Hypothermia as an adjunctive treatment for severe bacterial meningitis

Brain injury due to bacterial meningitis results in a high mortality rate a nd significant neurologic sequelae in survivors. The objective of this stud y was to determine if the application of moderate hypothermia shortly after the administration of antibiotics would attenuate the inflammatory respons e and increase in intracranial pressure that occurs in meningitis. For this study we used a rabbit model of severe Group B streptococcal meningitis. T he first component of this study evaluated the effects of hypothermia on bl ood-brain barrier function and markers of inflammation in meningitic animal s. The second part of the study evaluated the effects of hypothermia on int racranial pressure, cerebral perfusion pressure and brain edema. This study demonstrates that the use of hypothermia preserves CSF/serum glucose ratio , decreases CSF protein and nitric oxide and attenuates myeloperoxidase act ivity in brain tissue. In the second part of this study we show a decrease in intracranial pressure, an improvement in cerebral perfusion pressure and a decrease in cerebral edema in hypothermic meningitic animals. We conclud e that in the treatment of severe bacterial meningitis, the application of moderate hypothermia initiated shortly after antibiotic therapy improves sh ort-term physiologic measures associated with brain injury. (C) 2000 Elsevi er Science B.V. All rights reserved.