Tsarev A. Therapeutic hypothermia and methods of controlling thermoregulation in critical and terminal states

Dissertation is devoted to solving the problem of optimizing the management of disorders of temperature homeostasis in patients with critical and terminal conditions undergoing treatment in the intensive care unit. The presented study included the results of the examination and treatment of 318 patients, including those with severe trauma brain injury (TBI) with the inclusion of Target Temperature Management (ТTM) in the intensive care in the therapeutic hypothermia variant using non-invasive and invasive technology; accidental hypothermia, intraoperative hypothermia during urgent surgical interventions, including polytrauma, using the method of controlled normothermia. Based on the results of the study, indications, contraindications and a step-by-step algorithm for conducting therapeutic hypothermia with the purpose of brain neuroprotection were developed; non-invasive cooling technology in the development of hyperthermia of central genesis refractory to pharmacological therapy to ensure and maintain normothermia to prevent secondary brain damage. The positive effect of the use of TTM on the speed and completeness of neurological recovery of patients with severe TBI has been demonstrated. Investigated of the dynamics of pathophysiological changes developing in response to the action of systemic hypothermia were studied and a differentiated method of intensive care was developed depending on the severity of accidental hypothermia, the use of which increases the survival rate of this group of patients and reduces mortality. The advantages of the convection method of warming patients in the postoperative period during urgent surgical interventions, including in patients with polytrauma, in the form of reducing the development of cold postoperative shivering, blood loss and the need for transfusion of allogeneic erythrocytes.