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Latest & greatest articles for hypothermia
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Management of profound hypothermia in children without the use of extracorporeal life support therapy. Profound hypothermia is managed more and more with extracorporeal life support technology, especially when a patient's circulation is compromised. Many centres do not have rapid access to this service, however, and are still dependent on active internal rewarming techniques--eg, peritoneal and pleural lavage. Such interventions are invasive, and associated with inherent risk. Here, we report (...) our successful experience with an active external rewarming technique in children with profound hypothermia (core temperature <20 degrees C).
Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment. We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation.In this multicenter trial with blinded assessment of the outcome, patients who had been resuscitated after cardiac arrest due to ventricular fibrillation (...) were randomly assigned to undergo therapeutic hypothermia (target temperature, 32 degrees C to 34 degrees C, measured in the bladder) over a period of 24 hours or to receive standard treatment with normothermia. The primary end point was a favorable neurologic outcome within six months after cardiac arrest; secondary end points were mortality within six months and the rate of complications within seven days.Seventy-five of the 136 patients in the hypothermia group for whom data were available (55
Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained (...) unconscious after resuscitation from out-of-hospital cardiac arrest.The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33 degrees C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility.The
The role of hypothermia in the management of severe brain injury: a meta-analysis The role of hypothermia in the management of severe brain injury: a meta-analysis The role of hypothermia in the management of severe brain injury: a meta-analysis Harris O A, Colford J M, Good M C, Matz P G Authors' objectives To determine the effectiveness of hypothermia in the management of severe brain injury. Searching MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE and the abstract centre (...) of hypothermia in the management of severe head injury, compared with normothermia, were eligible for inclusion. In the included studies, the temperature of hypothermia ranged from 32 to 35 degrees C and the duration of hypothermia was between 24 hours and 14 days. The time to target temperature, where reported, ranged from 8 to 15 hours post-injury and the rewarming schedule varied between 12 hours and 5 days. Participants included in the review Studies of participants aged 10 years or older with post
Effects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Hypothermia to reduce neurological damage following coronary artery bypass surgery. Coronary artery bypass surgery (CABG) may be life saving, but known side effects include neurological damage and cognitive impairment. The temperature used during cardiopulmonary bypass (CPB) may be important with regard to these adverse outcomes, where hypothermia is used as a means of neuroprotection.To assess the effectiveness of hypothermia during CABG in reducing neurological damage and subsequent cognitive (...) deficits.The Cochrane Controlled Trials Register was searched for randomised controlled trials (RCT) and this was updated by searching MEDLINE and EMBASE to December 1999 using database specific RCT filters. Reference lists of retrieved articles were searched and experts in the field were contacted.Only RCTs were considered. All patients undergoing CABG, either first time or revisions, elective or emergency procedures, were included. Any hypothermia protocol was considered. Only trials reporting
Lack of effect of induction of hypothermia after acute brain injury. Induction of hypothermia in patients with brain injury was shown to improve outcomes in small clinical studies, but the results were not definitive. To study this issue, we conducted a multicenter trial comparing the effects of hypothermia with those of normothermia in patients with acute brain injury.The study subjects were 392 patients 16 to 65 years of age with coma after sustaining closed head injuries who were randomly (...) assigned to be treated with hypothermia (body temperature, 33 degrees C), which was initiated within 6 hours after injury and maintained for 48 hours by means of surface cooling, or normothermia. All patients otherwise received standard treatment. The primary outcome measure was functional status six months after the injury.The mean age of the patients and the type and severity of injury in the two treatment groups were similar. The mean (+/-SD) time from injury to randomization was 4.3+/-1.1 hours
Therapeutic hypothermia for head injury. Mild to moderate induced hypothermia has been used in the treatment of head injury for over 50 years, although few randomised controlled trials have been performed. Recent encouraging results from small, single-centre trials and consistent findings of a cerebral protection effect of cooling in laboratory models of global ischaemia has led to a renewed interest in the area.To determine whether the use of mild therapeutic hypothermia in the treatment (...) of moderate and severe head injury improves short-term control of intracranial pressure (ICP) and long-term functional outcome.Electronic searches of the Injuries Group trial registry and EMBASE for any relevant randomised trials, supplemented by hand searching of conference proceedings and reference lists of relevant articles.All randomised controlled trials of mild hypothermia versus control (open or normothermia) in the treatment of patients with any closed head injury requiring hospitalisation. Mild
Treatment of traumatic brain injury with moderate hypothermia. Traumatic brain injury initiates several metabolic processes that can exacerbate the injury. There is evidence that hypothermia may limit some of these deleterious metabolic responses.In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in 82 patients with severe closed head injuries (a score of 3 to 7 on the Glasgow Coma Scale). The patients assigned to hypothermia were cooled to 33 (...) degrees C a mean of 10 hours after injury, kept at 32 degrees to 33 degrees C for 24 hours, and then rewarmed. A specialist in physical medicine and rehabilitation who was unaware of the treatment assignments evaluated the patients 3, 6, and 12 months later with the use of the Glasgow Outcome Scale.The demographic characteristics and causes and severity of injury were similar in the hypothermia and normothermia groups. At 12 months, 62 percent of the patients in the hypothermia group and 38 percent
Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. In-vitro studies indicate that platelet function and the coagulation cascade are impaired by hypothermia. However, the extent to which perioperative hypothermia influences bleeding during surgery remains unknown. Accordingly, we tested the hypothesis that mild hypothermia increases blood loss and allogeneic transfusion requirements during hip arthroplasty.Blood loss and transfusion requirements (...) were evaluated in 60 patients undergoing primary, unilateral total hip arthroplasties who were randomly assigned to normothermia (final intraoperative core temperature 36.6 [0.4] degrees C) or mild hypothermia (35.0 [0.5] degrees C). Crystalloid, colloid, scavenged red cells, and allogeneic blood were administered by strict protocol.Intra- and postoperative blood loss was significantly greater in the hypothermic patients: 2.2 (0.5) L vs 1.7 (0.3) L, p < 0.001). Eight units of allogeneic packed red