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https://www.readbyqxmd.com/read/29135501/temperature-variability-in-a-modern-targeted-temperature-management-trial
#1
Ahmad Abu-Arafeh, Aryelly Rodriguez, Ross L Paterson, Peter J D Andrews
OBJECTIVES: The Eurotherm3235 trial showed that therapeutic hypothermia was deleterious in patients with raised intracranial pressure following traumatic brain injury. We sought to ascertain if increased temperature variability within the first 48 hours, or for 7 days post randomization, were modifiable risk factors associated with poorer outcome. DESIGN: Eurotherm3235 was a multicenter randomized controlled trial. Patients were randomized to receive either therapeutic hypothermia in addition to standard care or the later only...
November 10, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29109627/temperature-management-under-general-anesthesia-compulsion-or-option
#2
REVIEW
Barkha Bindu, Ashish Bindra, Girija Rath
Administration of general anesthesia requires continuous monitoring of vital parameters of the body including body temperature. However, temperature continues to be one of the least seriously monitored parameters perioperatively. Inadvertent perioperative hypothermia is a relatively common occurrence with both general and regional anesthesia and can have significant adverse impact on patients' outcome. While guidelines for perioperative temperature management have been proposed, there are no specific guidelines regarding the best site or best modality of temperature monitoring and management intraoperatively...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29108477/hyperthermia-and-mild-traumatic-brain-injury-effects-on-inflammation-and-the-cerebral-vasculature
#3
Jessie Truettner, Helen M Bramlett, W Dalton Dietrich
Mild traumatic brain injury (mTBI) or concussion represents the majority of TBIs brain trauma in the United States. The pathophysiology of mTBI is complex and may include both focal and diffuse injury patterns. In addition to altered circuit dysfunction and diffuse traumatic axonal injury (DTAI), chronic neuroinflammation has also been implicated in the pathophysiology of mTBI. Recently, our laboratory has reported the detrimental effects of mild hyperthermic mTBI in terms of worsening histopathological and behavioral outcomes...
November 6, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29102076/prevention-of-surgical-site-infection-analysis-and-narrative-review-of-clinical-practice-guidelines
#4
Francisco Javier Gómez-Romero, Maria Fernández-Prada, Juan Francisco Navarro-Gracia
Surgical site infection is one of the most prevalent healthcare-associated infections and presents a considerable morbidity. The aim of this comprehensive narrative review is to describe the evidence and grade of recommendation of the preventive measures developed in the three phases of the surgical process (preoperative, perioperative and postoperative phases), as well as coincidences and divergences between selected Clinical Practice Guidelines (CPG). Four preventive measures were recommended with similar high grade evidence in all CPG: Hair removal, antibiotic prophylaxis, surgical site preparation and normothermia...
October 25, 2017: Cirugía Española
https://www.readbyqxmd.com/read/29074466/neuroprotective-assessment-of-prolonged-local-hypothermia-post-contusive-spinal-cord-injury-in-rodent-model
#5
Daniel Teh Boon Loong, Soo Min Chua, Ankshita Prasad, Ioannis Kakkos, Wenxuan Jiang, Yue Mu, Xiaogang Liu, Angelo Homayoun All
BACKGROUND CONTEXT: While general hypothermia is recognised as a clinically applicable neuroprotective intervention, acute moderate local hypothermia post-contusive Spinal Cord Injury (SCI) is being considered a more effective approach. Previously, we have investigated the feasibility and safety of inducing prolonged local hypothermia in the Central Nervous System of rodent model. PURPOSE: Here, we aimed to verify the efficacy and neuroprotective effects of 5 and 8 hours local moderate hypothermia (30±0...
October 23, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29061477/effect-of-hypothermia-on-apoptosis-in-traumatic-brain-injury-and-hemorrhagic-shock-model
#6
Oğuz Eroğlu, Turgut Deniz, Üçler Kisa, Pınar Atasoy, Kuzey Aydinuraz
INTRODUCTION: The neuroprotective mechanisms of therapeutic hypothermia against trauma-related injury have not been fully understood yet. In this study, we aimed to investigate the effects of therapeutic hypothermia on biochemical and histopathological markers of apoptosis using Traumatic brain injury (TBI) and hemorrhagic shock (HS) model. METHODS: A total of 50 male albino-wistar rats were divided into five groups: Group isolated TBI, Group NT (HT+HS+normothermia), Group MH (HT+HS+mild hypothermia), Group MoH (HT+HS+moderate hypothermia) and Group C (control)...
September 28, 2017: Injury
https://www.readbyqxmd.com/read/29058556/feasibility-of-a-miniature-esophageal-heat-exchange-device-for-rapid-therapeutic-cooling-in-newborns-preliminary-investigations-in-a-piglet-model
#7
John Dingley, Satomi Okano, Silvia Planas, Elavazhagan Chakkarapani
Therapeutic hypothermia (TH) after neonatal encephalopathy, commonly provided by 72 hours of whole-body cooling using a wrap, limits parents' physical contact with their infants affecting bonding and may not be suitable for encephalopathic preterm infants with fragile skin. Alternative cooling methods are unavailable for this population. We investigated in a neonatal pig model the feasibility of achieving a 3.5°C reduction in rectal temperature (Trectal) similar to clinical TH protocols from 38.5°C (normothermia for pigs) to a target of 35°C ± 0...
October 23, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/29053702/the-effects-of-adding-prophylactic-phenobarbital-to-therapeutic-hypothermia-in-the-term-equivalent-hypoxic-ischemic-rat
#8
Sushma Krishna, Alexandra Hutton, Eric Aronowitz, Holly Moore, Susan J Vannucci
BackgroundHypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and mortality. Therapeutic hypothermia (TH) is the only available intervention, but neuroprotection is incomplete and variable. Seizures are common in infants with HIE undergoing TH and may worsen outcome. Phenobarbital is sometimes added, although use of prophylactic phenobarbital is controversial in the neonate. We hypothesize that prophylactic phenobarbital (PB) will not reduce, and may enhance, the neuroprotective effects of TH on brain injury and motor outcomes in the postnatal-day 10 (P10) hypoxic-ischemic (HI) rat...
October 20, 2017: Pediatric Research
https://www.readbyqxmd.com/read/29051228/thermal-strategies-of-king-penguins-during-prolonged-fasting-in-water
#9
Agnès Lewden, Manfred R Enstipp, Batshéva Bonnet, Caroline Bost, Jean-Yves Georges, Yves Handrich
Most animals experience periods of unfavourable conditions, challenging their daily energy balance. During breeding, king penguins fast voluntarily for up to 1.5 months in the colony, after which they replenish their energy stores at sea. However, at sea, birds might encounter periods of low foraging profitability, forcing them to draw from previously stored energy (e.g. subcutaneous fat). Accessing peripheral fat stores requires perfusion, increasing heat loss and thermoregulatory costs. Hence, how these birds balance the conflicting demands of nutritional needs and thermoregulation is unclear...
October 19, 2017: Journal of Experimental Biology
https://www.readbyqxmd.com/read/29051226/thermal-tachypnea-in-avian-embryos
#10
Kênia C Bícego, Jacopo P Mortola
Many adult mammals and birds respond to heat with thermal tachypnea, an increase in breathing frequency with shallow tidal volume, with minimal increase in oxygen consumption (V̇O2 ). This pattern favors heat dissipation by evaporative water loss (EWL) through the respiratory tract. We asked to what extent this response was apparent at the earliest stages of development, when pulmonary ventilation (V̇E) initiates. Measurements of V̇E(barometric technique), V̇O2 (open-flow methodology) and EWL (water scrubbers) were performed on chicken embryos at the earliest appearance of V̇E, during the internal pipping stage...
October 19, 2017: Journal of Experimental Biology
https://www.readbyqxmd.com/read/29049743/additional-veno-venous-gas-exchange-as-a-problem-solving-strategy-for-an-oxygenator-not-transferring-oxygen-in-paediatric-cardiopulmonary-bypass
#11
Wolfgang Boettcher, Nicodème Sinzobahamvya, Frank Dehmel, Andreas Matschke, Andre Iben, Mi-Young Cho, Mathias Redlin, Joachim Photiadis
OBJECTIVES: Oxygenator failure during cardiopulmonary bypass constitutes a life-threatening event, especially when perfusion is conducted under normothermia. An alternative solution to emergency oxygenator changeover is described. METHODS: A supplementary oxygenator is added in the venous line without interrupting perfusion. De-airing is achieved through the cardiotomy reservoir. Oxygen supply is adapted to ensure physiologic partial oxygen pressure. RESULTS: On 5 occasions in the past 4 years, Capiox Baby FX 05 oxygenator (n = 4) and Capiox FX15 (n = 1) failed to exchange blood gases after bypass run ranging from 290 min to 563 min...
November 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29038971/the-implementation-of-targeted-temperature-management-an-evidence-based-guideline-from-the-neurocritical-care-society
#12
Lori Kennedy Madden, Michelle Hill, Teresa L May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V Moreda, Neeraj Badjatia
BACKGROUND: Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges...
October 16, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29033729/use-of-rocuronium-and-sugammadex-under-neuromuscular-transmission-monitoring-in-a-patient-with-multiple-sclerosis
#13
Chryssoula Staikou, Martina Rekatsina
Multiple sclerosis (MS) is a potentially disabling disease characterized by demyelinating lesions in the central nervous system. One of the anesthetic challenges encountered in surgical patients with MS is the management of neuromuscular blockade (NMB) and its reversal. We report a case of a 31-year-old female patient suffering from MS, who underwent gynecological surgery under general anesthesia with sevoflurane, fentanyl, and rocuronium which was successfully reversed with sugammadex. Neuromuscular transmission (NMT) monitoring was used to guide the intraoperative doses of rocuronium and also the reversal of NMB by the use of sugammadex to ensure a safe tracheal extubation...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29024930/effect-of-concurrent-src-kinase-inhibition-with-short-duration-hypothermia-on-ca2-calmodulin-kinase-iv-activity-and-neuropathology-after-hypoxia-ischemia-in-the-newborn-swine-brain
#14
Panagiotis Kratimenos, Ioannis Koutroulis, Amit Jain, Shadi Malaeb, Maria Delivoria-Papadopoulos
BACKGROUND: Hypoxia-ischemia (HI) results in increased activation of Ca2+/calmodulin kinase IV (CaM kinase IV) mediated by Src kinase. Therapeutic hypothermia ameliorates neuronal injury in the newborn. HYPOTHESIS: Inhibition of Src kinase concurrently with hypothermia further attenuates the hypoxia-induced increased activation of CaM kinase IV compared with hypothermia alone. DESIGN/METHODS: Ventilated piglets were exposed to HI, received saline or a selective Src kinase inhibitor (PP2), and were cooled to 33°C...
October 13, 2017: Neonatology
https://www.readbyqxmd.com/read/29019723/accidental-hanging-injuries-in-children-recognition-and-management
#15
Siba P Paul, Ruby Paul, Paul A Heaton
Accidental hanging is rare in childhood but is often fatal. Window blind cords pose a particular and unique risk to young children in the UK, accounting for one to two deaths annually. These accidents are frequently associated with non-adherence to the safety instructions provided by the manufacturers. Early discovery of the child and initiation of effective cardiopulmonary resuscitation at the site of the incident are likely to improve the outcome. Prolonged suspension, children who are pulseless at first contact by the emergency paramedic responder, and patients with prolonged periods of remaining in asystole before return of spontaneous circulation after starting cardiopulmonary resuscitation are unlikely to have intact neurological survival...
October 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/28962807/targeted-temperature-management-in-brain-injured-patients
#16
REVIEW
Fred Rincon
Evidence from animal models indicates that lowering temperature by a few degrees can produce substantial neuroprotection. In humans, hypothermia has been found to be neuroprotective with a significant impact on mortality and long-term functional outcome only in cardiac arrest and neonatal hypoxic-ischemic encephalopathy. Clinical trials have explored the potential role of maintaining normothermia and treating fever in critically ill brain injured patients. This review concentrates on basic concepts to understand the physiologic interactions of thermoregulation, effects of thermal modulation in critically ill patients, proposed mechanisms of action of temperature modulation, and practical aspects of targeted temperature management...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28958318/an-integrative-review-of-postoperative-accelerated-recovery-protocols
#17
REVIEW
Ramon AntÔnio Oliveira, Gabrielle Meriche GalvÃo Bento da Silva Guatura, Aparecida de Cássia Giani Peniche, Ana Lúcia Siqueira Costa, Vanessa de Brito Poveda
We undertook an integrative literature review of articles pertaining to perioperative nursing care provided to patients using postoperative accelerated recovery protocols. To select the articles, we searched the MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature, and LiteraturaLatino-Americana e do Caribe em Ciências da Saúde databases. We identified 329 studies, 13 of which met our inclusion criteria and described perioperative nursing care activities. Nursing activities noted in these articles were hypothermia prevention and maintenance of normothermia, restriction of IV fluids, assessment of vital signs, management of symptoms and pain, support of early ambulation, care for tubes and drains, oral administration of carbohydrate-rich foods, assessment of ability to tolerate diet, and encouragement to resume activities of daily living...
October 2017: AORN Journal
https://www.readbyqxmd.com/read/28958025/spinal-ischaemia-after-thoracic-endovascular-aortic-repair-with-left-subclavian-artery-sacrifice-is-there-a-critical-stent-graft-length
#18
Fabian A Kari, Babak Saravi, Sonja Krause, Luisa Puttfarcken, Karin Wittmann, Katharina Förster, Bartosz Rylski, Sven Maier, Ulrich Göbel, Matthias Siepe, Martin Czerny, Friedhelm Beyersdorf
OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) is used for treatment of thoracic aortic pathologies, but the covered stent graft can induce spinal ischaemia depending on the length used. The left subclavian artery contributes to spinal cord collateralization and is frequently occluded by the stent graft. Our objective was to investigate the impact of covered stent graft length on the risk of spinal ischaemia in the setting of left subclavian artery sacrifice. METHODS: Twenty-six pigs (German country race, mean body weight 36 ± 4 kg) underwent simulated descending aortic TEVAR via left lateral thoracotomy, with left subclavian artery and thoracic segmental artery occlusion in normothermia...
August 24, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28951276/early-transient-mild-hypothermia-attenuates-neurological-deficits-and-brain-damage-after-experimental-subarachnoid-hemorrhage-in-rats
#19
Nadine Lilla, Christoph Rinne, Judith Weiland, Thomas Linsenmann, Ralf-Ingo Ernestus, Thomas Westermaier
OBJECTIVE: Metabolic exhaustion in ischemic tissue is the basis for a detrimental cascade of cell damage. In the acute stage of subarachnoid hemorrhage (SAH), a sequence of global and focal ischemia occurs, threatening brain tissue to undergo ischemic damage. This study was conducted to investigate whether early therapy with moderate hypothermia can offer neuroprotection after experimental SAH. MATERIALS AND METHODS: 20 male Sprague-Dawley rats were subjected to SAH and treated by active cooling (34° C) or served as controls by continuous maintenance of normothermia (37...
September 23, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28938976/the-nurse-anesthetists-adherence-to-swedish-national-recommendations-to-maintain-normothermia-in-patients-during-surgery
#20
Ingrid L Gustafsson, Carina Elmqvist, Mona From-Attebring, Ingrid Johansson, Mikael Rask
PURPOSE: The aim of this study was to determine if nurse anesthetists (NAs) have access, knowledge, and adhere to recommended guidelines to maintain normal body temperature during the perioperative period. DESIGN: A descriptive survey design. METHODS: Questionnaires were sent to heads of the department (n = 56) and NAs in the operating departments in Sweden. FINDING: The level of access to the recommendations is high, but only one third of the operating departments have included the recommendations in their own local guidelines...
October 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
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