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THERAPEUTIC Temperature Management

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...
October 12, 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
Tadashi Kaneko, Motoki Fujita, Susumu Yamashita, Yasutaka Oda, Eiichi Suehiro, Kenji Dohi, Shunji Kasaoka, Yasuhiro Kuroda, Hitoshi Kobata, Tsuyoshi Maekawa
Mild therapeutic hypothermia (MTH) is expected to improve the neurological outcomes of patients with severe traumatic brain injury (TBI). However, there are no standard protocols for managing the temperature of patients with severe TBI in order to improve their neurological outcomes. We conducted a post hoc analysis of the B-HYPO study, a randomized controlled trial of MTH in patients with TBI in Japan. We evaluated the impact of MTH methods on neurological outcomes. Ninety-seven patients who received MTH were included in the present analyses...
August 2, 2018: Scientific Reports
Sarah L Livesay, Leslie A Hamilton, William D Cahoon, Stephen A Figueroa, Dawn Gonzales Lovejoy, J J Baumann, Nicole Kupchik
No abstract text is available yet for this article.
September 2018: Therapeutic Hypothermia and Temperature Management
Alberto Pérez-Castellanos, Manuel Martínez-Sellés, Aitor Uribarri, Carolina Devesa-Cordero, José Carlos Sánchez-Salado, Albert Ariza-Solé, Iago Sousa, Miriam Juárez, Francisco Fernández-Avilés
INTRODUCTION AND OBJECTIVES: Despite therapeutic hypothermia, unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Our objective was to assess the usefulness of the variables obtained in the early moments after resuscitation in the prediction of 6-month prognosis. METHODS: A multicenter study was performed in 3 intensive cardiac care units. The analysis was done in 153 consecutive survivors of out-of-hospital cardiac arrest who underwent targeted temperature management between January 2007 and July 2015...
July 9, 2018: Revista Española de Cardiología
Hamit Yildiz
Targeted temperature management (therapeutic hypothermia) is a treatment method used to prevent potential complications that can develop in relation to the increased temperature in the brain as a result of cardiac arrest. Due to costs and various health policies there is no comprehensive study in the world that has been able to guide the relevant literature on therapeutic hypothermia. We have presented a 25-year-old female patient in our study who developed cardiac arrest after the administration of propofol for sedation before undergoing a diagnostic upper gastroscopy procedure and received a successful therapeutic hypothermia therapy following a resuscitation of 19 minutes...
July 11, 2018: Therapeutic Hypothermia and Temperature Management
Tetsuhisa Kitamura, Taku Iwami, Takahiro Atsumi, Tomoyuki Endo, Tomoo Kanna, Yasuhiro Kuroda, Atsushi Sakurai, Osamu Tasaki, Yoshio Tahara, Ryosuke Tsuruta, Jun Tomio, Kazuyuki Nakata, Sho Nachi, Mamoru Hase, Mineji Hayakawa, Takahiro Hiruma, Kenichi Hiasa, Takashi Muguruma, Takao Yano, Takeshi Shimazu, Naoto Morimura
Aim: To describe the registry design of the Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry as well as its profile on hospital information, patient and emergency medical service characteristics, and in-hospital procedures and outcomes among patients with OHCA who were transported to the participating institutions. Methods: The special committee aiming to improve the survival after OHCA by providing evidence-based therapeutic strategies and emergency medical systems from the JAAM has launched a multicenter, prospective registry that enrolled OHCA patients who were transported to critical care medical centers or hospitals with an emergency care department...
July 2018: Acute Medicine & Surgery
Salia Farrokh, Pouya Tahsili-Fahadan, Eva K Ritzl, John J Lewin, Marek A Mirski
BACKGROUND: The incidence of seizures in intensive care units ranges from 3.3% to 34%. It is therefore often necessary to initiate or continue anticonvulsant drugs in this setting. When a new anticonvulsant is initiated, drug factors, such as onset of action and side effects, and patient factors, such as age, renal, and hepatic function, should be taken into account. It is important to note that the altered physiology of critically ill patients as well as pharmacological and nonpharmacological interventions such as renal replacement therapy, extracorporeal membrane oxygenation, and target temperature management may lead to therapeutic failure or toxicity...
June 7, 2018: Critical Care: the Official Journal of the Critical Care Forum
Daniel Herschkowitz, Jana Kubias
Background Complex regional pain syndrome (CRPS) is a debilitating painful disorder, cryptic in its pathophysiology and refractory condition with limited therapeutic options. Type I CRPS with its variable relationship to trauma has often no discernible fractures or nerve injuries and remains enigmatic in its response to conservative treatment as well as the other limited interventional therapies. Neuromodulation in the form of spinal cord and dorsal root ganglion stimulation (SCS, DRGS) has shown encouraging results, especially of causalgia or CRPS I of lower extremities...
July 26, 2018: Scandinavian Journal of Pain
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