Terry L. Vanden Hoek,  Lance B. Becker

Key Points

"The notion of cooling patients for medical benefit is quite old. In 1814, Baron Larrey, a French surgeon in the service of Napoleon's army, reflected on soldiers who suffered major injuries on the frozen battlefields in Russia by commenting that "cold acts on the living parts . . . the parts may remain . . . in a state of asphyxia without losing their life."¹ A belated resurgence of interest in hypothermia has taken place in the past decade, expanding the possible medical indications for its use. Induced hypothermia, the intentional lowering of body temperature, has been explored in a number of acute critical care settings, including myocardial infarction, stroke, head trauma, and after cardiac arrest. While the optimal depth and timing of hypothermia are not yet established for these uses, most experts advocate a temperature goal of 32 to 34°C because it seems to provide significant benefit while avoiding most of the adverse effects associated with the intervention. Timing of hypothermia, with respect to both time of induction and duration of therapy, is even more uncertain, although general consensus holds that cooling should be initiated as soon as possible after the morbid event and should be maintained for at least 12 to 24 hours. Regarding specific uses, there is particularly good evidence that hypothermia is protective for the resuscitated cardiac arrest patient after return of spontaneous circulation.^2,3 The use of hypothermia in other clinical scenarios remains promising but less clear at present...."