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Therapeutic Hypothermia and Temperature Management

Kara R Melmed, Patrick D Lyden
Therapeutic hypothermia (TH) is a potent neuroprotectant for experimental ischemic stroke, but studies of TH for intracerebral hemorrhage (ICH) are emerging. We systematically reviewed the experimental literature to assess TH efficacy for ICH. We found 18 suitable papers; quality scores were moderately good. Compared with normothermia, TH reduced measures of edema (mean effect size (95% CI) -1.6873 (-2.3640, -1.0106), p < 0.0001) or blood-brain barrier leakage (p < 0.0001) and improved behavioral outcomes (p < 0...
December 1, 2016: Therapeutic Hypothermia and Temperature Management
Wook-Jin Choi, Yun Seok Kim, Jung Seok Hong, Jeong Won Kim
Targeted temperature management (TTM) improves survival and neurological outcome after nontraumatic cardiac arrest. However, TTM is not used widely after traumatic cardiac arrest because of concerns that it might exacerbate bleeding. We report the use of postarrest TTM after repair of blunt myocardial rupture. A 48-year-old man was admitted after being rescued from a major traffic accident by the local emergency service. Focused sonography showed pericardial fluid without cardiac tamponade. Computed tomography showed a large hematoma in the anterior mediastinum associated with hemopericardium...
November 22, 2016: Therapeutic Hypothermia and Temperature Management
Katie Zanyk-McLean, Kelly N Sawyer, Ryan Paternoster, Rebekah Shievitz, William Devlin, Robert Swor
Post cardiac arrest, neuroprognostication remains a complex and clinically challenging issue for critical care providers. For this reason, our primary objective in this study was to determine the frequency of survival and favorable neurological outcomes in post-cardiac arrest patients with delayed time to awakening. To assess whether early withdrawal of care may adversely impact survival, we also sought to describe the time to withdrawal of care of non-surviving patients. We performed a retrospective study of patients resuscitated after cardiac arrest in two large academic community hospitals...
November 18, 2016: Therapeutic Hypothermia and Temperature Management
Banu Karakus Yilmaz, Hatice Topcu, Yahya A Acar, Duygu Sultan Oran, Sule Ozsoy, Erdem Çevik, Aylin Hakligor, Orhan Çinar
Cooled oxygen inhalation was hypothesized as a novel hypothermia technique in a previous study. In the current study, we aimed to determine the optimal temperature of oxygen for this method. This is a prospective, randomized, controlled, examiner-blinded experimental study conducted with 45 healthy, adult, Wistar Hannover male rats. Rats were randomly divided into five groups; group 1: +4°C intubated group (n = 7), group 2: +4°C nonintubated group (n = 9), group 3: +8°C intubated group (n = 9), group 4: +8°C nonintubated group (n = 9), and group 5: control group (n = 9)...
November 16, 2016: Therapeutic Hypothermia and Temperature Management
Winchana Srivilaithon, Sombat Muengtaweepongsa
Targeted temperature management (TTM) is indicated for comatose survivors of cardiac arrest to improve outcomes. However, the benefit of TTM was verified by rigid controlled clinical trials. This study aimed at evaluating its effects in real-world practices. A prospective observational study was done at the emergency department of tertiary care, Thammasat Hospital, from March 2012 until October 2015. We included all who did not obey verbal commands after being resuscitated from cardiac arrest regardless of initial cardiac rhythm...
November 11, 2016: Therapeutic Hypothermia and Temperature Management
Parth Makker, Yuichi J Shimada, Deepika Misra, Yumiko Kanei
Therapeutic hypothermia is used in select patients after out-of-hospital cardiac arrest (OHCA) to improve neurologic outcome. Rebound hyperthermia (RH) is commonly observed post-treatment. Previous studies analyzing the association of RH with clinical outcome have reported conflicting results. The purpose of this study is to examine the impact of RH after completion of therapeutic hypothermia in patients postcardiac arrest. We analyzed a retrospective cohort from our institution. All adults who underwent therapeutic hypothermia post-OHCA were divided into two cohorts depending on the presence/absence of fever (T > 38°C) within 24 hours of completing hypothermia protocol...
October 26, 2016: Therapeutic Hypothermia and Temperature Management
Tiffany D Stafford, Joseph L Hagan, Curtis G Sitler, Caraciolo J Fernandes, Jeffrey R Kaiser
Perinatal hypoxic ischemic encephalopathy (HIE) can lead to severe neurodevelopmental outcome and death. Therapeutic hypothermia is neuroprotective for infants with moderate-to-severe HIE. However, therapeutic hypothermia is only offered at high-level regional neonatal intensive care units (NICUs), necessitating the need to transport sick infants to referral centers. The goal of this study was to evaluate whether active cooling on transport is more effective than passive cooling in achieving temperatures in the treatment target range (33°C-34°C) on arrival to the Texas Children's Hospital (TCH) NICU...
September 27, 2016: Therapeutic Hypothermia and Temperature Management
Raghuram Chava, Menekhem Zviman, Madhavan Srinivas Raghavan, Henry Halperin, Farhan Maqbool, Romergryko Geocadin, Alfredo Quinones-Hinojosa, Aravindan Kolandaivelu, Benjamin A Rosen, Harikrishna Tandri
Early induction of therapeutic hypothermia (TH) is recommended in out-of-hospital cardiac arrest (CA); however, currently no reliable methods exist to initiate cooling. We investigated the effect of high flow transnasal dry air on brain and body temperatures in adult porcine animals. Adult porcine animals (n = 23) under general anesthesia were subject to high flow of transnasal dry air. Mouth was kept open to create a unidirectional airflow, in through the nostrils and out through the mouth. Brain, internal jugular, and aortic temperatures were recorded...
September 16, 2016: Therapeutic Hypothermia and Temperature Management
Robert B Schock, Andreas Janata, W Frank Peacock, Nathan S Deal, Sarathi Kalra, Fritz Sterz
Our purpose was to analyze evidence related to timing of cooling from studies of targeted temperature management (TTM) after return of spontaneous circulation (ROSC) after cardiac arrest and to recommend directions for future therapy optimization. We conducted a preliminary review of studies of both animals and patients treated with post-ROSC TTM and hypothesized that a more rapid cooling strategy in the absence of volume-adding cold infusions would provide improved outcomes in comparison with slower cooling...
December 2016: Therapeutic Hypothermia and Temperature Management
W Dalton Dietrich
No abstract text is available yet for this article.
December 2016: Therapeutic Hypothermia and Temperature Management
Patrick Lyden, Gretchen M Brophy, Nicolas Deye, Christopher M Horn
No abstract text is available yet for this article.
December 2016: Therapeutic Hypothermia and Temperature Management
Ryan S Kitagawa, Christian Storm, Hiroshi Nonogi
No abstract text is available yet for this article.
December 2016: Therapeutic Hypothermia and Temperature Management
Mary Kay Bader, Gretchen M Brophy, Teresa Wavra, Claranne Mathiesen, Mary Kay Bader
No abstract text is available yet for this article.
December 2016: Therapeutic Hypothermia and Temperature Management
Kacey B Anderson, Samuel M Poloyac, Patrick M Kochanek, Philip E Empey
Targeted temperature management (TTM) has been shown to reduce mortality and improve neurological outcomes in out-of-hospital cardiac arrest (CA) patients and in neonates with hypoxic-ischemic encephalopathy (HIE). TTM has also been associated with adverse drug events in the critically ill patient due to its effect on drug pharmacokinetics (PKs) and pharmacodynamics (PDs). We aim to evaluate the current literature on the effect of TTM on drug PKs and PDs following CA. MEDLINE/PubMed databases were searched for publications, which include the MeSH terms hypothermia, drug metabolism, drug transport, P450, critical care, cardiac arrest, hypoxic-ischemic encephalopathy, pharmacokinetics, and pharmacodynamics between July 2006 and October 2015...
December 2016: Therapeutic Hypothermia and Temperature Management
Patrick J Coppler, Keith A Marill, David O Okonkwo, Lori A Shutter, Cameron Dezfulian, Jon C Rittenberger, Clifton W Callaway, Jonathan Elmer
Comatose patients after cardiac arrest should receive active targeted temperature management (TTM), with a goal core temperature of 32-36°C for at least 24 hours. Small variations in brain temperature may confer or mitigate a substantial degree of neuroprotection, which may be lost at temperatures near 37°C. The purpose of this study was to define the relationship between brain and core temperature after cardiac arrest through direct, simultaneous measurement of both. We placed intracranial monitors in a series of consecutive patients hospitalized for cardiac arrest at a single tertiary care facility within 12 hours of return of spontaneous circulation to guide postcardiac arrest care...
December 2016: Therapeutic Hypothermia and Temperature Management
Anders Morten Grejs, Jakob Gjedsted, Michael Pedersen, Hanne Birke-Sørensen, Andreas Rauff-Mortensen, Kristian Kjær Andersen, Hans Kirkegaard
The aim of this randomized porcine study was to compare surface targeted temperature management (TTM) to endovascular TTM evaluated by cerebral diffusion-weighted magnetic resonance imaging (MRI): apparent diffusion coefficient (ADC), and by intracerebral/intramuscular microdialysis. It is well known that alteration in the temperature affects ADC, but the relationship between cerebral ADC values and the cooling method per se has not been established. Eighteen anesthetized 60-kg female swine were hemodynamically and intracerebrally monitored and subsequently subjected to a baseline MRI...
December 2016: Therapeutic Hypothermia and Temperature Management
Hiromichi Naito, Eiji Isotani, Clifton W Callaway, Shingo Hagioka, Naoki Morimoto
Elevation of intracranial pressure (ICP) may worsen brain injury and neurological outcome. Studies on the use of therapeutic hypothermia (TH) for traumatic brain injury suggests that rapid rewarming from TH is associated with elevated ICP and poorer outcomes. However, few studies describe the time course of ICP changes during TH/rewarming after cardiac arrest (CA). In this study, we observed the changes in ICP during mild TH and rewarming after CA. Secondarily, we examined whether ICP is related to outcome...
December 2016: Therapeutic Hypothermia and Temperature Management
Shoichiro Tanaka, Sachiko Iwata, Masahiro Kinoshita, Kennosuke Tsuda, Sayaka Sakai, Mamoru Saikusa, Ryota Shindo, Eimei Harada, Junichiro Okada, Tadashi Hisano, Hiroshi Kanda, Yasuki Maeno, Yuko Araki, Kazuo Ushijima, Teruo Sakamoto, Yushiro Yamashita, Osuke Iwata
Adult patients frequently suffer from serious respiratory complications during therapeutic hypothermia. During therapeutic hypothermia, respiratory gases are humidified close to saturated vapor at 37°C (44 mg/L) despite that saturated vapor reduces considerably depending on temperature reduction. Condensation may cause serious adverse events, such as bronchial edema, mucosal dysfunction, and ventilator-associated pneumonia during cooling. To determine clinical variables associated with inadequate humidification of respiratory gases during cooling, humidity of inspiratory gases was measured in 42 cumulative newborn infants who underwent therapeutic hypothermia...
December 2016: Therapeutic Hypothermia and Temperature Management
(no author information available yet)
No abstract text is available yet for this article.
August 2016: Therapeutic Hypothermia and Temperature Management
Mary Kay Bader, Mary McKenna Guanci, Stephen A Figueroa, Gretchen M Brophy, Chris Laux
No abstract text is available yet for this article.
August 2016: Therapeutic Hypothermia and Temperature Management
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