ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－194－EL14Department of Intensive Care Medicine, St. George Hospital, AustraliaManoj Saxena“Give me the power to produce fever and I will cure disease”: attributed to Parmenides or Hippocrates, 400-500 BCE.“Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever”:William Osler, 1890 ACE.These two quotations, illustrate the problem that has challenged clinicians in their quest to manage temperature in patients withinjury due to trauma.The response of any tissue to injury involves inflammation, including regional swelling, increase in blood flow, pain and heatgeneration. For the tissue of the central nervous system, does such a process provide the optimal condition for healing to occur,or can modification of that response（by the use of drugs that influence inflammation or by physical cooling）improve healing ofthe injured tissue?On the basis of historical traditions, animal models of brain injury, observational clinical studies and the effect of temperaturereduction on intracranial pressure, it is possible to hypothesize that reducing body temperature in order to cool the brain, mayreduce the burden of death and disability for patients with traumatic head injury.However, controlled clinical trials have not demonstrated efficacy or safety for temperature reduction. The majority of controlledclinical trials have evaluated induced hypothermia against a heterogeneous control group. The overall direction of effect appearsto suggest that there is no benefit with induced hypothermia, when compared to the control strategies, and that there may beincreased harm.It is possible that these controlled clinical trials may be falsely negative. There may be issues related to patient selection or thetiming, depth and duration of induced hypothermia, or problems with statistical power, sample size or outcome assessment. Afurther consideration is whether temperature should be modified in response to intracranial pressure or should the strategy bea target temperature alone?An alternative explanation for the lack of effectiveness of induced hypothermia is the controversial proposal that the hostresponse to injury provides ideal conditions for repair and recovery to occur; that a strategy that permits higher thresholds forintracranial pressure and temperature（e.g. > 20mmg or > 38°C）could be beneficial.A crucial additional source of potential bias in trials of induced hypothermia is the variability of management in the controlgroup. Are the control group strategies really generalisable to “standard practice”? We lack information on “standard practice”and variation within and between national and international jurisdictions. Given that the majority of traumatic head injury occursin low and middle-income countries, this adds an additional filter of relevance.教育講演 14 2月12日（金）　9：00～9：50　第11会場Temperature management in traumatic head injury