BACKGROUND: Despite the advances in critical care, severe viral meningoencephalitis continues to impose high rates of morbidity and mortality. Consequently, new treatment strategies are needed and we present therapeutic hypothermia (TH) as one of the possible efficacious treatment tools. METHODS: We present the case series in an adult intensive care unit of a tertiary care hospital. Eleven patients suffering from severe viral meningoencephalitis were treated with hypothermia. The major indication for TH was severely impaired consciousness associated with carbon dioxide reactivity loss assessed by Transcranial Doppler. Besides from the established treatment, all the patients underwent TH. Mild hypothermia (rectal temperature of 32-34°C) was maintained with continuous veno-venous hemofiltration. RESULTS: Median Glasgow coma scale score in our patients at admission was 8 (3-10) and median Acute Physiology and Chronic Health Evaluation score was 24 (12-32). The overall mortality rate was 9% (1/11). Among survivors, the outcome was favorable in five patients [Glasgow Outcome Scale score (GOS) 4-5]. Remaining five patients had severe residual neurological deficit (GOS 3). Median GCS at discharge was 15 (8-15). With respect to disease severity, the outcome in presented patients was generally satisfactory. CONCLUSIONS: Our results suggest that use of mild hypothermia in selected adult patients with viral meningoencephalitis could be a promising treatment tool.
BACKGROUND: Despite the advances in critical care, severe viral meningoencephalitis continues to impose high rates of morbidity and mortality. Consequently, new treatment strategies are needed and we present therapeutic hypothermia (TH) as one of the possible efficacious treatment tools. METHODS: We present the case series in an adult intensive care unit of a tertiary care hospital. Eleven patients suffering from severe viral meningoencephalitis were treated with hypothermia. The major indication for TH was severely impaired consciousness associated with carbon dioxide reactivity loss assessed by Transcranial Doppler. Besides from the established treatment, all the patients underwent TH. Mild hypothermia (rectal temperature of 32-34°C) was maintained with continuous veno-venous hemofiltration. RESULTS: Median Glasgow coma scale score in our patients at admission was 8 (3-10) and median Acute Physiology and Chronic Health Evaluation score was 24 (12-32). The overall mortality rate was 9% (1/11). Among survivors, the outcome was favorable in five patients [Glasgow Outcome Scale score (GOS) 4-5]. Remaining five patients had severe residual neurological deficit (GOS 3). Median GCS at discharge was 15 (8-15). With respect to disease severity, the outcome in presented patients was generally satisfactory. CONCLUSIONS: Our results suggest that use of mild hypothermia in selected adult patients with viral meningoencephalitis could be a promising treatment tool.
Authors: Allan R Tunkel; Carol A Glaser; Karen C Bloch; James J Sejvar; Christina M Marra; Karen L Roos; Barry J Hartman; Sheldon L Kaplan; W Michael Scheld; Richard J Whitley Journal: Clin Infect Dis Date: 2008-08-01 Impact factor: 9.079
Authors: Carol A Glaser; Sabrina Gilliam; David Schnurr; Bagher Forghani; Somayeh Honarmand; Nino Khetsuriani; Marc Fischer; Cynthia K Cossen; Larry J Anderson Journal: Clin Infect Dis Date: 2003-03-03 Impact factor: 9.079
Authors: Juan M Flores-Cordero; Rosario Amaya-Villar; Maria D Rincón-Ferrari; Santiago R Leal-Noval; José Garnacho-Montero; Ana C Llanos-Rodríguez; Francisco Murillo-Cabezas Journal: Intensive Care Med Date: 2003-08-06 Impact factor: 41.787