Therapeutic Hypothermia.

Abstract

Mayo Clinic, Rochester, Minnesota. weglinski.margaret@mayo.eduTherapeutic Hypothermia. Edited by Stephan A. Mayer, M.D., and Daniel I. Sessler, M.D. New York, Marcel Dekker, 2005. Pages: 648. Price: $149.95.For many years, the therapeutic use of induced hypothermia was largely limited to cardiopulmonary bypass–facilitated cardiac—and less commonly, cerebrovascular—surgery. That all changed in the mid 1980s, when several laboratories demonstrated in animal models that mild hypothermia (33°–35°C) resulted in protection of the brain against ischemic and traumatic injuries. These discoveries rapidly led to the application of mild to moderate hypothermia in various clinical situations, including operative neurosurgery, stroke, cardiac arrest, and head trauma. Numerous uncontrolled studies began to appear in the literature. Other studies suggested that mild perioperative hypothermia was associated with an increased incidence of bleeding, infectious, and cardiovascular complications. Despite these conflicting study results, a 2003 survey from Great Britain and Ireland reported that hypothermia was being used in more than 50% of patients undergoing cerebral aneurysm surgery.It is against this historical backdrop that Therapeutic Hypothermia arrives on the scene. As the editors mention in the preface, one of the reasons therapeutic hypothermia has attracted such intense interest is because pharmacologic interventions have consistently failed to improve outcome after various neurologic injuries. As more is learned about the mechanisms of hypothermia-induced neuroprotection, physicians are becoming more inclined to treat body temperature like other physiologic variables and optimize it for each individual patient. This constitutes a new field of medicine that influences many areas of clinical practice: neurologic and cardiac surgery, critical care medicine, emergency medicine, neurology, and neurosurgery. Therapeutic Hypothermia is meant to be a comprehensive reference on this emerging field of medicine. It consists of 17 chapters written by an international collection of 26 authors. The chapters are grouped into four sections: Thermoregulation, Consequences of Hypothermia, Therapeutic Temperature Modulation, and Clinical Applications of Therapeutic Hypothermia. Chapters within the first three sections lay the scientific groundwork to better explain how and why hypothermia has been used in the clinical arena. I found that, throughout the book, each chapter provided enough background information on its topic to allow it to stand alone and therefore allow me to read the chapters that interested me first and then fill in my knowledge gaps by perusing the supporting chapters later. As with any multiauthor textbook, there is a small amount of repetition among the chapters, but for the most part, readers are appropriately referred to other chapters to avoid this. The text is easy to read, but some of the black-and-white figures are small and often dwarfed by their accompanying legends.The editors, Stephan A. Mayer, M.D. (Columbia University, New York, New York), and Daniel I. Sessler, M.D. (University of Louisville, Louisville, Kentucky), should be commended for having the foresight to publish a book that attempts to summarize all that is currently known about therapeutic hypothermia. The book does an excellent job of organizing and synthesizing the multitude of studies performed in this rapidly growing field, many of which come to conflicting conclusions. It belongs in the reference library of every department of anesthesiology, critical care medicine, neurosurgery, cardiac surgery, emergency medicine, and neurology. It is a book that will no doubt require future editions to keep current with all that is being published in the field. This is probably best demonstrated by the fact that the results of the Intraoperative Hypothermia for Aneurysm Surgery Trial, Part 2 (IHAST2), were not yet published at the time this book went to press and so are not included in the text (although they are alluded to in the foreword by Michael Todd, M.D., The University of Iowa, Iowa City, Iowa). I am hoping the next edition will include not only the IHAST2 results, but reports of yet more intriguing research in this promising field.Mayo Clinic, Rochester, Minnesota. weglinski.margaret@mayo.edu