Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Jan 2011
Therapeutic Hypothermia After Cardiac Arrest is Underutilized in the United States.
Little is known about the frequency of therapeutic hypothermia use after cardiac arrest in the United States. We, therefore, analyzed the Nationwide Inpatient Sample (NIS) to determine the prevalence of hypothermia use after cardiac arrest and patient and hospital factors associated with its use. Using 2007 NIS data, we identified adult patients with cardiac arrest using the ICD-9 diagnosis code, 427.5, while the use of therapeutic hypothermia was based on the ICD-9 procedure code, 99.81. ⋯ S. hospitals. We identified important patient and hospital factors associated with therapeutic hypothermia utilization. Efforts to increase generalized utilization of this effective resuscitation strategy are warranted.
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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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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.
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Ther Hypothermia Temp Manag · Jan 2011
Can a Cold (4°C) IV Fluid Bolus to Induce Therapeutic Hypothermia Really Deliver 4°C to Children?
Induced therapeutic hypothermia after pediatric cardiac arrest is under investigation. Animal and adult data suggest that rapid achievement of temperatures (T) <34°C may improve outcomes. Cold intravenous fluids (IVF) rapidly induce hypothermia in adults. ⋯ Tbag
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Ther Hypothermia Temp Manag · Jan 2011
Induction of therapeutic hypothermia requires modulation of thermoregulatory defenses.
Hypothermia has been linked to beneficial neurologic outcomes in different clinical situations and its therapeutic value is considered important. For example, in asphyctic neonates and in patients with out-of-hospital cardiac arrest (with ventricular fibrillation as the initial cardiac rhythm), rapid installation of hypothermia has been reported to add substantial therapeutic benefits over nonthermal standard treatments. ⋯ This overview summarizes the body's primary reactions to hypothermia and the defense mechanisms available or evoked. Then, clinically applicable ways to overcome these forceful cold defenses of the body are described to ensure both an optimal induction process for therapeutic hypothermia and maximal subjective comfort for these conscious patients.