Abstract
The current issue again highlights various aspects of therapeutic hypothermia including original articles as well as invited editorial comments and clinical question-and-answer sessions. Two expert panel discussions, roundtables held at our March 2011 Chilling at the Beach scientific symposium, will again be of interest to our readership. One panel targets the intensive care unit and intraoperative temperature management. The use of therapeutic hypothermia to target spinal cord injury is also discussed. Both experimental and clinical data indicate that moderate cooling after a severe spinal cord injury has beneficial effects on both tissue preservation and functional outcome. With continued study, these investigations could possibly move to a multi-center trial to determine the efficacy of therapeutic hypothermia in this patient population. A second question-and-answer session revolved around the use of therapeutic hypothermia in post-cardiac arrest. Therapeutic hypothermia has been shown to be beneficial in out-of-hospital cardiac arrest patients, and the continued clinical investigation on how best to utilize this potentially life-saving therapy is a timely discussion.
Original articles are also included on various aspects of therapeutic hypothermia both from the experimental and clinical arena. An original paper by Bramlett and Dietrich tests the beneficial effects of posttraumatic hypothermia on diffuse axonal injury following experimental brain trauma in rats. This particular study emphasizes the possible limitations of brief durations of hypothermia in protecting axons long term. Another original study concerns evaluating traditional prognostic measures in patients undergoing hypothermia after cardiac arrest. An important concept in this patient population is when one can be confident that hypothermic therapy is actually benefitting the patient. Thus different measures are summarized that would be useful to the treating physician, nurse, and other medical staff members. The concept of adjusting serum potassium after mild hypothermia after cardiac arrest is also discussed. In some patients, potassium seems to increase after injury, and it is important to determine whether this should be managed in terms of promoting good outcomes. Finally, the effects of prolonged hypothermia in a rat using both brain selective and systemic treatments are reviewed. Duration of hypothermia has now become a very important factor in determining long-term outcome. This interesting article describes new methodologies for both systemic and selective brain cooling and again provides a new strategy for targeting human disorders.
Finally, two invited editorial commentaries are included that provide additional discussion regarding studies published in our journal. Kochanek et al. provide a thoughtful discussion on politics and hypothermia and what common characteristics they may include. In another editorial, Colbourne comments on a paper by Li et al. (2011) to assess the beneficial effects of a combination approach including cooling and a magnesium treatment in a rat model of global ischemia.
Finally, our special ARCTIC Challenge section of the Journal again addresses questions currently being asked regarding strategies and risk factors associated with cooling strategies targeting a number of patient populations. One question asks whether individuals have experience with transcutaneous pacing or intravenously pacing patients with a goal of moderate hypothermia and which problems may warrant temperature cardiac pacing. Another discussion relates to the effect of temperature on significant bleeding and what strategies one should initiate to reverse the bleeding problem while continuing to cool. Common procedures including esophageal probe placement for measuring temperature are also discussed. Strategies for the critical placement of probes are briefly reviewed. Finally, the important question of why electrolytes shift during the induction of hypothermia therapy is discussed. These question-and-answer sessions should provide valuable information and data to our readers.
Again, we thank our authors for their high-quality submissions and for considering our Journal as a prime venue to present their new work. As Editor-in-Chief, I hope you are enjoying the Journal and that you will continue to support the continued growth of this important publication. If you have any questions or would like to submit a Letter to the Editor or other type of communication addressing points made in our articles, please contact me. I look forward to your participation in the coming year and the continued growth of our publication, recognizing these are important times in the Journal's progress and success.