Cooling and temperature management are key features of any ICU. NICU tend to cool longer than their counterparts in cardiology1. Also neurologists like their patients awake so that they can perform a neurological examination.
A way to reach that goal is to keep your patient awake in the process of cooling. Kama Guluma2 published in 2006 an article in which he described the feasibility of awake cooling in a small patient collective. He used an endovascular cooling device in 10 ischemic stroke patients. Cooling started as soon as possible. In case of systemic thrombolysis the placement of the femoral iv catheter was performed 30 minutes after completion of the t-PA infusion.
On initiation a meperidine drip was started at 30mg/h. A convective surface warming blanket was applied. 24h of cooling.
Shivering was countered by boluses of merepidine. There was no feeding. There was no significant shivering in the study period.
After all this could be a possible way to cool patients in the near future who received definitive treatment of a large vessel occlusion to prevent cerebral edema and hemorrhagic transformation3.
1. Kollmar R, Schwab S. Hypothermia and Ischemic Stroke. Current treatment options in neurology 2012.
2. Guluma KZ, Hemmen TM, Olsen SE, Rapp KS, Lyden PD. A trial of therapeutic hypothermia via endovascular approach in awake patients with acute ischemic stroke: methodology. Acad Emerg Med 2006;13:820-7.
3. Hong JM, Lee JS, Song HJ, Jeong HS, Choi HA, Lee K. Therapeutic hypothermia after recanalization in patients with acute ischemic stroke. Stroke; a journal of cerebral circulation 2014;45:134-40.