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THERAPEUTIC Temperature Management

Dong Suk Sung, Soo Young Sim, Hyung Won Jin, Woon Yong Kwon, Kyung Su Kim, Taegyun Kim, Yoon Sun Jung, Jung-In Ko, So Mi Shin, Gil Joon Suh, Kwang Suk Park
This paper introduces a mathematical model that can estimate deep brain temperature during therapeutic hypothermia based on a double sensor method. Although the cerebral temperature is more important than the non-cerebral core temperature during therapeutic hypothermia, pulmonary artery, rectal, and esophageal measurements (i.e., the typical core temperature measurement locations) have all been used for target temperature management. This is because there is no safe means of measuring the exact brain temperature...
November 14, 2018: Physiological Measurement
Benjamin N Cragun, Frances Hite Philp, John O'Neill, Matthew R Noorbakhsh, Rachel P Tindall, Allan S Philp, Michael F Ditillo
Therapeutic hypothermia (TH) and targeted temperature management (TTM) have been shown to improve outcomes in survivors of cardiac arrest, but prior research has excluded trauma and postoperative patients. We sought to determine whether TH/TTM is safe in trauma and surgical patients. A retrospective cohort study was conducted at a single level I trauma center reviewing adults presenting as a traumatic arrest or cardiac arrest in the postoperative period with a Glasgow Coma Scale <8 after return of circulation who were treated with either TH or TTM...
November 22, 2018: Therapeutic Hypothermia and Temperature Management
Yoshiko Kawata, Kazunori Nagasaka, Yoko Matsumoto, Katsutoshi Oda, Michihiro Tanikawa, Kenbun Sone, Mayuyo Mori-Uchino, Tetsushi Tsuruga, Takahide Arimoto, Yutaka Osuga, Tomoyuki Fujii
BACKGROUND: The management of refractory ascites in advanced ovarian cancer (AOC) is vital for patients with abdominal distention, respiratory distress, and anorexia due to massive ascites with cancer peritonitis. We analyzed the benefits of concentrated ascites reinfusion therapy (CART) in the management of AOC. METHODS: We reviewed records of AOC patients who underwent CART between January 2011 and March 2017. We retrospectively analyzed patients' backgrounds and physiological changes, including body weight, abdominal girth, urine volume, blood component values, blood pressure, heart rate, and body temperature before and after CART...
November 24, 2018: International Journal of Clinical Oncology
Hugo Oliveira, Ana Rita Costa, Alice Ferreira, Nico Konstantinides, Sílvio B Santos, Maarten Boon, Jean-Paul Noben, Rob Lavigne, Joana Azeredo
Acinetobacter baumannii is an important pathogen causative of healthcare-associated infections and is able to rapidly develop resistance to all known antibiotics including colistin. As an alternative therapeutic agent, we have isolated a novel myovirus (vB_AbM_B9) which specifically infects and makes lysis from without in strains of the K45 and K30 capsule type, respectively. Phage B9 has a genome of 93,641 bp and encodes 167 predicted proteins, of which 29 were identified by mass spectrometry. This phage holds a capsule depolymerase (B9gp69) able to digest extracted exopolysaccharides of both K30 and K45 strains and that remains active in a wide range of pH values (5 to 9), ionic strengths (0 to 500 mM), and temperatures (20 to 80°C)...
November 21, 2018: Journal of Virology
Mary Kay Bader, Stephen A Figueroa, Teresa Wavra, Sarah L Livesay, William D Cahoon, Leslie A Hamilton
No abstract text is available yet for this article.
November 14, 2018: Therapeutic Hypothermia and Temperature Management
Daniel C Schroeder, Alexandra C Maul, Maria Guschlbauer, Simon-Richard Finke, David de la Puente Bethencourt, Ingrid Becker, Stephan A Padosch, Andreas Hohn, Thorsten Annecke, Bernd W Böttiger, Anja Sterner-Kock, Holger Herff
BACKGROUND: Targeted temperature management is a standard therapy for unconscious survivors of cardiac arrest. To date, multiple cooling methods are available including invasive intravascular cooling devices (IVDs), which are widely used in the clinical setting. Recently, esophageal heat exchangers (EHEs) have been developed providing cooling via the esophagus that is located close to the aorta and inferior vena cava. The objective was to compare mean cooling rates, as well as differences, to target temperature during maintenance and the rewarming period of IVD and EHE...
November 9, 2018: Anesthesia and Analgesia
S Meißner, S Nuding, J Schröder, K Werdan, H Ebelt
BACKGROUND: According to ILCOR (International Liaison Committee on Resuscitation) recommendations (released in 2003), use of therapeutic hypothermia is recommended for unconscious adult patients who have survived a cardiac arrest regardless of the initial monitored cardiac rhythm. Thereby, the treatment goal is to achieve and maintain a body temperature of 32-34 °C for a period of 12-24 h. According to the October 2015 recommendations of the European Resuscitation Council (ERC), targeted temperature management (TTM) remains part of treatment, but, as an option, it is advised that the targeted body temperature be 36 °C rather than 32-34 °C...
November 5, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Giulia M Benedetti Md, Faye S Silverstein Md
Targeted temperature management encompasses a range of clinical interventions to regulate systemic temperature, and includes both induction of varying degrees of hypothermia and fever prevention ("targeted normothermia"). Targeted temperature management plays a key role in the contemporary management of critically ill neonates and children with acute brain injury. Yet, many unanswered questions remain regarding optimal temperature management in pediatric neurocritical care. The introduction highlights experimental studies that have evaluated the neuroprotective efficacy of therapeutic hypothermia and explored possible mechanisms of action in several brain injury models...
July 21, 2018: Pediatric Neurology
Gabriel Lima-Oliveira, Denis Monneret, Fabrice Guerber, Gian Cesare Guidi
The constrained economic context leads laboratories to centralize their routine analyses on high-throughput platforms, to which blood collection tubes are sent from peripheral sampling sites that are sometimes distantly located. Providing biochemistry results as quickly as possible implies to consolidate the maximum number of tests on a minimum number of blood collection tubes, mainly serum tubes and/or tubes with anticoagulants. However, depending on the parameters and their pre-analytical conditions, the type of matrix - serum or plasma - may have a significant impact on results, which is often unknown or underestimated in clinical practice...
November 2018: Critical Reviews in Clinical Laboratory Sciences
Barnaby R Scholefield, Faye S Silverstein, Russell Telford, Richard Holubkov, Beth S Slomine, Kathleen L Meert, James R Christensen, Vinay M Nadkarni, J Michael Dean, Frank W Moler
BACKGROUND: Separate trials to evaluate therapeutic hypothermia after paediatric cardiac arrest for out-of-hospital and in-hospital settings reported no statistically significant differences in survival with favourable neurobehavioral outcome or safety compared to therapeutic normothermia. However, larger sample sizes might detect smaller clinical effects. Our aim was to pool data from identically conducted trials to approximately double the sample size of the individual trials yielding greater statistical power to compare outcomes...
October 3, 2018: Resuscitation
Patrick M Kochanek, Travis C Jackson, Ericka L Fink
No abstract text is available yet for this article.
September 29, 2018: Resuscitation
Edoardo Picetti, Mauro Oddo, Lara Prisco, Raimund Helbok, Fabio Silvio Taccone
BACKGROUND: Fever is common in patients with acute brain injury and worsens secondary brain injury and clinical outcomes. Currently, there is a lack of consensus on the definition of fever and its management. The aims of the survey were to explore: (a) fever definitions, (b) thresholds to trigger temperature management, and (c) therapeutic strategies to control fever. MATERIALS AND METHODS: A questionnaire (26 items) was made available to members of the European Society of Intensive Care Medicine via its website between July 2016 and December 2016...
September 29, 2018: Journal of Neurosurgical Anesthesiology
Erin I Duffy, Jonah Garry, Lillian Talbot, David Pasternak, Ashley Flinn, Casey Minardi, Michele Dookram, Kathleen Grant, Debbie Fitzgerald, Jerry Rubano, James Vosswinkel, Randeep S Jawa
Background: Mechanically ventilated patients in the intensive care unit (ICU) are unable to communicate verbally. We sought to evaluate their needs via a communication board (CB) and a novel eye tracking device (ETD) that verbalizes selections made by gazing. Methods: This was a pilot prospective study conducted in a tertiary care surgical ICU. Continuously mechanically ventilated adult surgical ICU patients with a Richmond Agitation-Sedation Scale score of -1 to +1, without cognitive impairment, were eligible...
2018: Trauma surgery & acute care open
Beth S Slomine, Faye S Silverstein, James R Christensen, Kent Page, Richard Holubkov, J Michael Dean, Frank W Moler
Importance: Little is known about neuropsychological outcomes of children who survived pediatric cardiac arrest (CA). Objective: To describe the neuropsychological outcomes of CA survivors enrolled in the Therapeutic Hypothermia After Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) and Out-of-Hospital (THAPCA-OH) trials and compare the results with the primary outcome measure for these trials. Design, Setting, and Participants: Secondary analysis of 222 CA survivors aged 1 to 18 years who received chest compressions for 2 minutes or more, remained comatose and required mechanical ventilation after return of circulation, and were enrolled in targeted temperature-management trials from 41 pediatric intensive care units...
September 17, 2018: JAMA Neurology
Muharrem Akin, Jan-Thorben Sieweke, Florian Zauner, Vera Garcheva, Jörn Tongers, L Christian Napp, Lars Friedrich, Jens Treptau, Max-Udo Bahntje, Ulrike Flierl, Daniel G Sedding, Johann Bauersachs, Andreas Schäfer
OBJECTIVES: This study sought to analyze the impact of mandatory therapeutic hypothermia and cardiac catheterization in the absence of overt noncardiac cause of arrest as part of the Hannover Cardiac Resuscitation Algorithm before intensive care admission. BACKGROUND: Despite advanced therapies, out-of-hospital cardiac arrest (OHCA) is still associated with high mortality rates. Recently, the TTM (Target Temperature Management 33°C Versus 36°C After Out-of-Hospital Cardiac Arrest)-trial caused severe uncertainty about the efficacy of and need for therapeutic hypothermia...
September 24, 2018: JACC. Cardiovascular Interventions
Amanda K A Silva, Silvana Perretta, Guillaume Perrod, Laetitia Pidial, Véronique Lindner, Florent Carn, Shony Lemieux, Damien Alloyeau, Imane Boucenna, Philippe Menasché, Bernard Dallemagne, Florence Gazeau, Claire Wilhelm, Christophe Cellier, Olivier Clément, Gabriel Rahmi
Extracellular vesicles (EVs) are increasingly envisioned as the next generation of biological pro-regenerative nanotherapeutic agents, as has already been demonstrated for heart, kidney, liver, and brain tissues; lung injury repair; and skin regeneration. Herein, we explore another potential EV therapeutic application, fistula healing, together with a local minimally invasive delivery strategy. Allogenic extracellular vesicles (EVs) from adipose tissue-derived stromal cells (ASCs) are administered in a porcine fistula model through a thermoresponsive Pluronic F-127 (PF-127) gel, injected locally at 4 °C and gelling at body temperature to retain EVs in the entire fistula tract...
September 25, 2018: ACS Nano
Miyuki Tauchi, Maria Mercedes Tejada de Rink, Hiroshi Fujioka, Satoko Okayama, Kei-Ichiro Nakamura, Barbara Dietel, Stephan Achenbach, Rainer Kollmar, Stefan Schwab, Kazuo Ushijima, Hideki Harada
Targeted temperature management (TTM), or therapeutic hypothermia, is one of the most potent neuroprotective approaches after ischemic and traumatic brain injuries. TTM has been applied clinically with various methods, but effective achievement and maintenance of the target temperature remain challenging. Furthermore, timing of cooling and target body and brain temperature to optimize effectiveness for neuroprotection and to minimize side effects are yet to be standardized. Focal brain cooling is a potential strategy to minimize adverse effects of systemic TTM...
September 8, 2018: Therapeutic Hypothermia and Temperature Management
Kazuhiro Ueda, Junichi Murakami, Toshiki Tanaka, Kimikazu Hamano
BACKGROUND:  Although infectious complications occur occasionally after lung lobectomy, some of them are overlooked if the pathogen or origin is unidentifiable. METHODS:  We retrospectively reviewed 425 patients who underwent lobectomy for lung cancer. Infectious complications developed in 61 patients who consequently underwent empiric therapy: 44 had an identifiable focus and 17 did not irrespective of systemic surveillance. RESULTS:  The 17 patients without an identifiable focus were predominantly patients with squamous cell carcinoma, a smoking history, large tumor size, and undergoing lower lobectomy...
August 28, 2018: Thoracic and Cardiovascular Surgeon
Devika Nadkarni, Sara Gravelyn, Monica Brova, Sarem Rashid, Randy Yee, Donovan Guttieres, Katie Clifford, Darash Desai, Muhammad Zaman
BACKGROUND: Our objective is to estimate the effects of therapeutic oxytocin supply chain factors and social determinants of health on patient access to oxytocin in low-income settings using system dynamics modeling. Postpartum hemorrhage (PPH), a major cause of maternal mortality disproportionately affects women in low and middle income countries (LMICs). The World Health Organization recommends therapeutic oxytocin as the frontline uterotonic for PPH management and prevention. However, lack of access to quality therapeutic oxytocin in Tanzania, and throughout Sub-Saharan Africa, continues to result in a high number of preventable maternal deaths...
August 17, 2018: BMC Health Services Research
Y N Prashantha, P N Suman Rao, Saudamini Nesargi, B S Chandrakala, Kalyan Chakravarthy Balla, A Shashidhar
BACKGROUND: Different methods have been used for therapeutic hypothermia for neonates with moderate-to-severe hypoxic ischaemic encephalopathy (HIE). As standard cooling devices are expensive, there is a need to establish the safety and efficacy of low-cost devices such as ice packs (IP) and phase changing material (PCM). AIM: To assess the efficacy and safety of therapeutic hypothermia (TH) and the clinico-laboratory profile of neonates who underwent cooling with IP or PCM...
August 15, 2018: Paediatrics and International Child Health
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