Can we prevent secondary reperfusion injury following cerebral ischaemia?
Preventing secondary reperfusion injury following an ischaemic insult has been the subject of considerable research in Critical Care. In this talk given at SMACC Chicago, Professor Mervyn Singer uses his usual flamboyant style to spotlight this important topic.
The key clinical question has been, in situations where an ischaemic event has occurred, does medically induced hypothermia reduce secondary reperfusion injury.
There have been a number of recent high profile trials suggesting no clinically meaningful benefit from medically induced hypothermia. This in turn has led many clinicians to adopt a treatment plan of rigidly targeting normo-thermia (36 degrees Celsius) and in particular, avoiding hyperthermia greater than 37.5 degrees Celsius. Professor Singer boldly suggests that perhaps the jury is still out regarding the therapeutic efficacy of hypothermia.
He postulates that the negative trials for therapeutic hypothermia have reflected a delayed time to initiating cooling or an inadequate duration of treatment?
Additionally he discusses whether there is any role for inhaled or intra-venous sulphides in this setting to reduce mitochondrial respiration? The argument is to decrease oxygen consumption and prevent the secondary ischaemic reperfusion injury?
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