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Latest & greatest articles for hypothermia
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Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT Mild hypothermia after perinatal hypoxic-ischemic encephalopathy (HIE) reduces neurologic sequelae without significant adverse effects, but studies are needed to determine the most-efficacious methods.In the neo.nEURO.network trial, term neonates with clinical and electrophysiological evidence of HIE were assigned randomly to either a control group, with a rectal temperature of 37°C (range: 36.5-37.5°C (...) ), or a hypothermia group, cooled and maintained at a rectal temperature of 33.5°C (range: 33-34°C) with a cooling blanket for 72 hours, followed by slow rewarming. All infants received morphine (0.1 mg/kg) every 4 hours or an equivalent dose of fentanyl. Neurodevelopmental outcomes were assessed at the age of 18 to 21 months. The primary outcome was death or severe disability.A total of 129 newborn infants were enrolled, and 111 infants were evaluated at 18 to 21 months (53 in the hypothermia group and 58
Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China To investigate the efficacy and safety of selective head cooling with mild systemic hypothermia in hypoxic-ischemic encephalopathy (HIE) in newborn infants.Infants with HIE were randomly assigned to the selective head cooling or control group. Selective head cooling was initiated within 6 hours after birth to a nasopharyngeal temperature of 34 (...) and control groups, respectively, the combined outcome of death and severe disability was 31% and 49% (OR: 0.47; 95% CI: 0.26-0.84; P=.01), the mortality rate was 20% and 29% (OR:0.62; 95% CI: 0.32-1.20; P=.16), and the severe disability rate was 14% (11/80) and 28% (19/67) (OR: 0.40; 95% CI: 0.17-0.92; P=.01).Selective head cooling combined with mild systemic hypothermia for 72 hours may significantly decrease the combined outcome of severe disability and death, as well as severe disability.Copyright (c
Induction of Therapeutic Hypothermia by Paramedics After Resuscitation From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest. A Randomized Controlled Trial Therapeutic hypothermia is recommended for the treatment of neurological injury after resuscitation from out-of-hospital cardiac arrest. Laboratory studies have suggested that earlier cooling may be associated with improved neurological outcomes. We hypothesized that induction of therapeutic hypothermia by paramedics before hospital
Risk of mortality associated with neonatal hypothermia in southern Nepal To quantify the neonatal mortality/hypothermia relationship and develop evidence-based cutoffs for global definitions of neonatal hypothermia.Cohort study. Field workers recorded neonatal axillary temperature at home and recorded vital status at 28 days.Rural Nepal.Twenty-three thousand two hundred forty infants in Sarlahi, Nepal.Hypothermia.Mortality risk was estimated using binomial regression models. Infants were (...) classified using (1) World Health Organization (WHO) cutoffs for mild, moderate, and severe hypothermia; (2) quarter-degree intervals from 32.0 degrees C to 36.5 degrees C; and (3) continuous temperatures. Estimates were adjusted for age, ambient temperature, and other potential confounders.Mortality increased among mild (relative risk [RR], 1.70; 95% confidence interval [CI], 1.23-2.35]), moderate (RR, 4.66; 95% CI, 3.47-6.24]), and severe (RR, 23.36; 95% CI, 4.31-126.70]) hypothermia cases. Within
Therapeutic hypothermia for paediatric traumatic brain injury BestBets: Therapeutic hypothermia for paediatric traumatic brain injury within 8 hr Therapeutic hypothermia for paediatric traumatic brain injury within 8 hr Report By: Gabriel Cade - Emergency Medicine Physician Search checked by Venkatesh Gattu - Senior Emergency Medicine Trainee Institution: Baystate Medical Center aSpringfield, MA 01199, USA nd Manchester Royal Infirmary, Manchester, UK Date Submitted: 12th December 2009 Date (...) Completed: 9th July 2010 Last Modified: 9th July 2010 Status: Green (complete) Three Part Question In [paediatric patients presenting within 8 h of traumatic brain injury (TBI)] are [therapeutic hypothermia regimens better than normothermic care] in [improving patient survival]? Clinical Scenario An 8-year old child presents to the Emergency Department within six hours of an unclear incident at home which left nonspecific bruising and acute change in mental status. Fundoscopic exam reveals retinal
Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal brain injury (IPG347) Overview | Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal brain injury | Guidance | NICE Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal brain injury Interventional procedures guidance [IPG347] Published date: May 2010 Share Save Guidance The National Institute for Health and Clinical Excellence (NICE (...) ) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal brain injury. Description Hypoxic perinatal brain injury is caused by lack of oxygen in a baby's brain during labour and/or delivery. It can lead to death or permanent brain damage. Therapeutic hypothermia (deliberate lowering of the body temperature) aims to cool the brain soon after birth and for several days afterwards
Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data Edwards AD (...) caution. Authors' objectives To evaluate whether moderate hypothermia after hypoxic-ischaemic encephalopathy in neonates improves survival and neurological outcomes at 18 months of age. Searching PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and the Oxford Database of Perinatal Trials were searched to July 2009; search terms were reported. Bibliographies of previous reviews and abstracts (source not specified) were also searched, and trialists contacted. Study selection Studies
Hypothermia after cardiac arrest Hypothermia after cardiac arrest Hypothermia after cardiac arrest Flynn K Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Flynn K. Hypothermia after cardiac arrest. Boston: VA Technology Assessment Program (VATAP). 2010 Authors' objectives VHA’s TAAG asked TAP for a review of the literature as support (...) for use of hypothermia after cardiac arrest, initially in 2008 and again in 2010. TAP approached its charge through available systematic reviews, guidelines or technology assessments based on such reviews, and economic evaluations using high quality primary studies or reviews as sources of effectiveness data. This document will refer collectively to these synthesis publication types as “reviews”. We then updated review searches to the present to confirm the presence or absence of subsequently review
Cost-effectiveness of therapeutic hypothermia to treat neonatal encephalopathy Cost-effectiveness of therapeutic hypothermia to treat neonatal encephalopathy Cost-effectiveness of therapeutic hypothermia to treat neonatal encephalopathy Regier DA, Petrou S, Henderson J, Eddama O, Patel N, Strohm B, Brocklehurst P, Edwards AD, Azzopardi D Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary (...) of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The aim was to estimate the cost-effectiveness of total body hypothermia plus intensive care versus intensive care alone, in the treatment of neonatal encephalopathy. The authors concluded that the likelihood that cooling was cost-effective was finely balanced over the first 18 months after birth, but increased substantially when national incidence data
Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review Fox JL, Vu EN, Doyle-Waters M, Brubacher JR, Abu-Laban R, Hu Z CRD summary The review found that early prophylactic mild to moderate hypothermia improved mortality and functional outcomes after severe traumatic brain injury, especially when (...) a long-term or goal-directed cooling strategy was used. In view of limitations in the review, including poor quality studies and possible publication bias (both acknowledged by the authors), some caution may be required in interpreting the findings. Authors' objectives To evaluate the use of prophylactic hypothermia for traumatic brain injury. Searching MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, PapersFirst
Therapeutic Hypothermia Therapeutic Hypothermia – Clinical Correlations Search Therapeutic Hypothermia November 12, 2009 5 min read highlighted the remarkable recovery of a doctor who regained essentially all his mental function just six weeks after suffering a cardiac arrest with a post -resuscitation Glasgow coma score of 4.(1) Although the ambulance had originally rushed the doctor to the nearest hospital in Nassau County, he was quickly transferred to New York Presbyterian Hospital, where (...) the receiving team induced hypothermia for the subsequent 24 hours. Five days later, the doctor woke up. Success stories such as these have now prompted the New York City Fire Department to form plans to bypass hospitals that do not have a protocol in place for induced hypothermia following cardiac arrest. Resumption of spontaneous circulation after prolonged ischemia due to cardiac arrest carries significant morbidity and mortality and much effort has been directed toward reducing the debilitating
Does Head Cooling With Mild Systemic Hypothermia Affect Requirement for Blood Pressure Support? Our goal was to evaluate whether head cooling with mild systemic hypothermia for neonatal encephalopathy is associated with greater requirement for volume or inotrope support.We studied term infants (>/=36 weeks) with moderate-to-severe neonatal encephalopathy plus abnormal amplitude integrated electroencephalography, randomly assigned to head cooling for 72 hours starting within 6 hours of birth (...) cooling. The use of inotropes or volume was related to preceding mean arterial blood pressure and not to treatment group in the first 24 hours. In contrast, from 24 to 76 hours, there was no effect of mean arterial blood pressure, but there was an overall reduction in pressure support over time and significantly more frequent pressure support in the cooled group than in controls.Mild systemic hypothermia did not affect arterial blood pressure or initial treatment with inotropes or volume in infants
Hypothermia: First Aid and Management AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 9.3.3 HYPOTHERMIA: FIRST AID MANAGEMENT INTRODUCTION: For normal function of most body systems and organs the human body’s temperature is kept controlled between narrow limits (about 37 0 C). Hypothermia is when the body’s temperature is below 35 0 C. As the body’s temperature falls, systems and organs progressively fail until death occurs, usually from cardiac arrest. Infants and elderly people are at greater risk (...) . Hypothermia may develop acutely (eg: falling into icy water) or be a gradual and insidious process. COMMON CAUSES: ? ENVIRONMENTAL: exposure to cold, wet, or windy conditions; cold water immersion/submersion; exhaustion. ? TRAUMA: trauma, immobility and burns. ? DRUGS: alcohol and / or sedatives. ? NEUROLOGICAL: stroke and altered consciousness. ? ENDOCRINE: impaired metabolism. ? SYSTEMIC ILLNESS: severe infections, malnutrition. RECOGNITION: ? Mild hypothermia: ? victim shivering, ? pale, cool skin
Moderate hypothermia to treat perinatal asphyxial encephalopathy. Whether hypothermic therapy improves neurodevelopmental outcomes in newborn infants with asphyxial encephalopathy is uncertain.We performed a randomized trial of infants who were less than 6 hours of age and had a gestational age of at least 36 weeks and perinatal asphyxial encephalopathy. We compared intensive care plus cooling of the body to 33.5 degrees C for 72 hours and intensive care alone. The primary outcome was death (...) in other neurologic outcomes in the cooled group were not significant. Adverse events were mostly minor and not associated with cooling.Induction of moderate hypothermia for 72 hours in infants who had perinatal asphyxia did not significantly reduce the combined rate of death or severe disability but resulted in improved neurologic outcomes in survivors. (Current Controlled Trials number, ISRCTN89547571.)2009 Massachusetts Medical Society
The use of hypothermia as a treatment for traumatic brain injury The use of hypothermia as a treatment for traumatic brain injury The use of hypothermia as a treatment for traumatic brain injury Rupich K CRD summary This review evaluated hypothermia to treat traumatic brain injuries and concluded that there may be benefits of hypothermia treatment for some patients with severe traumatic head injuries. Insufficient information was presented about the conduct of the review, quality (...) of the included studies and results, so it was difficult to draw any conclusions about the reliability of the author's conclusions. Authors' objectives To evaluate the use of hypothermia as a treatment for traumatic brain injury. Searching MEDLINE, CINAHL, EMBASE and PubMed were searched from 2000 to 2006 for English-language studies. Search terms were reported. Study selection Controlled trials of therapeutic hypothermia used for at least 24 hours compared to normothermia in adults with a closed traumatic
Prehospital/emergency department therapeutic hypothermia for out-of-hospital cardiac arrest (OHCA) in adults Prehospital/emergency department therapeutic hypothermia for out-of-hospital cardiac arrest (OHCA) in adults Prehospital/emergency department therapeutic hypothermia for out-of-hospital cardiac arrest (OHCA) in adults Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database (...) . Report may be purchased from . Citation Prehospital/emergency department therapeutic hypothermia for out-of-hospital cardiac arrest (OHCA) in adults . Lansdale: HAYES, Inc.. 2009 Authors' objectives Out-of-hospital cardiac arrest (OHCA) causes approximately 310,000 deaths before the patient reaches the hospital Emergency Department each year in the United States. Sudden cardiac death occurs more often in patients who are recovering from a heart attack or whose hearts have a reduced ability to pump
Cost-effectiveness of therapeutic hypothermia after cardiac arrest Cost-effectiveness of therapeutic hypothermia after cardiac arrest Cost-effectiveness of therapeutic hypothermia after cardiac arrest Merchant RM, Becker LB, Abella BS, Asch DA, Groeneveld PW Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical (...) assessment on the reliability of the study and the conclusions drawn. CRD summary This study evaluated the cost-effectiveness of therapeutic hypothermia for patients following witnessed ventricular fibrillation and out-of-hospital cardiac arrest, compared with conventional care. The authors concluded that therapeutic hypothermia improved the clinical outcomes and was cost-effective in the USA. The methods were appropriate and the results were reported in full. The conclusions appear to be appropriate
Induced hypothermia and fever control for prevention and treatment of neurological injuries. Increasing evidence suggests that induction of mild hypothermia (32-35 degrees C) in the first hours after an ischaemic event can prevent or mitigate permanent injuries. This effect has been shown most clearly for postanoxic brain injury, but could also apply to other organs such as the heart and kidneys. Hypothermia has also been used as a treatment for traumatic brain injury, stroke, hepatic (...) encephalopathy, myocardial infarction, and other indications. Hypothermia is a highly promising treatment in neurocritical care; thus, physicians caring for patients with neurological injuries, both in and outside the intensive care unit, are likely to be confronted with questions about temperature management more frequently. This Review discusses the available evidence for use of controlled hypothermia, and also deals with fever control. Besides discussing the evidence, the aim is to provide information