Therapeutic hypothermia and temperature management最新文献

{"title":"Factors Associated with Favorable Outcomes in Cardiac Arrest and Target Temperature Management.","authors":"Nobuhiko Kimura, Yoshito Nishimura, Hangyul Chung-Esaki","doi":"10.1089/ther.2023.0018","DOIUrl":"10.1089/ther.2023.0018","url":null,"abstract":"<p><p>Current guidelines strongly recommend providing targeted temperature management (TTM) after cardiac arrest, but hypothalamic dysregulation may confound TTM's impact on a patient's ultimate outcome. Although time to reach target temperature has largely been viewed as a process measure for TTM protocols, the difference between initial presenting temperature and target temperature (Δ-temperature) may be a potential surrogate marker of hypothalamic dysregulation. We performed a retrospective observational study to explore whether Δ-temperature was associated with neurologic outcomes and mortality. We included 86 patients (53 with out-of-hospital cardiac arrest [OHCA] and 33 with in-hospital cardiac arrest [IHCA]) in our analysis; more than half of the patients were cooled to 33°C (56.9% in OHCA and 57.6% in IHCA). In univariate logistic regression analysis, Δ-temperature alone did not appear to be statistically associated with mortality or neurologic outcomes regardless of target temperature. In exploratory analysis, longer time from TTM initiation-to-target was associated with worse neurological outcomes in the 33°C target (odds ratio = 0.996, 95% confidence interval = 0.992-1.000). Further research investigating the impact of hypothalamic dysregulation and Δ-temperature as well as the rate of cooling may be warranted to elucidate additional factors contributing to outcomes after cardiac arrest. In addition, our study population was noted to have a higher proportion of Asians and Native Hawaiians/Pacific Islanders, with a potential disparity in outcomes. Future studies may be warranted to ensure generalizability of TTM protocols and findings across populations.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"179-185"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41149465","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":"Targeted Temperature Management After Cardiac Arrest in COVID-19 Patients.","authors":"Dhanesh D Binda, Connor M Logan, Victoria Rosales, Ala Nozari, Luis F Rendon","doi":"10.1089/ther.2023.0033","DOIUrl":"10.1089/ther.2023.0033","url":null,"abstract":"<p><p>There is a paucity of evidence regarding the utility of targeted temperature management (TTM) in COVID-19 patients who suffer cardiac arrest. This systematic review and meta-analysis aimed to use the available data of how temperature predicts outcomes in COVID-19 patients and the association between active cooling and outcomes in non-COVID-19 cardiac arrest patients to give recommendations for the utility of TTM in COVID-19 survivors of cardiac arrest. The PubMed, Embase, and Web of Science databases were queried in August 2022 for two separate searches: (1) temperature as a predictor of clinical outcomes in COVID-19 and (2) active cooling after return of spontaneous circulation (ROSC) in non-COVID-19. Forest plots were generated to summarize the results. Of the 4209 abstracts screened, none assessed the target population of TTM in COVID-19 victims of cardiac arrest. One retrospective cohort study evaluated hyperthermia in critically ill COVID-19 patients, two retrospective cohort studies evaluated hypothermia in septic COVID-19 patients, and 20 randomized controlled trials evaluated active cooling in non-COVID-19 patients after ROSC. Risk of death was higher in COVID-19 patients who presented with hyperthermia (risk ratio [RR] = 1.87) or hypothermia (RR = 1.77; <i>p</i> < 0.001). In non-COVID-19 victims of cardiac arrest, there was no significant difference in mortality (RR = 0.94; <i>p</i> = 0.098) or favorable neurological outcome (RR = 1.05; <i>p</i> = 0.41) with active cooling after ROSC. Further studies are needed to evaluate TTM in COVID-19 victims of cardiac arrest. However, given the available evidence that hyperthermia or hypothermia in COVID-19 patients is associated with increased mortality as well as our findings suggesting limited utility for active cooling in non-COVID-19 cardiac arrest patients, we posit that TTM to normothermia (core body temperature ∼37°C) would most likely be optimal for the best outcomes in COVID-19 survivors of cardiac arrest.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"130-143"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10003555","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":"Short-Term Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Receiving Active Versus Passive Cooling During Transport.","authors":"Ricky Rana, Ashleigh Manktelow, Elizabeth Lyden, Eric S Peeples","doi":"10.1089/ther.2023.0059","DOIUrl":"10.1089/ther.2023.0059","url":null,"abstract":"<p><p>Therapeutic hypothermia (TH) is the only currently approved treatment for neonatal hypoxic-ischemic encephalopathy (HIE) and must be started within 6 hours to optimize effectiveness. This narrow therapeutic window often requires initiation of TH before or during transport. The goal of this study was to assess the effects of servo-controlled TH versus passive hypothermia during transport on short-term outcomes in newborns with HIE. This was a single-center retrospective case-control study of neonates with HIE treated with active or passive TH during transport. Primary outcomes included brain injury on magnetic resonance imaging (MRI) and presence of seizures. Seventy-six neonates were included-13 active and 63 passive. The active TH group was more likely to arrive within goal temperature. No difference was noted between groups in seizures or TH complications. Active TH was associated with increased injury on MRI. Active TH resulted in tighter temperature control, but no improvement in short-term outcomes in our cohort. The MRI findings may be due to differences in overall disease severity, which could not be adjusted for, given the modest sample size.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"205-210"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040526","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":"Longer Periods of Hypothermia Provide Greater Protection Against Focal Ischemia: A Systematic Review of Animal Studies Manipulating Treatment Duration.","authors":"Megan J Eberle, Aline B Thorkelsson, Lane J Liddle, Mohammed Almekhlafi, Frederick Colbourne","doi":"10.1089/ther.2023.0042","DOIUrl":"10.1089/ther.2023.0042","url":null,"abstract":"<p><p>Decades of animal research show therapeutic hypothermia (TH) to be potently neuroprotective after cerebral ischemic injuries. While there have been some translational successes, clinical efficacy after ischemic stroke is unclear. One potential reason for translational failures could be insufficient optimization of dosing parameters. In this study, we conducted a systematic review of the PubMed database to identify all preclinical controlled studies that compared multiple TH durations following focal ischemia, with treatment beginning at least 1 hour after ischemic onset. Six studies met our inclusion criteria. In these six studies, six of seven experiments demonstrated an increase in cerebroprotection at the longest duration tested. The average effect size (mean Cohen's d ± 95% confidence interval) at the shortest and longest durations was 0.4 ± 0.3 and 1.9 ± 1.1, respectively. At the longest durations, this corresponded to percent infarct volume reductions between 31.2% and 83.9%. Our analysis counters previous meta-analytic findings that there is no relationship, or an inverse relationship between TH duration and effect size. However, underreporting often led to high or unclear risks of bias for each study as gauged by the SYRCLE Risk of Bias tool. We also found a lack of investigations of the interactions between duration and other treatment considerations (e.g., method, delay, and ischemic severity). With consideration of methodological limitations, an understanding of the relationships between treatment parameters is necessary to determine proper \"dosage\" of TH, and should be further studied, considering clinical failures that contrast with strong cerebroprotective results in most animal studies.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"144-151"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177092","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":"Characterization of Circulating Cold Shock Proteins FGF21 and RBM3 in a Multi-Center Study of Pediatric Cardiac Arrest.","authors":"Jeremy R Herrmann, Ericka L Fink, Anthony Fabio, Rachel P Berger, Keri Janesko-Feldman, Kiersten Gorse, Robert S B Clark, Patrick M Kochanek, Travis C Jackson","doi":"10.1089/ther.2023.0035","DOIUrl":"10.1089/ther.2023.0035","url":null,"abstract":"<p><p>Fibroblast Growth Factor 21 (FGF21) is a neuroprotective hormone induced by cold exposure that targets the β-klotho co-receptor. β-klotho is abundant in the newborn brain but decreases rapidly with age. RNA-Binding Motif 3 (RBM3) is a potent neuroprotectant upregulated by FGF21 in hypothermic conditions. We characterized serum FGF21 and RBM3 levels in patients enrolled in a prospective multi-center study of pediatric cardiac arrest (CA) via a secondary analysis of samples collected to evaluate brain injury biomarkers. Patients (<i>n</i> = 111) with remnant serum samples available from at least two of three available timepoints (0-24, 24-48 or 48-72 hours post-resuscitation) were included. Serum samples from 20 healthy controls were used for comparison. FGF21 was measured by Luminex and internally validated enzyme-linked immunoassay (ELISA). RBM3 was measured by internally validated ELISA. Of postarrest patients, 98 were managed with normothermia, while 13 were treated with therapeutic hypothermia (TH). FGF21 increased >20-fold in the first 24 hours postarrest versus controls (681 pg/mL [200-1864] vs. 29 pg/mL [15-51], <i>n</i> = 99 vs. 19, respectively, <i>p</i> < 0.0001, median [interquartile range]) with no difference in RBM3. FGF21 did not differ by sex, while RBM3 was increased in females versus males at 48-72 hours postarrest (1866 pg/mL [873-5176] vs. 1045 pg/mL [535-2728], <i>n</i> = 40 vs. 54, respectively, <i>p</i> < 0.05). Patients requiring extracorporeal membrane oxygenation (ECMO) postresuscitation had increased FGF21 versus those who did not at 48-72 hours (6550 pg/mL [1455-66,781] vs. 1213 pg/mL [480-3117], <i>n</i> = 7 vs 74, respectively, <i>p</i> < 0.05). FGF21 and RBM3 did not correlate (Spearman's rho = 0.004, <i>p</i> = 0.97). We conclude that in a multi-center study of pediatric CA patients where normothermic targeted temperature management was largely used, FGF21 was markedly increased postarrest versus control and highest in patients requiring ECMO postresuscitation. RBM3 was sex-dependent. We provide a framework for future studies examining the effect of TH on FGF21 or use of FGF21 therapy after pediatric CA.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"99-109"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10146103","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":"The Effect of Temperature Chain Management Scheme During da Vinci Robot-Assisted Radical Resection of Urological Tumor.","authors":"Fengxia Chen, Ailing Lian","doi":"10.1089/ther.2023.0040","DOIUrl":"10.1089/ther.2023.0040","url":null,"abstract":"<p><p>To explore the effect of the temperature chain management scheme on inadvertent perioperative hypothermia (IPH) during robot-assisted radical resection of urological tumors. Fifty male patients who underwent elective robot-assisted radical prostatectomy (RARP) or robot-assisted radical cystectomy (RARC) surgery from February 2022 to March 2023 in a teaching hospital were enrolled and randomized to receive either intraoperative warming, including forced-air warming blanket and prewarming fluid (group C) or the temperature chain management involving an active warming bunch covering the whole perioperative period (group T). Comparing the core temperature, IPH rates, the incidence of shivering, recovery from anesthesia, and thermal between the two groups. Perioperative core temperature of group T was higher compared with group C (<i>p</i> < 0.05); IPH rates and the incidence of shivering in postanesthesia care unit (PACU) of group T were lower compared with group C (<i>p</i> < 0.05); group T scored higher in thermal comfort compared with group C after PACU 15 minutes, after PACU 30 minutes, and when leaving the PACU (<i>p</i> < 0.05); group T took shorter time on recovering from anesthesia (<i>p</i> < 0.05). Temperature chain management could reduce IPH and postoperative complications during RARP and RARC.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"118-124"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166169","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":"A Systematic Literature Review to Assess Fever Management and the Quality of Targeted Temperature Management in Critically Ill Patients.","authors":"Benjamin Miao, Jeffrey R Skaar, Matthew O'Hara, Andrew Post, Tim Kelly, Benjamin S Abella","doi":"10.1089/ther.2023.0015","DOIUrl":"10.1089/ther.2023.0015","url":null,"abstract":"<p><p>Targeted temperature management (TTM) has been proposed to reduce mortality and improve neurological outcomes in postcardiac arrest and other critically ill patients. TTM implementation may vary considerably among hospitals, and \"high-quality TTM\" definitions are inconsistent. This systematic literature review in relevant critical care conditions evaluated the approaches to and definitions of TTM quality with respect to fever prevention and the maintenance of precise temperature control. Current evidence on the quality of fever management associated with TTM in cardiac arrest, traumatic brain injury, stroke, sepsis, and critical care more generally was examined. Searches were conducted in Embase and PubMed (2016 to 2021) following PRISMA guidelines. In total, 37 studies were identified and included, with 35 focusing on postarrest care. Frequently-reported TTM quality outcomes included the number of patients with rebound hyperthermia, deviation from target temperature, post-TTM body temperatures, and number of patients achieving target temperature. Surface and intravascular cooling were used in 13 studies, while one study used surface and extracorporeal cooling and one study used surface cooling and antipyretics. Surface and intravascular methods had comparable rates of achieving target temperature and maintaining temperature. A single study showed that patients with surface cooling had a lower incidence of rebound hyperthermia. This systematic literature review largely identified cardiac arrest literature demonstrating fever prevention with multiple TTM approaches. There was substantial heterogeneity in the definitions and delivery of quality TTM. Further research is required to define quality TTM across multiple elements, including achieving target temperature, maintaining target temperature, and preventing rebound hyperthermia.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"68-79"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9859938","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":"Effect of Prewarming on Postoperative Hypothermia, Vital Signs, and Thermal Comfort: A Randomized Controlled Trial.","authors":"Refiye Akpolat, Sevban Arslan","doi":"10.1089/ther.2023.0017","DOIUrl":"10.1089/ther.2023.0017","url":null,"abstract":"<p><p>This study aimed to determine the effects of preoperative active and passive warming on postoperative hypothermia, vital signs, and perception of thermal comfort in patients scheduled to undergo elective open abdominal surgery. This was a randomized controlled study. The study sample comprised 90 patients (30 in the active warming group, 30 in the passive warming group, and 30 in the control group) who agreed to participate and met the research criteria. According to the comparison of patients' vital signs, a statistically significant difference was observed in terms of patients' preoperative body temperature values (<i>χ</i>² = 56.959; <i>p</i> = 0.000). A comparison of the patients' postoperative thermal comfort perception scores yielded a statistically significant difference (<i>χ</i>² = 39.693; <i>p</i> = 0.000). Postoperative comfort scores in the active warming group were significantly higher than those in the passive warming and control groups. In conclusion, warming methods are effective in preventing undesirable postoperative hypothermia. The time to reach normothermia after surgery was shorter, vital signs were at a desirable level, and thermal comfort perceptions were higher in patients who were prewarmed. ClinicalTrials.gov (Identifier: NCT04997694).</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"89-98"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9642760","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":"Effects of Perioperative Hypothermia on Extubation, Recovery Time, and Postoperative Shivering in Breast Surgery.","authors":"Hatice Cansu Huniler, Mustafa Nuri Deniz, İlkben Günişen, Özlem Yakut Özdemir, Aslı Tetik, Sezgin Ulukaya","doi":"10.1089/ther.2023.0037","DOIUrl":"10.1089/ther.2023.0037","url":null,"abstract":"<p><p>Women undergoing breast surgery seem to be under the risk for hypothermia (central body temperature <36°) due to the uncertainty caused by the preoperative preparation time and the variety of operations, leading to neglect of warming precautions. The study examines the perioperative hypothermia (PH) in breast surgery and the relationships between the depth of decrease in body temperature and individual or clinical variables. This prospective, cross-sectional, observational study includes 120 female patients 18-65 years of age who were given general anesthesia for breast surgery. The incidence of hypothermia was 68.1%. The given patients were discriminated as body temperature <36°, hypothermia was significantly related with lower weight, body mass index, American Society of Anesthesiology (ASA) score, baseline body temperatures, higher extubation, and recovery times. When patients' temperature decreases by >1 or 1.5°, lower age and longer durations of operation and anesthesia were also significant variables. The incidence of shivering is quite high at temperatures below 36°C or at 1 and 1.5°C reductions from baseline (72.7%, 84%, 94.1%, respectively). Body temperature changes of the patients had no effect on nausea-vomiting and pain scores. It turned out that the incidence of PH and shivering is high in women who underwent breast surgery. We think that the depth of decrease in body temperature should be taken into account when evaluating the predictors or clinical consequences of hypothermia, except for the 36°C limit for body temperature.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"110-117"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10113195","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":"Case Report of the Use of an Intravascular Cooling Device in the Management of Malignant Hyperthermia.","authors":"Benjamin Von Schweinitz, Brendon J Gros","doi":"10.1089/ther.2024.0004","DOIUrl":"10.1089/ther.2024.0004","url":null,"abstract":"<p><p>Malignant hyperthermia (MH) is a rare, life-threatening condition caused by alterations in skeletal muscle calcium channels inherited through an autosomal dominant pattern. The use of specific agents in anesthesia such as inhaled anesthetics and succinylcholine can precipitate a hyperthermic crisis. Patients experience a rapid increase in muscle rigidity, secondary to skeletal muscle calcium dysregulation, leading to acute rhabdomyolysis and possible hyperthermia. Providers must have a high index of suspicion of this disease process because early diagnosis is critical to mortality reduction. Management centers around removal of the offending agent, dantrolene, and supportive care including cooling if hyperthermic. Intravascular cooling devices have been used in thermodynamic regulation after cardiac arrest and have shown to be more effective than dermal cooling techniques; however, they have not been well described in other disease processes. The following case report is the first to describe a patient suffering from MH to undergo invasive intravenous cooling in order to counteract the effects of this life-threatening disease.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"125-127"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161788","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}