Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Jun 2012
Induction of a prolonged hypothermic state by drug-induced reduction in the thermoregulatory set-point.
The marked improvement in outcome following induction of hypothermia after cardiac arrest has spurred the search for better methods to induce cooling. A regulated decrease in core temperature mediated by a drug-induced reduction in the set point for thermoregulation may be an ideal means of inducing hypothermia. To this end, the exploratory drug HBN-1 was assessed as a means to induce mild and prolonged hypothermia. ⋯ HBN-1 infusion induced a mild and prolonged hypothermia in free moving, unanesthetized rats characterized by modulation of thermoeffectors to reduce heat gain and increase heat loss. HBN-1 thus appears to elicit regulated hypothermia and may provide a new method for achieving a prolonged state of therapeutic hypothermia.
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Ther Hypothermia Temp Manag · Jun 2012
Effects of different fluid regimes and desmopressin on uncontrolled hemorrhage during hypothermia in the rat.
Resuscitation with large volumes of crystalloids during traumatic hemorrhagic shock might increase the mortality by inducing rebleeding. However, few studies have addressed this problem during hypothermic conditions. Sixty-eight Sprague-Dawley rats were exposed to a standardized femoral artery injury and resuscitated with low (LRe), medium (MRe), or high (HRe) intensity using lactated Ringer's solution after being cooled to 30°C. ⋯ Overall, the mortality increased if rebleeding occurred (10/35 rebleeders died vs. 1/25 nonrebleeders, p=0.015). Liberal fluid administration increased the rebleeding volume while a trend toward higher mortality was seen with the restrictive fluid program. Desmopressin had no effect on the studied parameters.
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Ther Hypothermia Temp Manag · Mar 2012
Evaluating traditional prognostic measures in patients undergoing hypothermia after cardiac arrest.
Therapeutic hypothermia is one of the few interventions that improve mortality and neurologic outcomes in patients who have experienced cardiac arrest. There is a lack of validated tools to predict survival in patients who have undergone hypothermia after cardiac arrest (HACA). ⋯ Lactate levels show promise as a biomarker for survival in HACA patients resuscitation length, presence of PCI, and APACHE-II scores can provide good prognostic information, even in the early hours following a resuscitation event.
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Ther Hypothermia Temp Manag · Mar 2012
Serum Potassium Changes During Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest-Should It Be Treated?
Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) is associated with adverse events, for example hypokalemia and arrhythmias. In the present study, we report the impact of serum potassium changes related to the rate of cardiac arrhythmias, and the advantages and disadvantages of potassium supplementation are discussed. ⋯ Serum potassium decreases significantly during the induction of TH (p=0.005). Potassium levels were not found to be different in patients with and without VF/VT in this study, perhaps due to the low number of patients, as a difference has been seen in other studies. It is recommended that an infusion of supplementary potassium be initiated during the early cooling phase in order to avoid severe hypokalemia (serum potassium <3.0 mmol/L) and terminated in due time before normothermia is reached during rewarming in order to avoid severe hyperkalemia (serum potassium >5.5 mmol/L), as serum potassium increases during rewarming.
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Ther Hypothermia Temp Manag · Dec 2011
The Use of Hypothermia Therapy in Traumatic Ischemic / Reperfusional Brain Injury: Review of the Literatures.
Therapeutic mild hypothermia has been used widely in brain injury. It has evaluated in numerous clinical trials, and there is strong evidence for the use of hypothermia in treating patients with several types of ischemic / reperfusional (I/R) injuries, examples being cardiac arrest and neonatal hypoxic-ischemic encephalopathy. ⋯ This suggested that mild therapeutic hypothermia might be effective for I/R related traumatic brain injury. In this article we have reviewed much of the previous literature concerning the mechanisms of I/R injury to the protective effects of mild therapeutic hypothermia.