{"title":"Applying Adult Learning Theory in Improving Knowledge, Attitude, and Practice of Inadvertent Perioperative Hypothermia in Operating Room Nurses: Single-Group \"Before and After Study\".","authors":"Fengxia Chen, Ailing Lian","doi":"10.1089/ther.2023.0072","DOIUrl":"10.1089/ther.2023.0072","url":null,"abstract":"<p><p>The study aimed to explore the effect of the training scheme guided by Knowles' adult learning theory model on perioperative hypothermia prevention-related knowledge, practice, and behavior in operating room nurses. Operating room nurses of a teaching hospital were included from February to May 2023. Under the guideline of the adult learning theory, we accessed the score of the knowledge, attitude, and practice in operating room nurses about the prevention of the inadvertent perioperative hypothermia (IPH) before and after trainings through qualitative interviews and questionnaire surveys. There were statistically significant differences in scores of knowledge, attitude, and practice of IPH prevention in operating room nurses before and after training. The training program guided by adult learning theory could significantly increase the scores of IPH prevention-related knowledge of operating room nurses, improve the attitude of perioperative hypothermia prevention, and advance the compliance with IPH prevention interventions. Clinical Trial Registration number: 2023IIT109.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"252-257"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72210881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Julia Brittes Gabiatti, Geovana Bressiani Hillesheim, Milena Zambiazi Gomildes, Dernival Bertoncello, Márcia Rosângela Buzanello, Gladson Ricardo Flor Bertolini
{"title":"Cryotherapy in Postoperative Shoulder Surgery: A Systematic Review.","authors":"Anna Julia Brittes Gabiatti, Geovana Bressiani Hillesheim, Milena Zambiazi Gomildes, Dernival Bertoncello, Márcia Rosângela Buzanello, Gladson Ricardo Flor Bertolini","doi":"10.1089/ther.2023.0071","DOIUrl":"10.1089/ther.2023.0071","url":null,"abstract":"<p><p>Cryotherapy, a therapeutic technique involving localized cooling of the body, has gained popularity for postsurgical rehabilitation. It induces a reduction in cellular metabolism, vasoconstriction, and pain relief, making it an attractive option for managing postoperative (PO) shoulder pain. This systematic review aimed to assess the effectiveness of cryotherapy in PO shoulder patients, focusing on pain, range of motion, functionality, and temperature changes. The review included six randomized clinical trials, involving a total of 233 patients who underwent various shoulder surgeries. Cryotherapy was applied using different methods, including Cryo/Cuff, Cryoton<sup>®</sup>, Polar Care 300, and ice packs. Results indicated that cryotherapy was generally effective in reducing PO shoulder pain. However, one study found no significant difference in pain outcomes between the cryotherapy group and control group. Furthermore, three studies demonstrated a decrease in intra-articular and skin temperatures with cryotherapy application. A risk of bias analysis revealed some concerns in the overall risk of bias for five studies, with one study considered to have a high risk of bias. Although publication bias assessment was not conducted due to the limited number of included studies, it was noted that the studies exhibited heterogeneity in terms of population, intervention methods, and outcome measures. In conclusion, cryotherapy appears to be a promising adjunctive treatment for PO shoulder pain, although the existing evidence has some limitations, including small sample sizes and methodological concerns. More high-quality studies are needed to establish the full extent of cryotherapy's effectiveness in PO shoulder rehabilitation, especially regarding its impact on functionality and range of motion.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"218-228"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138798187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Barriers and Solutions in Implementing Evidence-Based Recommendations to Prevent Intraoperative Inadvertent Hypothermia: A Qualitative Study.","authors":"Ozlem Sahin Akboga, Yesım Dikmen Aydin","doi":"10.1089/ther.2023.0052","DOIUrl":"10.1089/ther.2023.0052","url":null,"abstract":"<p><p>In this study, it was aimed to understand the barriers and solutions for operating room (OR) nurses and anesthesiologists to implement evidence-based recommendations to prevent intraoperative inadvertent hypothermia (IIH). A qualitative, inductive, and descriptive study was conducted. This qualitative interview study was conducted face-to-face with 19 participants working in OR units between February and March 2023. The interviews were analyzed using qualitative content analysis. The COREQ checklist was followed. Two main themes and five sub-themes were identified as a result of content analysis. According to the participants, barriers to IIH prevention interventions are caused by individual and organizational inefficiencies and personal opinions, and the main solution is education. Participants reported many factors that hinder IIH prevention practices. The individual characteristics of OR staff and the opinions and behavior of the institution are very important for IIH prevention.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"282-289"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lei Ye, Shaoyi Wang, Xiaowen Wang, Wei Zhong, Song Zhou
{"title":"Application of Portable Peritoneal Lavage Device to Explore the Effect of Different Lavage Fluid Volumes on Dogs with Seawater-Immersed Open Abdominal Injury.","authors":"Lei Ye, Shaoyi Wang, Xiaowen Wang, Wei Zhong, Song Zhou","doi":"10.1089/ther.2021.0024","DOIUrl":"10.1089/ther.2021.0024","url":null,"abstract":"<p><p>To investigate the effects of different amounts of lavage fluids on vital signs, inflammatory response, main organ function, and electrolytes on dogs with seawater-immersed open abdominal injury by portable peritoneal lavage device. Twenty dogs were randomly divided into four groups according to different irrigation volume and irrigation time, they were divided into group A (50 mL/min, 1 hour, 3 L), group B (50 mL/min, 1.5 hours, 4.5 L), group C (50 mL/min, 2 hours, 6 L) and group D (50 mL/min, 3 hours, 9 L). Seawater-immersed open abdominal injury dog model was developed and portable peritoneal lavage device was used for lavaging and rewarming. The change of blood pressure, body temperature, heart beat rate, serum tumor necrosis factor-α, interleukin-6, superoxide dismutase, and other indicators of each group were observed before and after immersion, and immediately, 1, 3, and 5 days after lavage. Immediately after lavage, the body temperature, mean arterial pressure, and heart rate of each group gradually recovered to normal, and the recovery rate of group C was faster than that of group A and group B. The indicator of central venous pressure (CVP) continued to decrease immediately after lavaging. CVP in group C was lower than that of groups A and B (<i>p</i> < 0.05, respectively). The inflammatory response was enhanced in all groups after immersion and after lavage, and reached the highest level at 1 day after lavage. The level of interleukin-1β in group C was significantly lower than that in group A (<i>p</i> < 0.05) and no significant difference when compared with other groups on 1 day after lavage. Three days after lavage, all indexes gradually decreased to the level of preinjury. Alanine transaminase (ALT) and lactic dehydrogenase reached the highest level on 1 day after lavage, and the level of ALT in group C was lower than that in group A (<i>p</i> < 0.05). On 1 and 3 days after lavage, the level of Na<sup>+</sup> in group C was lower than those in group A (<i>p</i> < 0.05) and no significant difference compared with those in group B and group D. Application of the portable abdominal lavage device with 6 L of lavage fluid (group C) has the best effect of treatment for seawater-immersed open abdominal injury, which can maintain better vital signs and reduce inflammation.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"e310-e315"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39925838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kelsey E Kline, Ashley L Russell, Jason P Stezoski, Ian G Gober, Emma G Dimeo, Keri Janesko-Feldman, Tomas Drabek, Patrick M Kochanek, Amy K Wagner
{"title":"Differential Effects of Targeted Temperature Management on Sex-Dependent Outcomes After Experimental Asphyxial Cardiac Arrest.","authors":"Kelsey E Kline, Ashley L Russell, Jason P Stezoski, Ian G Gober, Emma G Dimeo, Keri Janesko-Feldman, Tomas Drabek, Patrick M Kochanek, Amy K Wagner","doi":"10.1089/ther.2023.0061","DOIUrl":"10.1089/ther.2023.0061","url":null,"abstract":"<p><p>Asphyxial cardiac arrest (ACA) survivors face lasting neurological disability from hypoxic ischemic brain injury. Sex differences in long-term outcomes after cardiac arrest (CA) are grossly understudied and underreported. We used rigorous targeted temperature management (TTM) to understand its influence on survival and lasting sex-specific neurological and neuropathological outcomes in a rodent ACA model. Adult male and female rats underwent either sham or 5-minute no-flow ACA with 18 hours TTM at either ∼37°C (normothermia) or ∼36°C (mild hypothermia). Survival, temperature, and body weight (BW) were recorded over the 14-day study duration. All rats underwent neurological deficit score (NDS) assessment on days 1-3 and day 14. Hippocampal pathology was assessed for cell death, degenerating neurons, and microglia on day 14. Although ACA females were less likely to achieve return of spontaneous circulation (ROSC), post-ROSC physiology and biochemical profiles were similar between sexes. ACA females had significantly greater 14-day survival, NDS, and BW recovery than ACA males at normothermia (56% vs. 29%). TTM at 36°C versus 37°C improved 14-day survival in males, producing similar survival in male (63%) versus female (50%). There were no sex or temperature effects on CA1 histopathology. We conclude that at normothermic conditions, sex differences favoring females were observed after ACA in survival, NDS, and BW recovery. We achieved a clinically relevant ACA model using TTM at 36°C to improve long-term survival. This model can be used to more fully characterize sex differences in long-term outcomes and test novel acute and chronic therapies.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"299-309"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angely Claire C Suerte, Lane J Liddle, Ashley Abrahart, Elmira Khiabani, Frederick Colbourne
{"title":"A Systematic Review and Meta-Analysis of Therapeutic Hypothermia and Pharmacological Cotherapies in Animal Models of Ischemic Stroke.","authors":"Angely Claire C Suerte, Lane J Liddle, Ashley Abrahart, Elmira Khiabani, Frederick Colbourne","doi":"10.1089/ther.2024.0012","DOIUrl":"10.1089/ther.2024.0012","url":null,"abstract":"<p><p>Therapeutic hypothermia (TH) lessens ischemic brain injury. Cytoprotective agents can augment protection, although it is unclear which combinations are most effective. The objective of this study is to identify which cytoprotective drug works best with delayed TH. Following PRISMA guidelines, a systematic review (PubMed, Web of Science, MEDLINE, Scopus) identified controlled experiments that used an <i>in vivo</i> focal ischemic stroke model and evaluated the efficacy of TH (delay of ≥1 hour) coupled with cytoprotective agents. This combination was our main intervention compared with single treatments with TH, drug, or no treatment. Endpoints were brain injury and neurological impairment. The CAMARADES checklist for study quality and the SYRCLE's risk of bias tool gauged study quality. Twenty-five studies were included. Most used young, healthy male rats, with only one using spontaneously hypertensive rats. Two studies used mice models, and six used adult animals. Study quality was moderate (median score = 6), and risk of bias was high. Pharmacological agents provided an additive effect on TH for all outcomes measured. Magnesium coupled with TH had the greatest impact compared with other agent-TH combinations on all outcomes. Longer TH durations improved both behavioral and histological outcomes and had greater cytoprotective efficacy than shorter durations. Anti-inflammatories were the most effective in reducing infarction (standardized mean difference [SMD]: -1.64, confidence interval [CI]: [-2.13, -1.15]), sulfonylureas reduced edema the most (SMD: -2.32, CI: [-3.09, -1.54]), and antiapoptotic agents improved behavioral outcomes the most (normalized mean difference: 52.38, CI: [45.29, 59.46]). Statistically significant heterogeneity was observed (<i>I</i><sup>2</sup> = 82 - 98%, all <i>p</i> < 0.001), indicating that studies wildly differ in their effect size estimates. Our results support the superiority of adding cytoprotective therapies with TH (vs. individual or no therapy). Additional exploratory and confirmatory studies are required to identify and thoroughly assess combination therapies owing to limited work and inconsistent translational quality.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"229-242"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nurses' Awareness and Practices of Unintentional Perioperative Hypothermia Prevention: A Cross-Sectional Study.","authors":"Ousman Jallow, Nurhan Bayraktar","doi":"10.1089/ther.2022.0030","DOIUrl":"10.1089/ther.2022.0030","url":null,"abstract":"<p><p>Unintentional perioperative hypothermia can cause potentially life-threatening complications. The aim of this study was to determine the awareness and practices of nurses regarding unintentional perioperative hypothermia prevention. The study was conducted at a teaching hospital in Gambia with descriptive cross-sectional design. A total of 53 nurses voluntarily participated in this study. The questionnaire used in this study was developed based on the American periOperative Registered Nurses (AORN) and National Institute for Health and Care Excellence perioperative hypothermia guidelines. Descriptive statistics, Pearson correlation, Student <i>t</i>-test, and one-way ANOVA were used in the analysis of data. The result of the study showed that nurses had high level of awareness of unintentional perioperative hypothermia prevention; however, practice levels were found to be low. Based on the results of the study, development of policies, implementation of the unintentional perioperative hypothermia prevention guidelines, and continuous education to improve nurses' knowledge and practices were recommended.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"e323-e330"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33445656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association Between Temperature During Intensive Care Unit and Mortality in Patients With Acute Respiratory Distress Syndrome.","authors":"Yipeng Fang, Yunfei Zhang, Xianxi Huang, Qian Liu, Yueyang Li, Chenxi Jia, Lingbin He, Chunhong Ren, Xin Zhang","doi":"10.1089/ther.2023.0047","DOIUrl":"10.1089/ther.2023.0047","url":null,"abstract":"<p><p>The relationship between body temperature changes and prognosis in patients with acute respiratory distress syndrome (ARDS) remains inconclusive. Our study aimed to investigate the clinical value of body temperature in the management of ARDS. Data from the Medical Information Mart for Intensive Care III database were collected. Adult patients with ARDS were enrolled and further grouped based on their temperature values in the intensive care unit. Both the maximum (temperature<sub>max</sub>) and minimum (temperature<sub>min</sub>) temperatures were used. The primary outcome was 28-day mortality rate. Polynomial regression, subgroup analysis, and logistic regression analysis were performed in the final analysis. A total of 3922 patients with ARDS were enrolled. There was a U-shaped relationship between 28-day mortality and body temperature. For patients with infection, the elevated temperature<sub>max</sub> (≥37.0°C) was associated with decreased mortality, with an odds ratio ranging from 0.39 to 0.49, using temperature<sub>max</sub> from 36.5°C to 36.9°C as reference. For patients without infection, a similar tendency was observed, but the protective effect was lost at extremely high temperatures (≥38.0°C, <i>p</i> < 0.05). Elevated temperature<sub>min</sub> (≥37.0°C) and decreased temperature<sub>min</sub> (<35.0°C) were associated with increased mortality, using the temperature<sub>min</sub> from 36.0°C to 36.9°C as a reference. Hypothermia was associated with increased mortality in patients with ARDS, while the effect of hyperthermia (≥37.0°C) on the mortality of patients with ARDS was not fully consistent in the infection and noninfection subgroups. Short-term and transient temperatures above 37.0°C would be beneficial to patients with ARDS, but extreme hyperthermia and persistent temperatures above 37.0°C should be avoided.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"258-268"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Barka Sajid, Zarnab Tufail, Maria Asim, Sania Riaz, Sahar Imtiaz, Hamna Khan, Muhammad Asad Shabbir, Syed Muhammad Bilal Shah, Fariha Ejaz, Muhammad Wajeeh Anis, Arais Khan, Aliza Ahmed, Marium Rana, Fiza Sohail, Muhammad Umair Anjum, Muhammad Omar Larik
{"title":"Comparison of Clopidogrel Versus Ticagrelor for Percutaneous Coronary Intervention (PCI) Patients Managed with Therapeutic Hypothermia: A Systematic Review and Meta-Analysis.","authors":"Barka Sajid, Zarnab Tufail, Maria Asim, Sania Riaz, Sahar Imtiaz, Hamna Khan, Muhammad Asad Shabbir, Syed Muhammad Bilal Shah, Fariha Ejaz, Muhammad Wajeeh Anis, Arais Khan, Aliza Ahmed, Marium Rana, Fiza Sohail, Muhammad Umair Anjum, Muhammad Omar Larik","doi":"10.1089/ther.2023.0055","DOIUrl":"10.1089/ther.2023.0055","url":null,"abstract":"<p><p>Various antiplatelet drugs, such as clopidogrel and ticagrelor, are available on the market for use after percutaneous coronary intervention (PCI). However, the efficacy of such drugs in patients being managed with therapeutic hypothermia (TH) has always been debated. In light of this controversy, this systematic review and meta-analysis was performed to enhance existing literature. Various databases were searched for potentially relevant studies from inception to April 2023, including PubMed, Cochrane Library, and Scopus. The risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and the Cochrane risk of bias tool for randomized controlled trials. Outcomes of interest included risk of bleeding, stent thrombosis, and all-cause mortality. Five studies were shortlisted for inclusion into the meta-analysis, featuring a total of 245 patients receiving either clopidogrel or ticagrelor. Overall, no significant differences were noted when the use of clopidogrel and ticagrelor was compared in PCI patients being managed with TH. To the best of our knowledge, this is the most comprehensive meta-analysis comparing the outcomes of clopidogrel and ticagrelor in PCI patients being managed with TH. Despite existing studies claiming an altered efficacy of clopidogrel in such conditions, our meta-analytic findings could not prove this relationship. Due to the limited sample size, further comprehensive and randomized studies are encouraged to arrive at a robust conclusion.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"211-217"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49692516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Bro-Jeppesen, Anders M Grejs, Ove Andersen, Anni N Jeppesen, Christophe Duez, Hans Kirkegaard
{"title":"Soluble Urokinase-Type Plasminogen Activator Receptor in Comatose Survivors After Out-of-Hospital Cardiac Arrest Treated with Targeted Temperature Management.","authors":"John Bro-Jeppesen, Anders M Grejs, Ove Andersen, Anni N Jeppesen, Christophe Duez, Hans Kirkegaard","doi":"10.1089/ther.2023.0039","DOIUrl":"10.1089/ther.2023.0039","url":null,"abstract":"<p><p>Exposure to whole-body ischemia/reperfusion after out-of-hospital cardiac arrest (OHCA) triggers a systemic inflammatory response where soluble urokinase plasminogen activator receptor (suPAR) is released. This study investigated serial levels of suPAR in differentiated target temperature management and the associations with mortality and 6-month neurological outcome. This is a single-center substudy of the randomized Targeted Temperature Management (TTM) for 24-hour versus 48-hour trial. In this analysis, we included 82 patients and measured serial levels of suPAR at 24, 48, and 72 hours after achievement of target temperature (32-34°C). We assessed all-cause mortality and neurological function evaluated by the Cerebral Performance Categories (CPC) at 6 months after OHCA. Levels of suPAR between TTH groups were evaluated in repeated measures mixed models. Mortality was assessed by the Kaplan-Meier method and serial measurements of suPAR (log<sub>2</sub> transformed) were investigated by Cox proportional-hazards models. Good neurological outcome at 6 months was assessed by logistic regression analyses. Levels of suPAR were significantly different between TTH groups (p<sub>interaction</sub> = 0.04) with the highest difference at 48 hours, 4.7 ng/mL (95% CI: 4.1-5.4 ng/mL) in the TTH24 group compared to 2.8 ng/mL (95% CI: 2.2-3.5 ng/mL) in the TTH48 group, <i>p</i> < 0.0001. Levels of suPAR above the median value were significantly associated with increased all-cause mortality at any time point (p<sub>log-rank</sub><0.05). The interaction of suPAR levels and TTH group was not significant (p<sub>interaction</sub> = NS). A twofold increase in levels of suPAR was significantly associated with a decreased odds ratio of a good neurological outcome in both unadjusted and adjusted analyses without interaction of TTH group (p<sub>interaction</sub> = NS). Prolonged TTM of 48 hours versus 24 hours was associated with lower levels of suPAR. High levels of suPAR were associated with increased mortality and lower odds for good neurological outcome at 6 months with no significant interaction of TTH group.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"243-251"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}