Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Jan 2011
Prehospital use of therapeutic hypothermia after resuscitation from cardiac arrest.
The use of therapeutic hypothermia (TH) in the care of patients after resuscitation from sudden cardiac arrest (SCA) has been shown to improve both survival and neurologic outcomes in randomized, controlled trials and a growing number of cohort studies with historical controls. The robust nature of the data supporting postarrest TH is reflected in the wide variety of clinical investigations that have confirmed outcome benefits of similar magnitude. A number of important questions remain surrounding the implementation of postarrest TH, including the timing of cooling induction and how rapidly providers need to initiate cooling therapy. ⋯ In this paradigm, emergency medical service (EMS) personnel are able to start cooling therapies immediately after resuscitation, which can then be continued during transport. Newer technologies may provide other opportunities for rapid cooling in the field; however, the risks and benefits of prehospital cooling remain poorly understood. This review will describe the growing literature and future directions pertaining to prehospital induction of TH after SCA.
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Ther Hypothermia Temp Manag · Jan 2011
A review of clinical trials of hypothermia treatment for severe traumatic brain injury.
Clinical trials of hypothermia treatment of traumatic brain injury can be divided into (1) trials designed to abort the biochemical cascade after injury-neuroprotection, (2) trials primarily designed to test the effect of hypothermia in reducing elevated intracranial pressure (ICP), and (3) trials with features of both neuroprotection and elevated ICP control. Three of the four clinical trials testing hypothermia induction after failure of conventional means of ICP control showed decreased mortality rate, though sample sizes were small and findings were not always statistically significant. Nine randomized trials have tested hypothermia as a neuroprotectant, inducing it from 2.5 to 15 hours after injury and continuing it for a predetermined period of time regardless of ICP. ⋯ All found improved outcome and reduced ICP. Based on these findings and the negative results of neuroprotection trials that extended hypothermia for a defined period of time, it is likely that the mechanism of protection in these combined mechanism trials was early control of ICP. This literature suggests the need for clinical trials with two distinct objectives-(1) testing hypothermia for ICP control when conventional means (sedation and paralysis, mannitol, hyperventilation, and cerebrospinal fluid drainage) fail and (2) testing early induction of hypothermia before hematoma evacuation individualizing the duration of hypothermia to the patient's ICP responses.
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Ther Hypothermia Temp Manag · Jan 2011
Management of febrile critically ill adults: a retrospective assessment of regional practice.
The aim of this study was to report on fever epidemiology and management strategies within a general population of critically ill patients. This was a retrospective cohort study among febrile patients (temperature ≥38.3°C) without acute brain injury admitted to one of four regional adult intensive care units (ICUs). There were 7535 ICU admissions over the 30-month study period. ⋯ Fever was most commonly infectious in origin. Treatment of patients with fever was a common and nonstandardized practice in this cohort of critically ill patients. This is likely due to lack of evidence in support of a particular temperature management strategy.
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The annual incidence of out-of-hospital cardiac arrests in the United States is ∼350,000-450,000 per year. The prognosis for cardiac arrest survivors remains extremely poor. ⋯ It reviews the contraindications to the use of this therapy, methods of cooling, and phases of TH and elaborates on the intensive care unit management of TH. The use of TH in ventricular fibrillation survivors has become the standard of care and continues to evolve in its application as an essential therapy in cardiac arrest patients.