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Medical management of the critical patient. Neuroprotective hypothermia in newborns, children, infants and adults in critical condition (the first 24 hours – ‘golden hours’)
Therapeutic hypothermia allows us to improve both survival and neurological recovery in patients with different causes of neuronal aggression. This article is based on demographic studies conducted both in the U.S. and Europe, and aims to present the pathophysiological mechanisms of these therapeutic methods and their indications, focusing on patients who suffered cardiac arrest. There are also presented criteria for including and excluding patients in the studies, methods of inducing hypothermia, and treatment protocols. Variables related to the timing of the start method of cooling, process cooling, rate, depth, duration of cooling and reheating are disputed here, which may all have an impact on mortality and morbidity. However, at this time, these variables are not well studied and are at present in several experimental and clinical studies. In addition, these variables are most likely to have different levels of importance depending on clinical indications.
Key words: neuroprotection by hypothermia in critical ill patient, management of critical patient transfer, proper medical equipment