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Patient Temperature Management

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https://www.readbyqxmd.com/read/28323720/neuroprognostication-after-cardiac-arrest-in-the-light-of-targeted-temperature-management
#1
Mauro Oddo, Hans Friberg
PURPOSE OF REVIEW: Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction...
March 20, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28321277/clinical-outcomes-among-febrile-children-aged-2-to-59-months-with-negative-malaria-rapid-diagnostic-test-results-in-mchinji-district-malawi
#2
Dyson Mwandama, Chawanangwa Mwale, Andrew Bauleni, Themba Phiri, Joseph Chisaka, Humphreys Nsona, Don P Mathanga
BACKGROUND: Malawi malaria treatment guidelines recommend a definitive diagnosis, using a malaria rapid diagnostic test (mRDT), for all patients with fever or history of fever. Improving the management and outcomes of febrile children with negative mRDT results should be a priority. METHODS: Through a prospective cohort study designed to investigate clinical outcomes of children treated at the community level, we followed, for 7 days, children aged 2 to 59 months, who had negative mRDT results and were treated with antipyretic medication...
December 2016: Malawi Medical Journal: the Journal of Medical Association of Malawi
https://www.readbyqxmd.com/read/28315727/increasing-or-fluctuating-bispectral-index-values-during-post-resuscitation-targeted-temperature-management-can-predict-clinical-seizures-after-rewarming
#3
Kanae Ochiai, Atsushi Shiraishi, Yasuhiro Otomo, Yuuichi Koido, Takashi Kanemura, Masato Honma
AIM: To investigate whether an increasing bispectral index (BIS) value during targeted temperature management (TTM) correlates with increased clinical seizures after TTM or worse neurological prognoses after TTM. METHODS: We performed a retrospective prognostication study of patients who were treated with TTM after recovery of spontaneous circulation from cardiac arrest at a tertiary care hospital. We recorded the BIS regularly during TTM and calculated the correlations of the mean BIS values, standard deviations of the BIS values, and linear regression coefficient of the trend of the BIS values over time as index tests...
March 15, 2017: Resuscitation
https://www.readbyqxmd.com/read/28314465/data-capture-and-communication-during-transfers-to-definitive-care-in-an-inclusive-trauma-system
#4
Nori L Bradley, Naisan Garraway, Nathaniel Bell, Nasira Lakha, S Morad Hameed
INTRODUCTION: Background trauma survivors in rural areas transferred to urban centers have higher mortality than trauma patients admitted directly to urban centers. Transfer data in trauma registries is important for injury control. Prehospital and early physiologic data may reflect processes of pre-hospital care. British Columbia currently has no standardized process for trauma patient data transfer. PATIENTS AND METHODS: We performed a retrospective data analysis for major trauma patients (ISS>15) transferred to a Level I trauma center over a 1year period (n=243)...
November 5, 2016: Injury
https://www.readbyqxmd.com/read/28314170/-pseudo-subarachnoid-hemorrhage-sign-on-early-brain-computed-tomography-in-out-of-hospital-cardiac-arrest-survivors-receiving-targeted-temperature-management
#5
Byung Kook Lee, Youn-Jung Kim, Seung Mok Ryoo, Su Jin Kim, Dong Hun Lee, Kyung Woon Jeung, Won Young Kim
PURPOSE: Newly updated guidelines suggest brain computed tomography for out-of-hospital cardiac arrest survivors to identify a neurologic cardiac arrest cause. We hypothesized that the "pseudo-subarachnoid hemorrhage" (p-SAH) sign in cardiac arrest survivors is associated with poor outcome. MATERIALS AND METHODS: We retrospectively evaluated the registries of 2 tertiary hospitals, identifying 836 adult (≥18 years) patients achieving return of spontaneous circulation after out-of-hospital cardiac arrest...
February 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28306631/thermoregulate-autoregulate-and-ventilate-brain-directed-critical-care-for-pediatric-cardiac-arrest
#6
Jonathan E Kurz, Craig M Smith, Mark S Wainwright
PURPOSE OF REVIEW: Cardiac arrest in childhood is associated with a high risk for mortality and poor long-term functional outcome. This review discusses the current evidence for neuroprotective therapies and goals for postarrest care in the context of the pathophysiology of hypoxic-ischemic injury, modalities for neurologic prognostication in these children and potential future monitoring paradigms for maximizing cerebral perfusion in the postarrest period. RECENT FINDINGS: The recent publication of the in-hospital and out-of-hospital Therapeutic Hypothermia After Cardiac Arrest trials demonstrated a lack of statistically significant benefit for the use of postarrest therapeutic hypothermia...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28302139/targeted-temperature-management-in-cardiac-arrest-survival-evaluated-by-propensity-score-matching
#7
Eirik A Buanes, Karl O Hufthammer, Jørund Langørgen, Anne-Berit Guttormsen, Jon-Kenneth Heltne
BACKGROUND: Targeted temperature management in cardiac arrest was introduced following evidence of increased survival from two controlled trials published in 2002. We wanted to investigate whether the introduction of targeted temperature management to clinical practice had increased the survival of cardiac arrest patients at Haukeland University Hospital, Norway. METHODS: We included 336 unresponsive patients admitted to the emergency department between December 2003 and December 2008 with return of spontaneous circulation following out-of-hospital cardiac arrest in the analysis...
March 16, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28291783/oesophageal-heat-exchangers-with-a-diameter-of-11mm-or-14-7mm-are-equally-effective-and-safe-for-targeted-temperature-management
#8
Daniel C Schroeder, Maria Guschlbauer, Alexandra C Maul, Daniel A Cremer, Ingrid Becker, David de la Puente Bethencourt, Peter Paal, Stephan A Padosch, Wolfgang A Wetsch, Thorsten Annecke, Bernd W Böttiger, Anja Sterner-Kock, Holger Herff
BACKGROUND: Targeted temperature management (TTM) is widely used in critical care settings for conditions including hepatic encephalopathy, hypoxic ischemic encephalopathy, meningitis, myocardial infarction, paediatric cardiac arrest, spinal cord injury, traumatic brain injury, ischemic stroke and sepsis. Furthermore, TTM is a key treatment for patients after out-of-hospital cardiac-arrest (OHCA). However, the optimal cooling method, which is quick, safe and cost-effective still remains controversial...
2017: PloS One
https://www.readbyqxmd.com/read/28285322/intensive-care-medicine-research-agenda-on-cardiac-arrest
#9
REVIEW
Jerry P Nolan, Robert A Berg, Stephen Bernard, Bentley J Bobrow, Clifton W Callaway, Tobias Cronberg, Rudolph W Koster, Peter J Kudenchuk, Graham Nichol, Gavin D Perkins, Tom D Rea, Claudio Sandroni, Jasmeet Soar, Kjetil Sunde, Alain Cariou
Over the last 15 years, treatment of comatose post-cardiac arrest patients has evolved to include therapeutic strategies such as urgent coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management (TTM)-requiring mechanical ventilation and sedation-and more sophisticated and cautious prognostication. In 2015, collaboration between the European Resuscitation Council (ERC) and the European Society for Intensive Care Medicine (ESICM) resulted in the first European guidelines on post-resuscitation care...
March 11, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28284166/the-effect-of-targeted-temperature-management-on-qt-and-corrected-qt-intervals-in-patients-with-cardiac-arrest
#10
Zachary Rosol, David F Miranda, Yader Sandoval, Bradley A Bart, Stephen W Smith, Steven R Goldsmith
BACKGROUND: Targeted Temperature Management (TTM) improves outcomes after cardiac arrest but may affect the QT and QTc intervals which could increase the chance of subsequent arrhythmia. We report here the effects of TTM on both computer-derived and manually calculated QT and QTc as well as the relationship of the length of the QTc and serious arrhythmia in a retrospective single-center experience. METHODS: 193 patients undergoing TTM for cardiac arrest were studied...
February 22, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28280382/retention-of-finger-blood-flow-against-postural-change-as-an-indicator-of-successful-sympathetic-block-in-the-upper-limb
#11
Toshihiko Nakatani, Tatsuya Hashimoto, Ichiro Sutou, Yoji Saito
BACKGROUND: Sympathetic block in the upper limb has diagnostic, therapeutic and prognostic utility for disorders in the upper extremity that are associated with sympathetic disturbances. Increased skin temperature and decreased sweating are used to identify the adequacy of sympathetic block in the upper limb after stellate ganglion block (SGB). Baroreflexes elicited by postural change induce a reduction in peripheral blood flow by causing sympathetic vasoconstriction. We hypothesized that sympathetic block in the upper limb reduces the decrease in finger blood flow caused by baroreflexes stimulated by postural change from the supine to long sitting position...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28268685/multimodel-quantitative-analysis-of-somatosensory-evoked-potentials-after-cardiac-arrest-with-graded-hypothermia
#12
Leanne Moon Young, Rishabh Choudhary, Xiaofeng Jia
Cardiac arrest (CA) is one of the most prominent causes of morbidity and mortality in adults. Therapeutic hypothermia (TH) is a recommended treatment to improve survival and functional outcome following CA, however, it is unclear what degree of TH is most beneficial. It has been suggested that TH of 33°C provides no survival or outcome benefits over TH of 36°C. Additionally, there is a lack of verified objective quantitative prognostic tools for comatose CA patients under TH. In this study, we calculated three quantitative markers of somatosensory evoked potentials (SSEP) to examine their potential to track recovery in the early period following CA under graded TH...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28263778/evaluation-of-the-bundle-zero-surgical-site-infection-to-prevent-surgical-site-infection-in-vascular-surgery
#13
María Fernández-Prada, Carmen Martínez-Ortega, Livia Revuelta-Mariño, Ángeles Menéndez-Herrero, Juan F Navarro-Gracia
OBJECTIVE: To compare the incidence of Surgical Site Infections (SSIs) before and after the implementation of a bundle of care called 'Zero Surgical Site Infection'. Secondary goals included estimating measures of association and their potential impact, determining care management indicators in vascular surgery, and evaluating the level of compliance with the bundle. METHODS: This is a prospective observational study with a historic control group. The bundle included: 1) removal of body hair with clippers; 2) preoperative showering with chlorhexidine soap; 3) preparation of the surgical field with alcoholic chlorhexidine 2%; 4) adequacy of antimicrobial prophylaxis; 5) and 6) intra- and post-operative glycemic and central temperature control...
March 2, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28259678/safety-of-repetitive-transcranial-magnetic-stimulation-in-patients-with-implanted-cortical-electrodes-an-ex-vivo-study-and-report-of-a-case
#14
Nicolás M Phielipp, Utpal Saha, Tejas Sankar, Akihiro Yugeta, Robert Chen
OBJECTIVE: To evaluate the safety of repetitive transcranial magnetic stimulation (rTMS) in patients with implanted subdural cortical electrodes. METHODS: We performed ex-vivo experiments to test the temperature, displacement and current induced in the electrodes with single pulse transcranial magnetic stimulation (TMS) from 10 to 100% of stimulator output and tested a typical rTMS protocol used in a clinical setting. We then used rTMS to the motor cortex to treat a patient with refractory post-herpetic neuralgia who had previously been implanted with a subdural motor cortical electrode for pain management...
February 13, 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/28246924/jsa-guideline-for-the-management-of-malignant-hyperthermia-crisis-2016
#15
REVIEW
(no author information available yet)
Malignant hyperthermia (MH) can be fatal if the crisis is not appropriately treated. It is an inherited disease usually triggered by the administration of volatile inhalational anesthetics and/or succinylcholine, a muscle relaxant. In a patient with suspected MH, the mechanism of calcium release from storage in the sarcoplasmic reticulum in the skeletal muscle is abnormally accelerated. Unexplained hypercarbia representing >55 mmHg of end-tidal carbon dioxide, tachycardia, and muscle rigidity (including masseter muscle rigidity) are early signs of the initiation of MH, because the metabolism is accelerated...
February 28, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28243991/normothermia-and-stroke
#16
REVIEW
Jonathan Marehbian, David M Greer
In the past two decades, there has been much focus on the adverse effect of fever on neurologic outcome, the benefits of hypothermia on functional outcomes, and the interplay of associated complications. Despite decades of experience regarding randomized, safety and feasibility, case-controlled, retrospective studies, there has yet to be a large, randomized, multicenter, clinical trial with the appropriate power to address the potential benefits of targeted temperature modulation compared to hypothermia alone...
January 2017: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/28242531/recent-developments-in-the-management-of-patients-resuscitated-from-cardiac-arrest
#17
REVIEW
Jacob C Jentzer, Casey M Clements, Joseph G Murphy, R Scott Wright
Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by coronary artery disease; patients with coronary artery disease likely benefit from early coronary angiography and intervention. After resuscitation, cardiac arrest patients remain critically ill and frequently suffer cardiogenic shock and multiorgan failure. Early cardiopulmonary stabilization is important to prevent worsening organ injury...
February 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28239054/critical-care-management-focused-on-optimizing-brain-function-after-cardiac-arrest
#18
Ryuta Nakashima, Toru Hifumi, Kenya Kawakita, Tomoya Okazaki, Satoshi Egawa, Akihiko Inoue, Ryutaro Seo, Nobuhiro Inagaki, Yasuhiro Kuroda
The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia...
February 24, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28229199/-coronary-artery-disease-interventional-and-operative-therapeutic-options-after-cardiac-arrest
#19
M Behnes, K Mashayekhi, M Borggrefe, I Akin
Coronary artery disease (CAD) represents a common structural cause for developing cardiac arrest in older patients, whereas in young adults cardiac arrest is more often caused by cardiomyopathies and cardiac channelopathies. A structural heart disease is known in almost 50% of patients prior to cardiac arrest. The present review outlines current interventional and operative therapeutic options for patients surviving cardiac arrest. The focus is on associations between epidemiological data on the incidence of malignant arrhythmias causing cardiac arrest depending on the presence or absence of CAD...
February 22, 2017: Herz
https://www.readbyqxmd.com/read/28226872/multimodel-quantitative-analysis-of-somatosensory-evoked-potentials-after-cardiac-arrest-with-graded-hypothermia
#20
Leanne Moon Young, Rishabh Choudhary, Xiaofeng Jia, Leanne Moon Young, Rishabh Choudhary, Xiaofeng Jia, Xiaofeng Jia, Leanne Moon Young, Rishabh Choudhary
Cardiac arrest (CA) is one of the most prominent causes of morbidity and mortality in adults. Therapeutic hypothermia (TH) is a recommended treatment to improve survival and functional outcome following CA, however, it is unclear what degree of TH is most beneficial. It has been suggested that TH of 33°C provides no survival or outcome benefits over TH of 36°C. Additionally, there is a lack of verified objective quantitative prognostic tools for comatose CA patients under TH. In this study, we calculated three quantitative markers of somatosensory evoked potentials (SSEP) to examine their potential to track recovery in the early period following CA under graded TH...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
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