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Targetted temperature management

Jessica A Castillo, Clinton W Epps, Mackenzie R Jeffress, Chris Ray, Thomas J Rodhouse, Donelle Schwalm
Landscape connectivity is essential for maintaining viable populations, particularly for species restricted to fragmented habitats or naturally arrayed in metapopulations and facing rapid climate change. The importance of assessing both structural connectivity (physical distribution of favorable habitat patches) and functional connectivity (how species move among habitat patches) for managing such species is well understood. However, the degree to which functional connectivity for a species varies among landscapes, and the resulting implications for conservation, have rarely been assessed...
September 2016: Ecological Applications: a Publication of the Ecological Society of America
Gyuho Song, Yeonho You, Wonjoon Jeong, Junwan Lee, Yongchul Cho, Seungwhan Lee, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo
OBJECTIVE: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) due to an acute myocardial infarction without cardiogenic shock required higher doses of vasopressors with low targeted temperature management (TTM) after return of spontaneous circulation. METHODS: We included consecutive comatose patients resuscitated from OHCA between January 2011 and December 2013. Patients with return of spontaneous circulation, regional wall motion abnormality on echocardiography, and coronary artery stenosis of ≥70% on percutaneous coronary artery angiography were enrolled...
March 2016: Clin Exp Emerg Med
Kathleen Meert, Russell Telford, Richard Holubkov, Beth S Slomine, James R Christensen, J Michael Dean, Frank W Moler
OBJECTIVE: To explore the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to an apparent life threatening event (ALTE) recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest Out-of-Hospital trial. METHODS: Fifty-four infants (48h to <1year of age) with ALTE who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation were included...
October 11, 2016: Resuscitation
Cornelia Genbrugge, Ward Eertmans, Ingrid Meex, Margaretha Van Kerrebroeck, Noami Daems, An Creemers, Frank Jans, Willem Boer, Jo Dens, Cathy De Deyne
BACKGROUND: The aim of this study was to elucidate the possible role of cerebral saturation monitoring in the post-cardiac arrest setting. METHODS: Cerebral tissue saturation (SctO2) was measured in 107 successfully resuscitated out-of-hospital cardiac arrest patients for 48 hours between 2011 and 2015. All patients were treated with targeted temperature management, 24 hours at 33 °C and rewarming at 0.3 °C per hour. A threshold analysis was performed as well as a linear mixed models analysis for continuous SctO2 data to compare the relation between SctO2 and favorable (cerebral performance category (CPC) 1-2) and unfavorable outcome (CPC 3-4-5) at 180 days post-cardiac arrest in OHCA patients...
October 13, 2016: Critical Care: the Official Journal of the Critical Care Forum
Takashi Tagami, Hiroki Matsui, Masamune Kuno, Yuuta Moroe, Junya Kaneko, Kyoko Unemoto, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: Patients resuscitated after cardiac arrest are reportedly at high risk for infection and sepsis, especially those treated with targeted temperature management (TTM). There is, however, limited evidence suggesting that early antibiotic use improves patient outcomes. We examined the hypothesis that early treatment with antibiotics reduces mortality in patients with cardiac arrest receiving TTM. METHODS: We identified 2803 patients with cardiogenic out-of-hospital cardiac arrest (OHCA) that were treated with TTM and were admitted to 371 hospitals that contribute to the Japanese Diagnosis Procedure Combination inpatient database between July 2007 and March 2013...
October 7, 2016: BMC Anesthesiology
James F Doyle, Frédérique Schortgen
The concept of pyrexia as a protective physiological response to aid in host defence has been challenged with the awareness of the severe metabolic stress induced by pyrexia. The host response to pyrexia varies, however, according to the disease profile and severity and, as such, the management of pyrexia should differ; for example, temperature control is safe and effective in septic shock but remains controversial in sepsis. From the reported findings discussed in this review, treating pyrexia appears to be beneficial in septic shock, out of hospital cardiac arrest and acute brain injury...
October 3, 2016: Critical Care: the Official Journal of the Critical Care Forum
Mark Cooper
There is growing evidence to support the use of mild therapeutic hypothermia (MTH), also known as targeted temperature management, in out-of-hospital patients who have experienced cardiac arrest. Reducing core body temperatures to 32-34°C can reduce mortality and neurological disability significantly among such patients, but recent surveys have shown that use of MTH is variable and there can be a considerable delay in initiating it.
July 9, 2012: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Robert Anton Cesnjevar, Ariawan Purbojo, Frank Muench, Joerg Juengert, André Rueffer
Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called "total body perfusion (TBP)" is somewhat difficult to achieve...
July 2016: Translational pediatrics
Mohammad Fazel Bakhsheshi, Yong Wang, Lynn Keenliside, Ting-Yim Lee
BACKGROUND: Target temperature management is the single most effective intervention and the gold standard in post-resuscitation care today. However, cooling the whole body below 33-34 °C can cause severe complications. Therefore, developing a selective brain cooling (SBC) approach which can be initiated early to induce rapid cooling and maintain the target temperature over 12-24 h before slowly rewarming brain temperature by itself alone would be advantageous. Vortex tubes are simple mechanical devices generating cold air from a stream of compressed air without applied chemical or energy...
December 2016: Intensive Care Medicine Experimental
Patrik Gilje, Sasha Koul, Jakob Hartvig Thomsen, Yvan Devaux, Hans Friberg, Michael Kuiper, Janneke Horn, Niklas Nielsen, Tomasso Pellis, Pascal Stammet, Matthew P Wise, Jesper Kjaergaard, Christian Hassager, David Erlinge
AIM OF THE STUDY: Predicting outcome of unconscious patients after successful resuscitation is challenging and better prognostic markers are highly needed. Ischemic heart disease is a common cause of out-of-hospital cardiac arrest (OHCA). Whether or not high-sensitivity troponin T (hs-TnT) is a prognostic marker among survivors of OHCA with both ischemic and non-ischemic aetiologies remains to be determined. We sought to evaluate the ability of hs-TnT to prognosticate all-cause mortality, death due to cardiovascular causes or multi-organ failure and death due to cerebral causes after OHCA...
October 2016: Resuscitation
Veerapong Vattanavanit, Rungsun Bhurayanontachai
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of intensive care unit admission, which results in high hospital mortality. Targeted temperature management (TTM) was introduced several years ago and is considered to improve neurological and mortality outcomes. This management process was implemented in our hospital in 2012, which was expected to improve the standard of care in OHCA patients. PURPOSE: We aimed to report the clinical and mortality outcomes after TTM was introduced to our hospital in 2012...
2016: Open Access Emergency Medicine: OAEM
Heather Worthington, Will Pickett, Laurie J Morrison, Damon C Scales, Chun Zhan, Steve Lin, Paul Dorian, Katie N Dainty, Niall D Ferguson, Steven C Brooks
OBJECTIVE: Patient volume as a surrogate for institutional experience has been associated with quality of care indicators for a variety of illnesses. We evaluated the association between hospital experience with comatose out-of-hospital cardiac arrest (OHCA) patients and important care processes. METHODS: This was a population-based, retrospective cohort study using data from 37 hospitals in Southern Ontario from 2007 to 2013. We included adults with atraumatic OHCA who were comatose on emergency department arrival and survived at least 6h...
September 20, 2016: Resuscitation
H-C Mochmann
Witnessed collapse, bystander resuscitation and the use of automated external defibillators for defibrillatable arrhythmias, are recognized as strong predictors for a good prognosis after cardiac arrest. In addition, patient care after return of spontaneous circulation (ROSC), i.e. postresuscitation care, has been identified as an important factor for survival. It is necessary to differentiate between measures for treating the underlying cause of the cardiac arrest and measures for limiting reperfusion injury after global hypoxia and ischemia...
September 21, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Julianna Jung
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm...
October 2016: Emergency Medicine Practice
Alberto Maria Cattaneo, Jonas Martin Bengtsson, Nicolas Montagné, Emmanuelle Jacquin-Joly, Omar Rota-Stabelli, Umberto Salvagnin, Angela Bassoli, Peter Witzgall, Gianfranco Anfora
Transient receptor potential (TRP) channels are an ancient family of cation channels, working as metabotropic triggers, which respond to physical and chemical environmental cues. Perception of chemical signals mediate reproductive behaviors and is therefore an important target for sustainable management tactics against the codling moth Cydia pomonella L. (Lepidoptera: Tortricidae). However, olfactory behavior strongly depends on diel periodicity and correlation of chemical with physical cues, like temperature, and physical cues thus essentially contribute to the generation of behavioral response...
2016: Journal of Insect Science
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...
September 13, 2016: Therapeutic Hypothermia and Temperature Management
Salim Surani, Joseph Varon
No abstract text is available yet for this article.
September 9, 2016: Resuscitation
Martin Frydland, Jesper Kjaergaard, David Erlinge, Pascal Stammet, Niklas Nielsen, Michael Wanscher, Tommaso Pellis, Hans Friberg, Jan Hovdenes, Janneke Horn, Jørn Wetterslev, Jakob H Thomsen, John Bro-Jeppesen, Matilde Winther-Jensen, Matthew P Wise, Michael Kuiper, Tobias Cronberg, Yvan Gasche, Yvan Devaux, Anders Åneman, Christian Hassager
N-terminal pro-B-type natriuretic (NT-proBNP) is expressed in the heart and brain, and serum levels are elevated in acute heart and brain diseases. We aimed to assess the possible association between serum levels and neurological outcome and death in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Of the 939 comatose OHCA patients enrolled and randomized in the Targeted Temperature Management (TTM) trial to TTM at 33°C or 36°C for 24 hours, 700 were included in the biomarker substudy...
October 1, 2016: American Journal of Cardiology
H Olai, G Thornéus, H Watson, M R Macleod, H Friberg, J Rhodes, N Nielsen, T Cronberg, T Deierborg
Targeted temperature management (TTM) of 32-34 °C has been the standard treatment for out-of-hospital cardiac arrest since clinical trials in 2002 showed benefits to survival and neurological outcome. Recently, this treatment has been challenged by another clinical trial showing no difference in outcome between TTM of 33 °C and 36 °C. This protocol describes the methodology for a meta-analysis detailing temperature-reducing interventions to treat global ischaemia in animal models. By combining relevant data sets in the literature, we will explore the experimental evidence for TTM...
August 2016: Evidence-based Preclinical Medicine
Tian Fu, Jinglin Yi, Songyi Lv, Bing Zhang
CONTEXT: Fungal keratitis, a corneal fungal infection of the eye caused mainly by Candida species, has become the leading cause of blindness resulting from corneal disease in China. Present limitations in the management of ophthalmic fungal infections include the inability to provide long-term extraocular drug delivery without compromising intraocular structures and/or systemic drug exposure. OBJECTIVE: The aim of this study was to construct amphotericin B (AmB) loaded, chitosan-modified, nanostructured lipid carriers (AmB-CH-NLC) for prolonged ocular application and for the improvement of the targeted delivery of AmB to the ocular mucosa...
September 7, 2016: Journal of Liposome Research
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