Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Jun 2018
Observational StudyPlasma Neutrophil Gelatinase-Associated Lipocalin Measured Immediately After Restoration of Spontaneous Circulation Predicts Acute Kidney Injury in Cardiac Arrest Survivors Who Underwent Therapeutic Hypothermia.
Early diagnosis of acute kidney injury (AKI) after cardiac arrest (CA) is challenging. We aimed to identify the diagnostic and prognostic performance of neutrophil gelatinase-associated lipocalin (NGAL) for AKI and its clinical outcomes. A retrospective observational study, involving adult comatose CA survivors treated with therapeutic hypothermia between May 2013 and December 2016, was conducted. ⋯ The development of AKI was independently associated with mortality (OR 4.926; 95% CI 2.353-10.311); however, NGAL level was not associated with mortality (OR 1.000; 95% CI 0.999-1.001). Plasma NGAL level measured after ROSC can be an early predictor for the development of AKI after CA. The presence of AKI was associated with increased inhospital mortality.
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Ther Hypothermia Temp Manag · Jun 2018
Determination of the Target Temperature Required to Block Increases in Extracellular Glutamate Levels During Intraischemic Hypothermia.
This study aimed to determine a target temperature for intraischemic hypothermia that can block increases in extracellular glutamate levels. Two groups of 10 rats each formed the normothermia and intraischemic hypothermia groups. Extracellular glutamate levels, the extracellular potential, and the cerebral blood flow were measured at the adjacent site in the right parietal cerebral cortex. ⋯ In conclusion, the target temperature for blocking glutamate release during intraischemic hypothermia was found to be 32.6°C ± 0.9°C. Our results suggest that the induction of intraischemic hypothermia can maintain low glutamate levels without disrupting glutamate reuptake. Institutional protocol number: OKU-2016146.
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Ther Hypothermia Temp Manag · Jun 2018
Precise Control of Target Temperature Using N6-Cyclohexyladenosine and Real-Time Control of Surface Temperature.
Targeted temperature management is standard of care for cardiac arrest and is in clinical trials for stroke. N6-cyclohexyladenosine (CHA), an A1 adenosine receptor (A1AR) agonist, inhibits thermogenesis and induces onset of hibernation in hibernating species. Despite promising thermolytic efficacy of CHA, prior work has failed to achieve and maintain a prescribed target core body temperature (Tb) between 32°C and 34°C for 24 hours. ⋯ All animals treated in this way rewarmed without incident. During the initiation of cooling, we observed bradycardia within 30 minutes of the start of IV infusion, transient hyperglycemia, and a mild hypercapnia; the latter normalized via metabolic compensation. In conclusion, we describe an intravenous delivery protocol for CHA at 0.25 mg/(kg·h) that, when coupled with conductive cooling, achieves and maintains a prescribed and consistent target Tb between 32°C and 34°C for 24 hours.
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Ther Hypothermia Temp Manag · Mar 2018
Case ReportsRewarming After Severe Accidental Hypothermia Using the Esophageal Heat Transfer Device: A Case Report.
Patients with severe accidental hypothermia require active rewarming. External rewarming may not be successful in severe hypothermia, and use of invasive techniques is limited to regional centers and is associated with vascular access site and other complications. We present a patient with severe accidental hypothermia who was successfuly rewarmed using a novel esophageal heat transfer device. ⋯ After rewarming, we maintained his body temperature in the range 35-36°C until accidental removal of the device. We observed no major adverse effects. To conclude, rewarming from severe accidental hypothermia was possible using the esophageal heat transfer device.
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Ther Hypothermia Temp Manag · Mar 2018
Feasibility Study of a Novel High-Flow Cold Air Cooling Protocol of the Porcine Brain Using MRI Temperature Mapping.
Early, prehospital cooling seeks to reduce and control the body temperature as early as possible to protect the brain and improve patient outcome in cardiac arrest, stroke, and traumatic brain injury. In this study, we investigate the feasibility of localized cooling of the porcine brain by using a novel high-flow cold air protocol, which utilizes the close proximity between the nasal cavity and the brain. Five adult pigs were anesthetized and temperature change was mapped before, during, and after cooling by using the proton resonance frequency method on a 3 T Siemens Magnetom Skyra system. ⋯ However, a large variability of the temperature drop was observed between the animals. This variability may be caused by not well-controlled factors confounding the MRI temperature mapping, for example, subject movement, or cooling effectiveness, for example, core temperature or nasal patency. The results indicate that the proposed high-flow cold air protocol allows for localized cooling of the frontal porcine brain, which may be clinically relevant for traumatic injuries of the frontal brain where systemic cooling is unfavorable.