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Induced hypothermia to treat post-ischemic and post-traumatic injury.

Although the concept that low temperatures can protect cells from various types of injury is not new (indeed this has been recognised since ancient times), effective clinical usage of induced hypothermia has only recently become feasible, with the advent of high-quality intensive care facilities and new insights into the mechanisms underlying hypothermiaʼs protective effects. These insights have led to the realisation that benefits can be achieved using mild (32-35°C) rather than moderate or deep hypothermia, with easier induction and less severe side effects. Clinical use of hypothermia received a significant boost when two recently published clinical trials showed that neurological outcome after CPR can be improved by relatively brief periods of cooling, at least in some situations. Nevertheless, appropriate and effective use of induced hypothermia presents a challenge to clinicians working in the ICU and ER, and realising the potential benefits of hypothermia is far from easy. This paper reviews several potential clinical applications of induced hypothermia, and discusses physiological and practical aspects as well as side effects of artificial cooling. The concepts underlying hypothermia-associated neuroprotection and cardioprotection are discussed, as well as possible reasons why clinical trials for some indications such as severe head injury have produced conflicting results.