Therapeutic hypothermia and temperature management
-
Ther Hypothermia Temp Manag · Mar 2020
Clinical TrialA Prospective Clinical Trial Measuring the Effects of Cardiopulmonary Bypass Under Mild Hypothermia on the Inflammatory Response and Regulation of Cold-Shock Protein RNA-Binding Motif 3.
Therapeutic hypothermia during cardiac surgery has been widely used for neuroprotection and to attenuate the systemic inflammatory response due to cardiopulmonary bypass (CPB). Experimental data suggest that cold-shock protein RNA-binding motif 3 (RBM3), which is induced in response to hypothermia, plays a key role in hypothermia-induced organ protection. To date, investigation on RBM3 has been performed exclusively in vitro or in animal models, and the detection and regulation of RBM3 in human blood has not been investigated until now. ⋯ The use of CPB is still associated with a complex inflammatory response. RBM3 protein is measurable in blood samples of patients with significantly higher concentrations after cardiac surgery with CPB and mild-to-moderate hypothermia. RBM3 is a new candidate as a biomarker for therapeutic hypothermia and a possible new therapeutic target for organ protection.
-
Ther Hypothermia Temp Manag · Dec 2019
Clinical TrialEsophageal Temperature Management in Patients Suffering from Traumatic Brain Injury.
Traumatic brain injury (TBI) is a leading cause of death in the United States, and represents 2.5 million Emergency Department attendances, admissions into hospital, and deaths. A range of temperature modulating devices have been used to proactively cool TBI patients; however, there are currently no uniform targeted temperature management (TTM) guidelines in this patient population. Esophageal temperature management (ETM) is a relatively new TTM modality and the purpose of this study is to determine whether ETM is effective in controlling core temperature in TBI cases. ⋯ The average time to target was 5.83 ± 5.01 hours (range 1-20), with an average cooling rate of 0.58°C/h (range 0.15-1.5°C/h). This prospective interventional trial supports that ETM is a feasible TTM modality for severe TBI cases. The esophageal heat transfer device used in this study demonstrated comparable or superior performance to other commercially available TTM modalities, and the low adverse event rate may offer advantages over more invasive methods with reported higher complication rates.
-
Ther Hypothermia Temp Manag · Dec 2019
Observational StudyFactors Associated with the Transfer Decision in Resuscitated Patients with Out-of-Hospital Cardiac Arrest Presenting to a Hospital with Limited Targeted Temperature Management Capability in Korea.
This study aimed to identify factors associated with the decision to transfer resuscitated patients with out-of-hospital cardiac arrest (OHCA) who were initially examined at hospitals with limited targeted temperature management capability (HLTC) in Korea. We included adult patients with OHCA who were initially transported to HLTC from 2012 to 2015. We limited the study population with OHCA who were admitted or transferred. ⋯ In terms of patient-level factors, age, socioeconomic status, and initial electrocardiogram rhythm were associated with the transfer decision. Hospital factors, such as percutaneous coronary intervention capability of HLTC (adjusted odds ratio = 0.16; 95% confidence interval = 0.14-0.19) and location of the metropolitan or urban hospital, were negatively associated with the transfer decision. Several hospital and patient factors were associated with the decision to transfer out patients with OHCA who were initially examined at HLTC.
-
Ther Hypothermia Temp Manag · Dec 2019
Lack of Variability in Cerebral Oximetry Tendency in Infants with Severe Hypoxic-Ischemic Encephalopathy Under Hypothermia.
Cerebral oximetry using near-infrared spectroscopy (NIRS) provides continuous, noninvasive assessment of the degree of hemoglobin saturation of the brain tissue. Previous studies suggest that high values of regional cerebral tissue oxygen saturation (rScO2) during the first days in neonates with significant hypoxic-ischemic encephalopathy (HIE) are correlated with an adverse neurological outcome. However, the results are not consistent among the studies. ⋯ Variability in each patient was considered ≤5% when changes in rScO2 values in all periods were ≤5%. Twenty-three newborns were included. Infants who suffered from severe HIE, seizures, abnormal aEEG background, altered MRI or death, and abnormal outcome had rScO2 values >90% and with less variability (≤5%). rScO2 values >90% and a lack of variability over time in infants with HIE during cooling provide useful information about the severity of neurological status.
-
Ther Hypothermia Temp Manag · Sep 2019
Amplitude-Integrated Electroencephalography and Brain Oxygenation for Postcardiac Arrest Patients with Targeted Temperature Management.
Brain injury is the most common cause of death postcardiac arrest. Amplitude-integrated electroencephalography (aEEG) is suggested to be useful in the prognostication in cases of postcardiac arrest brain injury. However, combined monitoring with aEEG and regional oxygen saturation (rSO2) for postcardiac arrest syndrome (PCAS) patients to improve accuracy has not been reported. ⋯ Patients with C pattern had a significantly more favorable neurologic outcome compared with patients with an NC pattern at each point in time. No significant difference in rSO2 values was observed between the C pattern and the NC pattern at any time point. Variation coefficient at rSO2 in the NC group was significantly greater than that in the C group from the start of the monitoring to 24 hours. aEEG is useful in predicting outcome for PCAS patients whereas rSO2 is not.