(Rewarming) articles in PubMed
- Association between blood glucose levels the next day following targeted temperature initiation and outcome in traumatic brain injury: a post-hoc analysis of the B-HYPO study. [Journal Article]
- J Neurotrauma 2016 Sep 27JN
- We investigated associations between blood glucose levels and clinical outcomes in participants of the multicenter prospective randomized controlled Brain-Hypothermia (B-HYPO) study. Patients with se...
We investigated associations between blood glucose levels and clinical outcomes in participants of the multicenter prospective randomized controlled Brain-Hypothermia (B-HYPO) study. Patients with severe traumatic brain injury (TBI, Glasgow Coma Scale 4-8) were assigned to therapeutic hypothermia (TH, 32-34°C, n=98) or fever control (35.5-37.0°C, n=50) groups. TH patients were cooled as soon as possible for ≥72 h and rewarmed at a rate of <1°C/day. We recorded blood glucose (BG) levels on days 0, 1, and 3 after treatment initiation, and day 1 after rewarming. The Glasgow Outcome Scale was assessed at 6 months. Median BG levels decreased from day 0 to day 1 (163 vs. 132 mg/dL, p=0.0062) in the fever control group. In contrast, a decrease was observed from day 1 to day 3 (157.5 vs. 126 mg/dL, p<0.001) in the TH group. Day 1 BG was higher in the TH group compared with the fever control group (p=0.0252). At day 0, BG levels were higher in non-survivors compared with survivors across all patients (p=0.0035), the TH group (p=0.0125), and the non-surgical group (p=0.0236). Higher day 1 BG levels were observed in non-survivors compared with survivors across all patients (p=0.0071), the fever control group (p=0.0495), and the surgical group (p=0.0364). In the TH group, the initial stress hyperglycemia was sustained the next day after TH induction. Day 1 BG predicted outcome in TBI patients with TH and fever control. Optimal BG control during fever management may affect outcome and thus should be carefully managed. Our findings indicate significance of BG control particularly during TH treatment.
- [Postresuscitation care]. [Journal Article]
- Med Klin Intensivmed Notfmed 2016 Sep 21MK
- 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 arr...
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. The importance of urgent coronary angiography in cases of ST-elevation myocardial infarction (STEMI) and for patients with suspected cardiac origin without STEMI, especially with hemodynamic instability is emphasized in the current European Resuscitation Council (ERC) guidelines. In order to minimize reperfusion injury targeted temperature management (32-36 °C) is advised, rewarming must be controlled and fever and hyperthermia avoided. The mean arterial pressure should be adjusted to allow sufficient urine production (1 ml/kg/h) and blood glucose should be ≤10 mmol/l (≤180 mg/dl). Analgosedation is necessary in most patients, especially with the use of targeted temperature management. Convulsive seizures must be consistently treated. Cardiac arrest centers provide a treatment strategy for postresuscitation care involving emergency percutaneous coronary angiography, targeted temperature management and comprehensive neurological evaluation for estimating the prognosis. Whether establishing these centers will actually lead to improved survival still needs to be proven.
- Comparison of Effects of Propofol and Isosorbide Dinitrate during Rewarming on Cardiopulmonary Bypass. [Journal Article]
- Pak J Med Sci 2016 Jul-Aug; 32(4):806-10PJ
- CONCLUSIONS: Propofol alone is capable of fulfilling the requirements of adequate rewarming during Cardiopulmonary bypass and can produce more hemodynamic stability and early post-operative recovery.
- Chronic dietary salt stress mitigates hyperkalemia and facilitates chill coma recovery in Drosophila melanogaster. [Journal Article]
- J Insect Physiol 2016 Sep 15; 95:89-97JI
- Chill susceptible insects like Drosophila lose the ability to regulate water and ion homeostasis at low temperatures. This loss of hemolymph ion and water balance drives a hyperkalemic state that dep...
Chill susceptible insects like Drosophila lose the ability to regulate water and ion homeostasis at low temperatures. This loss of hemolymph ion and water balance drives a hyperkalemic state that depolarizes cells, causing cellular injury and death. The ability to maintain ion homeostasis at low temperatures and/or recover ion homeostasis upon rewarming is closely related to insect cold tolerance. We thus hypothesized that changes to organismal ion balance, which can be achieved in Drosophila through dietary salt loading, could alter whole animal cold tolerance phenotypes. We put Drosophila melanogaster in the presence of diets highly enriched in NaCl, KCl, xylitol (an osmotic control) or sucrose (a dietary supplement known to impact cold tolerance) for 24h and confirmed that they consumed the novel food. Independently of their osmotic effects, NaCl, KCl, and sucrose supplementation all improved the ability of flies to maintain K(+) balance in the cold, which allowed for faster recovery from chill coma after 6h at 0°C. These supplements, however, also slightly increased the CTmin and had little impact on survival rates following chronic cold stress (24h at 0°C), suggesting that the effect of diet on cold tolerance depends on the measure of cold tolerance assessed. In contrast to prolonged salt stress, brief feeding (1.5h) on diets high in salt slowed coma recovery, suggesting that the long-term effects of NaCl and KCl on chilling tolerance result from phenotypic plasticity, induced in response to a salty diet, rather than simply the presence of the diet in the gut lumen.
- The influence of natural photoperiod on seasonal torpor expression of two opportunistic marsupial hibernators. [Journal Article]
- J Comp Physiol B 2016 Sep 16JC
- Many mammals use torpor throughout the year but the individual contributions of environmental variables to seasonal changes in torpor expression are often difficult to tease apart. In many mammals, t...
Many mammals use torpor throughout the year but the individual contributions of environmental variables to seasonal changes in torpor expression are often difficult to tease apart. In many mammals, torpor is most often used opportunistically in response to decreased ambient temperature (T a ) and food availability, but information on how seasonally changing photoperiod per se influences torpor patterns is scant. Therefore, we quantified patterns of torpor use in response to natural photoperiod in captive marsupial pygmy-possums held at near-constant T a with a stable food supply over a period of 19 months. Western pygmy-possums (Cercartetus concinnus) and eastern pygmy-possums (C. nanus) used spontaneous torpor in every month of the year; in total we measured >1100 individual torpor bouts. Torpor bout duration was >60 % longer in winter than in summer and increased with decreasing day length for both species. Interestingly, the duration of torpor appeared to be adjusted at both the beginning and end of bouts because the time of entry into and rewarming from torpor relative to sunrise and sunset, respectively, changed with season. We propose that this reflects a synchronisation of torpor timing with foraging periods in the wild, which would enable animals to maintain a high body mass year-round by maximising both energy savings via torpor and energy input via food consumption. Our study suggests that photoperiod makes a significant contribution to the seasonal change in torpor bout duration of small hibernating mammals that use torpor throughout the year.
- Accidental hypothermia-an update : The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). [Review]
- Scand J Trauma Resusc Emerg Med 2016; 24(1):111SJ
- CONCLUSIONS: Based on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.
- Effect of Hypothermia and Targeted Temperature Management on Drug Disposition and Response Following Cardiac Arrest: A Comprehensive Review of Preclinical and Clinical Investigations. [Journal Article]
- Ther Hypothermia Temp Manag 2016 Sep 13TH
- 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 enceph...
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. Twenty-three studies were included in this review. The studies demonstrate that hypothermia impacts PK parameters and increases concentrations of cytochrome-P450-metabolized drugs in the cooling and rewarming phase. Furthermore, the current data demonstrate a combined effect of CA and hypothermia on drug PK. Importantly, these effects can last greater than 4-5 days post-treatment. Limited evidence suggests hypothermia-mediated changes in the Phase II metabolism and the Phase III transport of drugs. Hypothermia also has been shown to potentially decrease the effect of specific drugs at the receptor level. Therapeutic hypothermia, as commonly deployed/applied during TTM, alters PK, and elevates concentrations of several commonly used medications. Hypothermia-mediated effects are an important factor when dosing and monitoring patients undergoing TTM treatment.
- Hypothermia and Rewarming Activate a Macroglial Unfolded Protein Response Independent of Hypoxic-Ischemic Brain Injury in Neonatal Piglets. [Journal Article]
- Dev Neurosci 2016 Sep 14DN
- Therapeutic hypothermia provides incomplete neuroprotection after hypoxia-ischemia (HI)-induced brain injury in neonates. We previously showed that cortical neuron and white matter apoptosis are prom...
Therapeutic hypothermia provides incomplete neuroprotection after hypoxia-ischemia (HI)-induced brain injury in neonates. We previously showed that cortical neuron and white matter apoptosis are promoted by hypothermia and early rewarming in a piglet model of HI. The unfolded protein response (UPR) may be one of the potential mediators of this cell death. Here, neonatal piglets underwent HI or sham surgery followed by 29 h of normothermia, 2 h of normothermia + 27 h of hypothermia or 18 h of hypothermia + rewarming. Piglets recovered for 29 h. Immunohistochemistry for endoplasmic reticulum to nucleus signaling-1 protein (ERN1), a marker of UPR activation, was used to determine the ratios of ERN1+ macroglia and neurons in the motor subcortical white matter and cerebral cortex. The ERN1+ macroglia were immunophenotyped as oligodendrocytes and astrocytes by immunofluorescent colabeling. Temperature (p = 0.046) and HI (p < 0.001) independently affected the ratio of ERN1+ macroglia. In sham piglets, sustained hypothermia (p = 0.011) and rewarming (p = 0.004) increased the ERN1+ macroglia ratio above that in normothermia. HI prior to hypothermia diminished the UPR. Ratios of ERN1+ macroglia correlated with white matter apoptotic profile counts in shams (r = 0.472; p = 0.026), thereby associating UPR activation with white matter apoptosis during hypothermia and rewarming. Accordingly, macroglial cell counts decreased in shams that received sustained hypothermia (p = 0.009) or rewarming (p = 0.007) compared to those in normothermic shams. HI prior to hypothermia neutralized the macroglial cell loss. Neither HI nor temperature affected ERN1+ neuron ratios. In summary, delayed hypothermia and rewarming activate the macroglial UPR, which is associated with white matter apoptosis. HI may decrease the macroglial endoplasmic reticulum stress response after hypothermia and rewarming.
- Triad of death: the importance of temperature monitoring in trauma patients. [Journal Article]
- Emerg Nurse 2016; 24(5):19-23EN
- Multiple organ failure is a significant complication in traumatic injury, and can be exacerbated by a failure to adequately monitor and control trauma patients' core body temperature in emergency dep...
Multiple organ failure is a significant complication in traumatic injury, and can be exacerbated by a failure to adequately monitor and control trauma patients' core body temperature in emergency departments (EDs). Nearly half of trauma patients are hypothermic on arrival at emergency departments, often due to factors beyond the control of emergency service responders and during on-scene resuscitation attempts. This article examines the physiology of the 'triad of death' -hypothermia, metabolic acidosis and coagulopathy - to highlight the importance of monitoring and maintaining normothermia, or normal body temperature, which is between 36°C and 37.2°C, in trauma patients to improve outcomes. It also describes some rewarming interventions that can help to save the lives of patients with multiple injuries. Major traumatic injury is the leading cause of death in people under 40 years of age in the UK. Among major trauma patients, 75% are male and 98% of injuries are caused by blunt force such as falls or road traffic incidents ( National Institute for Health and Care Excellence (NICE) 2015 ). The cost in terms of lost economic output is variously estimated to be between £3.3 billion ( National Audit Office 2010 ) and £3.7 billion a year ( Scott 2016 ). Multiple organ failure is a significant complication of traumatic injury, and is exacerbated by failure to adequately monitor and control the patient's core body temperature in ED. On arrival at ED, 43% of trauma patients are hypothermic ( Allen et al 2010 ), often due to factors beyond the control of emergency service responders, such as complicated extrications in adverse environmental conditions. Initial resuscitative attempts on-scene can further reduce core body temperature, because of prolonged exposure to the environment and administration of cold intravenous (IV) fluids ( Duchesne et al 2010 ).
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- Time Matters in Severe Frostbite: Assessment of Limb/Digit Salvage on the Individual Patient Level. [Journal Article]
- J Burn Care Res 2016 Aug 18JB
- Severe frostbite is associated with high levels of morbidity through loss of digits or limbs. The aim of this study was to examine the salvage rate following severe frostbite injury. Frostbite patien...
Severe frostbite is associated with high levels of morbidity through loss of digits or limbs. The aim of this study was to examine the salvage rate following severe frostbite injury. Frostbite patients from 2006 to 2014 were identified in the prospectively maintained database at a single urban burn and trauma center. Patients with imaging demonstrating a lack of blood flow in limbs/digits were included in the analysis (N = 73). The Hennepin Frostbite Score was used to quantify frostbite injury and salvage. This score provides a single value to assess each individual patient's salvage rate. The majority of patients with perfusion deficits were male (80%) with an average age of 42 years (range 11-83 years). Patients requiring amputation tended to be older (P = .002), have more tissue impacted by frostbite (P < .001), and experienced a longer time from rewarming to thrombolytic therapy (P = .001). A majority of patients (62%) received thrombolytic treatment. The percentage of patients requiring amputation was lower and the salvage rate was higher in patients treated with thrombolytics; however, the differences failed to reach statistical significance (P = .092 and P = .061, respectively). The rate of salvage decreases as the time from rewarming to thrombolytic therapy increases. Regression analysis demonstrates an additional 26.8% salvage loss with each hour of delayed treatment (P = .006). When the amount of tissue at risk for amputation is included in the model, each hour delay in thrombolytic treatment results in a 28.1% decrease in salvage (P = .011). This study demonstrates a significant decrease in limb/digit salvage with each hour of delayed administration of thrombolytics in patients with severe frostbite.