{"title":"Evaluation of Prognostic Findings in Newborns with Hypoxic Ischemic Encephalopathy: 5-Year Experience.","authors":"Ozlem Sahin, Derya Colak, Funda Yavanoglu Atay, Omer Guran, Ilke Mungan Akin","doi":"10.1089/ther.2025.0011","DOIUrl":"10.1089/ther.2025.0011","url":null,"abstract":"<p><p>Hypoxic-ischemic encephalopathy (HIE) is a constellation of neurological signs as a result of hypoxia, hypercapnia, metabolic acidosis, and cerebral ischemia before birth. The aim was to evaluate risk factors, clinical and laboratory findings, and morbidity and mortality in neonates diagnosed with HIE who underwent therapeutic hypothermia (TH). Between January 2015 and December 2020, neonates diagnosed with HIE were evaluated in the neonatal intensive care unit. Risk factors, sociodemographic characteristics, degree of encephalopathy, clinical and laboratory findings, results of amplitude-integrated electroencephalography (aEEG), electroencephalography (EEG), magnetic resonance imaging (MRI) including diffusion weighted imaging (DWI) and cranial ultrasound (cUS), and mortality were retrospectively recorded. Of the 81 cases, we followed up with a diagnosis of HIE. When the patients were divided into groups and evaluated according to the Sarnat & Sarnat staging system, it was observed that 22 (27.2%) of the patients had mild HIE, 49 (60.5%) of the patients had moderate HIE, and 10 (12.3%) of the patients had severe HIE. The aEEG, EEG, DWI, and renal pathology of patients with seizures were statistically significantly higher than those of patients without seizures (<i>p</i> = 0.004, <i>p</i> = 0.002, <i>p</i> = 0.014, <i>p</i> = 0.025). MRI was performed in 66 patients within the first 7 days of life, and diffusional restriction was found in 22 of them. We found that DWI is superior to cUS in determining the severity of hypoxic injury and that renal involvement may be associated with poor neurodevelopmental outcomes. Due to the abnormal prognostic findings detected in infants with mild HIE, the existence of a standard definition of mild HIE that will determine the efficacy and reliability of therapeutic hypothermia will enable at risk infants to benefit from neuroprotective strategies.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"97-103"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher P Kovach, Jan Leonard, John C Messenger, Stephen W Waldo, Sarah M Perman
{"title":"Impact of Time to Initiation of Targeted Temperature Management Among Patients with Out-of-Hospital Cardiac Arrest Undergoing Percutaneous Coronary Intervention.","authors":"Christopher P Kovach, Jan Leonard, John C Messenger, Stephen W Waldo, Sarah M Perman","doi":"10.1089/ther.2024.0030","DOIUrl":"10.1089/ther.2024.0030","url":null,"abstract":"<p><p>Delays in initiation of targeted temperature management (TTM) have been observed in randomized trials evaluating immediate or delayed coronary angiography among survivors of ventricular tachycardia (VT) or ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA), but whether delays are associated with adverse clinical outcomes is unknown. Resuscitated survivors of VT/VF OHCA who received TTM between April 2011 and June 2015 were identified and time to TTM initiation was described. The association between TTM initiation <2 versus ≥2 hours, neurologically favorable, and overall survival to hospital discharge was assessed. In a propensity-weighted analysis of 2954 patients, a significantly larger proportion of patients undergoing percutaneous coronary intervention (PCI) had TTM initiation ≥2 hours (48.6%) as compared to patients undergoing angiography (41.4%) or those who did not undergo a procedure (33.0%; <i>p</i> < 0.001 for all comparisons). In this cohort, the odds of neurologically favorable survival (odds ratios [OR]: 0.88, 95% confidence intervals [CI] = 0.75-1.02) and overall survival (OR: 0.92, 95% CI = 0.83-1.03) to hospital discharge were similar among ST-elevation myocardial infarction (STEMI) patients who underwent PCI with TTM initiation <2 versus ≥2 hours. Patients without STEMI who underwent PCI with TTM initiation ≥2 hours and did not have a \"do not resuscitate\" order or withdrawal of life-sustaining care had decreased odds of neurologically favorable survival to hospital discharge (OR: 0.45, 95% CI = 0.22-0.93) compared to TTM initiation <2 hours. PCI was associated with delays in TTM initiation ≥2 hours among resuscitated survivors of VT/VF OHCA. Delays in TTM initiation ≥2 hours were associated with decreased odds of neurologically favorable survival among patients without STEMI who underwent PCI.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"74-81"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association Between the Rewarming Duration and Neurological Outcomes after Extracorporeal Cardiopulmonary Resuscitation Followed by Targeted Temperature Management for Out-of-Hospital Cardiac Arrests: A Secondary Analysis of the SAVE-J II Study.","authors":"Sohma Miyamoto, Toru Hifumi, Akira Komori, Hiroki Iriyama, Toshikazu Abe, Akihiko Inoue, Tetsuya Sakamoto, Yasuhiro Kuroda, Norio Otani","doi":"10.1089/ther.2024.0036","DOIUrl":"10.1089/ther.2024.0036","url":null,"abstract":"<p><p>There are no studies examining the association between rewarming durations and neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management (TTM) for patients with out-of-hospital cardiac arrest (OHCA). This study aimed to examine the association between rewarming durations and neurological outcomes after ECPR with TTM for patients with OHCA. This was a secondary analysis of the Advanced Life Support Study Registry for Ventricular Fibrillation with Extracorporeal Circulation in Japan study, a retrospective, multicenter study. Patients with OHCA who underwent ECPR and completed a TTM of 34°C and <34°C were included. Favorable neurological outcomes (cerebral performance categories 1-2) and survival upon hospital discharge were the primary outcomes. In total, 407 patients were included, with favorable neurological outcomes upon hospital discharge in 106 patients. The numbers of patients with rewarming durations of <24 hours, 24 hours, and >24 hours were 178, 133, and 96, respectively. In the multivariable analysis, a rewarming duration of <24 hours was not significantly associated with favorable neurological outcomes [odds ratio (OR): 1.06, 95% confidence interval (CI): 0.60-1.87, <i>p</i> = 0.84] or survival (OR: 0.96, 95% CI: 0.58-1.57, <i>p</i> = 0.86) compared with that of 24 hours, and that of <24 hours was not significantly associated with favorable neurological outcomes (OR: 0.74, 95% CI: 0.40-1.71, <i>p</i> = 0.56) or survival (OR: 0.74, 95% CI: 0.42-1.28, <i>p</i> = 0.38) than that of >24 hours. A rewarming duration of <24 hours in TTM after ECPR for OHCA was not significantly associated with favorable neurological outcomes or survival than that of 24 hours or >24 hours.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"89-96"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zehra Arslan, Asli Okbay Gunes, Mehmet Fatih Deveci, Ayse Unal Yuksekgonul, Kamber Kasali
{"title":"The Association Between Neonatal Intensive Care Unit Arrival Temperatures and Short-Term Outcomes of Neonates with Moderate and Severe Hypoxic-Ischemic Encephalopathy.","authors":"Zehra Arslan, Asli Okbay Gunes, Mehmet Fatih Deveci, Ayse Unal Yuksekgonul, Kamber Kasali","doi":"10.1089/ther.2024.0021","DOIUrl":"10.1089/ther.2024.0021","url":null,"abstract":"<p><p>Therapeutic hypothermia (TH) is the only treatment method that is known to reduce mortality and neurological sequela rates in newborns with moderate and severe hypoxic-ischemic encephalopathy (HIE). We aimed to evaluate the relationship between rectal temperatures measured upon arrival to our unit and short-term outcomes in newborns with HIE/TH. This was a retrospective study conducted between January 2022 and January 2023. The neonates were divided into three groups according to their rectal temperatures measured upon arrival at our unit as follows: Group 1) <33°C, Group 2) 33-34°C (group arriving at target temperature), and Group 3) >34°C. Short-term outcomes and mortality were compared between the groups. Group 1 consisted of 17 (19.8%) neonates, Group 2 consisted of 34 (39.5%) neonates, and Group 3 consisted of 35 (40.7%) neonates who had HIE and an indication for TH. Rectal temperature on arrival to the unit was not related to the rate of clinical convulsions, rates of abnormal attenuated electroencephalography and magnetic resonance imaging findings, rate of pulmonary hypertension, duration of mechanical ventilation and length of hospital stay. Although the mortality rate was 29% in Group 1, it was 3% and 6% in Groups 2 and 3, respectively (<i>p</i> = 0.016). No relationship was found between the rectal temperature upon arrival to the NICU and the short-term outcomes in HIE/TH neonates. However, the mortality rate in those who were overcooled was significantly higher compared with the other groups.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"62-68"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prevalence of Pulmonary Hypertension During Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy and Evaluation of Short-Term Outcomes.","authors":"Rashida Javed, James Hodson, Harsha Gowda","doi":"10.1089/ther.2024.0023","DOIUrl":"10.1089/ther.2024.0023","url":null,"abstract":"<p><p>Infants with perinatal asphyxia and moderate-to-severe hypoxic ischemic encephalopathy (HIE) are currently treated with therapeutic hypothermia (TH) as part of a brain protective strategy. However, perinatal asphyxia is a risk factor for development of persistent pulmonary hypertension (PPHN). As such, the aim of this study was to quantify the risk of PPHN in infants undergoing TH and assess short-term outcomes in infants developing PPHN. All <i>N</i> = 59 infants undergoing TH for moderate-to-severe HIE over a period of 3 years (January 2020-December 2022) at a single center were included. PPHN was diagnosed in <i>N</i> = 10 (17%), with this deemed to have been exacerbated by TH in <i>n</i> = 6 (10%). Only 50% (5/10) with PPHN required inhaled nitric oxide, and none of the infants received extracorporeal membrane oxygenation. PPHN was not found to be significantly associated with short-term outcomes, including the extent of HIE on brain magnetic resonance imagings, in-hospital mortality or requirement for nasogastric feeding at discharge. In conclusion, TH appears to be a safe and effective treatment for moderate-to-severe HIE with or without PPHN.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"69-73"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Correlation Between Preoperative Perfusion Index and Intraoperative Hypothermia During Laparoscopic Radical Surgery for Urological Malignancies.","authors":"Yingying Zhang, Yuxiao Li, Fengxia Chen","doi":"10.1089/ther.2024.0035","DOIUrl":"10.1089/ther.2024.0035","url":null,"abstract":"<p><p>This study aimed to explore the relationship between preoperative baseline perfusion index (PI) and intraoperative hypothermia during general anesthesia. PI reflects the peripheral perfusion status, which may be associated with the decrease of core temperature during general anesthesia, as the redistribution of temperature from the core compartment to the peripheral compartment depends on the peripheral perfusion status. A total of 68 patients underwent radical surgery for urological malignancies in this study. The baseline PI value was measured upon entering the operating room. Core temperature was continuously monitored using a nasal pharyngeal probe from anesthesia induction to the end of surgery, with temperature data recorded every 15 minutes. Univariate and multivariate logistic regression analyses were used to identify risk factors for intraoperative hypothermia. Intraoperative hypothermia occurred in 26 patients, whose baseline PI (2.70 ± 0.73) was significantly lower than that of the normothermic group (3.65 ± 1.05), with <i>P</i><0.05. The baseline PI was independently associated with intraoperative hypothermia (PI: [OR] 0.375, 95% confidence interval [CI]: 1.584-6.876, <i>p</i> = 0.001). This study suggests that low baseline PI is an independent factor associated with intraoperative hypothermia. In future studies, PI value could be considered as a predictor for the treatment of intraoperative hypothermia.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"82-88"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atsushi Sakurai, Yoshihisa Kato, Haruka Uki, Kana Yagi, Atsushi Watanabe, Jun Sato, Katsuhiro Nakagawa, Hayato Nakabayashi, Kosaku Kinoshita
{"title":"Exploratory Feasibility Study of Cerebral Cooling by Transpulmonary Cooling During Cardiac Arrest in a Swine Cardiac Arrest Model.","authors":"Atsushi Sakurai, Yoshihisa Kato, Haruka Uki, Kana Yagi, Atsushi Watanabe, Jun Sato, Katsuhiro Nakagawa, Hayato Nakabayashi, Kosaku Kinoshita","doi":"10.1089/ther.2024.0017","DOIUrl":"10.1089/ther.2024.0017","url":null,"abstract":"<p><p>Studies on targeted temperature management for postcardiac arrest syndrome have shown no difference in outcomes between normothermia and hypothermia in patients with postcardiac arrest brain injury. Therefore, further development of therapeutic methods for temperature control in cardiac arrest patients is desirable. Although animal studies have shown that inducing hypothermia during cardiac arrest improves outcomes, no clinically effective method has yet been reported. We investigated whether intra-arrest lung cooling (IALC) effectively lowers brain temperature. A device capable of cooling oxygen was developed. The pigs were subjected to cardiac arrest using the device, ventilated, cooled during cardiopulmonary resuscitation, and resuscitated for 1 hour, with changes in brain temperature closely monitored. A device capable of cooling oxygen to -30°C was used to cool the lungs during cardiac arrest. Through this approach, IALC successfully reduced the brain temperature. Optimal cooling efficiency was observed when chest compressions and ventilation were synchronized at a ratio of 5:1, resulting in an approximate brain temperature reduction of 1.5°C/h. Our successful development of an oxygen-cooling device underscores the potential for lowering brain temperature through IALC using inhaled oxygen cooling.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"55-61"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charlotte Lengauer, Mark Adams, Barbara Brotschi, Michael Kleber, Vera Bernet, Maren Tomaske, Dirk Bassler, Beate Grass
{"title":"Therapeutic Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy-Drift in Clinical Practice in Swiss Neonatal (Intensive Care) Units?","authors":"Charlotte Lengauer, Mark Adams, Barbara Brotschi, Michael Kleber, Vera Bernet, Maren Tomaske, Dirk Bassler, Beate Grass","doi":"10.1089/ther.2025.0019","DOIUrl":"https://doi.org/10.1089/ther.2025.0019","url":null,"abstract":"<p><p>The objective of this study was to assess the adherence to inclusion criteria for therapeutic hypothermia (TH) in neonates with hypoxic-ischemic encephalopathy (HIE) and to survey current attitudes on TH. This multicenter observational study therefore combined a retrospective analysis of the Swiss National Asphyxia and Cooling Register (2011-2023) and a prospective survey (2024) among neonatologists in the Canton of Zurich, Switzerland. A total of 456 neonates with HIE were registered in the Swiss National Asphyxia and Cooling Register in the Canton of Zurich, Switzerland, between 2011 and 2023. The rate of TH (52.6% [2011-2017] versus 52.0% [2018-2023]) as well as the incidence of off-protocol cooling remained stable over time (<i>p</i> = 0.614). The survey response rate was 69.5% (57/82). Difficulties with clinical grading of encephalopathy were identified. Subjectively, respondents considered themselves more generous to initiate TH. In conclusion, register data reflected good adherence to inclusion criteria for TH. The survey confirmed willingness to consider TH in milder HIE cases. However, there was no drift in clinical practice-yet?</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Heated High-Flow Nasal Cannula for the Treatment of Unintended Perioperative Hypothermia: A Feasibility Study.","authors":"Kirklen Petersen, Spencer Rice, Kenneth Potter, Shannon Boylan, Kristina Clark, Megan McCartney, Laura Lahaye","doi":"10.1089/ther.2025.0010","DOIUrl":"https://doi.org/10.1089/ther.2025.0010","url":null,"abstract":"<p><p>There are many established strategies to target normothermia in the perioperative period; however, hypothermia remains a common occurrence and can have significant impacts on patient outcomes, unanticipated admissions, and postanesthesia care unit (PACU) throughput. This pilot study serves to shed light on the effectiveness of using high-flow nasal cannula (HFNC) as an alternative to a Bair Hugger (BH). This pilot study compares 10 patients warmed to normothermia with HFNC in the PACU with 15 patients warmed with traditional BH. Patients in the HFNC group reached the goal temperature of 36°C 9.1 minutes faster than the BH group. However, these findings were not statistically significant (mean time: 72.1 minutes vs 81.2; <i>p</i> = 0.247). In addition, phase 1 recovery times were about 8 minutes longer in the HFNC group compared with the BH group but were also not statistically significant (mean time: 180.8 minutes vs 172.4; <i>p</i> = 0.338). Based on the initial data, HFNC may play an important role in the future by making PACU rewarming more efficient and therefore having a huge impact on PACU discharge times, unanticipated hospital admissions, delayed emergence from anesthesia, and morbid cardiac events. Further large scale, randomized control studies need to be done to investigate HFNC as an alternative rewarming method for hypothermic patients in the PACU.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wenjun Liu, Xuetao Jiang, Haolin Zhang, Guiying Yang
{"title":"Development and Internal Validation of a Risk Model to Estimate Probability of Intraoperative Hypothermia in Adult Surgical Patients.","authors":"Wenjun Liu, Xuetao Jiang, Haolin Zhang, Guiying Yang","doi":"10.1089/ther.2024.0058","DOIUrl":"https://doi.org/10.1089/ther.2024.0058","url":null,"abstract":"<p><p>Intraoperative hypothermia is associated with various perioperative complications and an increased risk of mortality. This study aims to develop and validate a reliable risk model, the Intraoperative Hypothermia Risk Estimating Model (IHREM), for assessing the likelihood of intraoperative hypothermia in adult patients receiving different types of surgery and anesthesia. Data from 1815 surgical patients were collected, with 1521 used to develop the IHREM training set. Univariate logistic regression was utilized to evaluate the parameters included in the study. For the first time, parameters showing non-linear associations with the risk of intraoperative hypothermia were evaluated and then incorporated into a primary model using restricted cubic splines (RCS), based on the result of multivariate logistic regression. The final model was comprised of 12 risk factors, including body mass index (BMI), fasting time, preoperative heart rate, preoperative tympanic temperature, intravenous fluid administration volume, intraoperative irrigation volume, estimated blood loss, duration of anesthesia, surgical position, intraoperative warming, operation room temperature, and humidity. The IHREM model demonstrated satisfactory performance in the training set, exhibiting reliable discrimination, calibration, overall performance, and clinical utility. In the temporal validation set (<i>n</i> = 294), the c-index, calibration intercept and calibration slope, Brier score, and <i>R</i><sup>2</sup> were determined to be 0.763 (95% CI, 0.710-0.819), 0.394 (95% CI, 0.118-0.680), 0.865 (95% CI, 0.638-1.114), 0.204 (95% CI, 0.180-0.229), and 0.236, respectively. Meanwhile, decision curve analysis and clinical impact curve showed that IHREM provides promising clinical value. In addition, RCS analysis indicated that maintaining the operation room temperature above 20°C is sufficient to prevent hypothermia while increasing or sustaining the preoperative core temperature to around 36.7-36.8°C significantly reduces the risk of hypothermia. IHREM holds promise as a valuable tool for identifying adult patients at risk of intraoperative hypothermia under various types of surgery and anesthesia, thereby supporting clinical decision-making.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}