Therapeutic hypothermia and temperature management最新文献

{"title":"Hypothermia as an Adjunctive Therapy in Cardiogenic Shock: A Systematic Review and Meta-Analysis.","authors":"Mohammed Mhanna, Ahmad Al-Abdouh, Michael C Sauer, Ahmad Jabri, Waiel Abusnina, Mohammed Safi, Azizullah Beran, Shareef Mansour","doi":"10.1089/ther.2023.0005","DOIUrl":"10.1089/ther.2023.0005","url":null,"abstract":"<p><p>In the setting of out-of-hospital cardiac arrest, therapeutic hypothermia (TH) has been shown to improve clinical outcomes. However, trials showing the advantage of TH did not include patients with cardiogenic shock (CS). We performed a comprehensive literature search for studies that evaluated the efficacy and safety of adjunctive TH compared with the standard of care (SOC) in patients with CS. The primary outcome was the mortality rate (in-hospital, short-, and mid-term). The secondary outcomes were the TH-related complications, duration of Intensive Care Unit (ICU) stay, duration of mechanical ventilation (MV-days), and improvement in cardiac function. Relative risk (RR) or the standardized mean difference (SMD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. A total of 7 clinical studies (3 RCTs included), and 712 patients (341 in the TH group and 371 in the SOC group) were included. As compared with the SOC, TH was not associated with a statistically significant improvement in the in-hospital (RR: 0.73%, 95% CI: 0.51-1.03; <i>p</i> = 0.08), short-term (RR: 0.90%, 95% CI: 0.75-1.06; <i>p</i> = 0.21), or mid-term (RR: 0.93%, 95% CI: 0.78-1.10; <i>p</i> = 0.38) mortality rates. Despite the improvement in the cardiac function in the TH group (SMD: 1.08, 95% CI: 0.02-2.1; <i>p</i> = 0.04), the TH strategy did not significantly shorten the MV days, or the ICU stay (<i>p</i>-values >0.05). Finally, there was a trend toward higher risks for infection, major bleeding, and the need for blood transfusion in the TH group. According to our meta-analysis of published clinical studies, TH is not beneficial in patients with CS and has a marginal safety profile. Larger-scale RCTs are needed to further clarify our results.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"160-169"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9440714","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":"Successful Therapeutic Hypothermia in a Patient with Drug-Induced J Waves and Cardiac Arrest: A Case Report.","authors":"Jun Sato, Tsukasa Yagi, Erika Shimada, Masashi Kobori, Kazuhiro Watanabe, Tsukasa Kuwana, Nobutaka Chiba, Takeshi Saito, Kosaku Kinoshita","doi":"10.1089/ther.2023.0041","DOIUrl":"10.1089/ther.2023.0041","url":null,"abstract":"<p><p>A 50-year-old man was admitted to our hospital with hypotension and bradycardia after receiving high doses of atenolol, amlodipine, and etizolam. He had a drug-induced J wave on electrocardiography and subsequently underwent cardiac arrest. The patient was successfully rescued by venoarterial extracorporeal membrane oxygenation (VA-ECMO) and a good neurological outcome was achieved with therapeutic hypothermia (TH). In patients with J waves, TH is thought to increase the J waves and cause fatal arrhythmias, but in this case, rapid cooling with VA-ECMO allowed the patient to successfully complete TH.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"230-233"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10312498","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 Targeted Temperature Management on the Metabolome Following Out-of-Hospital Cardiac Arrest.","authors":"Rasmus Paulin Beske, Laust Emil Roelsgaard Obling, John Bro-Jeppesen, Niklas Nielsen, Martin Abild Steengaard Meyer, Jesper Kjaergaard, Pär Ingemar Johansson, Christian Hassager","doi":"10.1089/ther.2022.0065","DOIUrl":"10.1089/ther.2022.0065","url":null,"abstract":"<p><p>Targeted temperature management (TTM) may moderate the injury from out-of-hospital cardiac arrest. Slowing the metabolism has been a suggested effect. Nevertheless, studies have found higher lactate levels in patients cooled to 33°C compared with 36°C even days from TTM cessation. Larger studies have not been performed on the TTM's effect on the metabolome. Accordingly, to explore the effect of TTM, we used ultra-performance liquid-mass spectrometry in a substudy of 146 patients randomized in the TTM trial to either 33°C or 36°C for 24 hours and quantified 60 circulating metabolites at the time of hospital arrival (T₀) and 48 hours later (T₄₈). From T₀ to T_48, profound changes to the metabolome were observed: tricarboxylic acid (TCA) cycle metabolites, amino acids, uric acid, and carnitine species all decreased. TTM significantly modified these changes in nine metabolites (Benjamini-Hochberg corrected false discovery rate <0.05): branched amino acids valine and leucine levels dropped more in the 33°C arm (change [95% confidence interval]: -60.9 μM [-70.8 to -50.9] vs. -36.0 μM [-45.8 to -26.3] and -35.5 μM [-43.1 to -27.8] vs. -21.2 μM [-28.7 to -13.6], respectively), whereas the TCA metabolites including malic acid and 2-oxoglutaric acid remained higher for the first 48 hours (-7.7 μM [-9.7 to -5.7] vs. -10.4 μM [-12.4 to -8.4] and -3 μM [-4.3 to -1.7] vs. -3.7 μM [-5 to -2.3]). Prostaglandin E2 only dropped in the TTM 36°C group. The results show that TTM affects the metabolism hours after normothermia have been reached. Clinical Trial Number: NCT01020916.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"208-215"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9563041","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":"Core Warming of Coronavirus Disease 2019 Patients Undergoing Mechanical Ventilation: A Pilot Study.","authors":"Nathaniel P Bonfanti, Nicholas M Mohr, David C Willms, Roger J Bedimo, Emily Gundert, Kristina L Goff, Erik B Kulstad, Anne M Drewry","doi":"10.1089/ther.2023.0030","DOIUrl":"10.1089/ther.2023.0030","url":null,"abstract":"<p><p>Fever is a recognized protective factor in patients with sepsis, and growing data suggest beneficial effects on outcomes in sepsis with elevated temperature, with a recent pilot randomized controlled trial (RCT) showing lower mortality by warming afebrile sepsis patients in the intensive care unit (ICU). The objective of this prospective single-site RCT was to determine if core warming improves respiratory physiology of mechanically ventilated patients with coronavirus disease 2019 (COVID-19), allowing earlier weaning from ventilation, and greater overall survival. A total of 19 patients with mean age of 60.5 (±12.5) years, 37% female, mean weight 95.1 (±18.6) kg, and mean body mass index 34.5 (±5.9) kg/m² with COVID-19 requiring mechanical ventilation were enrolled from September 2020 to February 2022. Patients were randomized 1:1 to standard of care or to receive core warming for 72 hours through an esophageal heat exchanger commonly utilized in critical care and surgical patients. The maximum target temperature was 39.8°C. A total of 10 patients received usual care and 9 patients received esophageal core warming. After 72 hours of warming, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratios were 197 (±32) and 134 (±13.4), cycle thresholds were 30.8 (±6.4) and 31.4 (±3.2), ICU mortalities were 40% and 44%, 30-day mortalities were 30% and 22%, and mean 30-day ventilator-free days were 11.9 (±12.6) and 6.8 (±10.2) for standard of care and warmed patients, respectively (<i>p</i> = NS). This pilot study suggests that core warming of patients with COVID-19 undergoing mechanical ventilation is feasible and appears safe. Optimizing time to achieve febrile-range temperature may require a multimodal temperature management strategy to further evaluate effects on outcome. ClinicalTrials.gov Identifier: NCT04494867.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"225-229"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9974692","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":"Re: \"Heat Transfer Capabilities of Surface Cooling Systems for Inducing Therapeutic Hypothermia\" by Leclerc et al.","authors":"Robert B Schock","doi":"10.1089/ther.2023.0069","DOIUrl":"10.1089/ther.2023.0069","url":null,"abstract":"","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"159"},"PeriodicalIF":0.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213645","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":"Cerebral Tissue Oxygen Saturation Measurements in Perinatal Asphyxia Cases Treated with Therapeutic Hypothermia.","authors":"Halil Kazanasmaz, Abdulsamed Akan, Ömer Yalçın, Muhammed Turgut Ölçücü, Selehattin Onar, Özlem Kazanasmaz","doi":"10.1089/ther.2022.0060","DOIUrl":"10.1089/ther.2022.0060","url":null,"abstract":"<p><p>Cerebral tissue oxygen saturation (CrSO₂) measured with near-infrared spectroscopy (NIRS) technology has recently become the subject of several research studies. The aim of this study was to investigate the diagnostic value of CrSO₂ measurements in perinatal asphyxia (PA) cases. The study included a patient group of 42 PA cases, who were to be applied with therapeutic hypothermia (TH), and a control group of 42 healthy term newborns. PA cases were determined as moderate or severe encephalopathy (Sarnat score stage II or III) in clinical evaluation. In both groups, left (CrSO₂L) and right (CrSO₂R) NIRS measurements were taken for 10 minutes on the scalp. The arithmetic mean value of measurements was calculated and compared. The mean measurements were CrSO₂R 67.38 ± 9.39 and CrSO₂L 66.73 ± 7.76 in the patient group, and CrSO₂R 80.28 ± 8.04 and CrSO₂L 79.14 ± 8.49 in the control group. The mean CrSO₂R and CrSO₂L measurements of the patient group were statistically significantly lower than those of the control group (<i>p</i> < 0.001). In the Pearson correlation analysis, a significant correlation was determined in the patient group between cord blood gas pH and CrSO₂R (<i>r</i>: 0.539, <i>p</i> < 0.001) and CrSO₂L (<i>r</i>: 0.54, <i>p</i> < 0.001). For a cutoff value of CrSO₂L ≤ 72%, the positive predictive value was 80 and the negative predictive value was 84.6. For a cutoff value of CrSO₂R ≤ 74%, the positive predictive value was 79.5 and the negative predictive value was 82.5. Low CrSO₂ measurements obtained with the NIRS method in PA cases to be applied with TH together with cord blood gas parameters can be considered a helpful parameter in diagnosis.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"184-190"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9465840","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":"Comparing Three Methods of Therapeutic Hypothermia Among Transported Neonates with Hypoxic-Ischemic Encephalopathy.","authors":"Sarfaraz Momin,&nbsp;Sumesh Thomas,&nbsp;Hussein Zein,&nbsp;James N Scott,&nbsp;Lara M Leijser,&nbsp;Sakeer Vayalthrikovil,&nbsp;Kamran Yusuf,&nbsp;Renee Paul,&nbsp;Alexandra Howlett,&nbsp;Khorshid Mohammad","doi":"10.1089/ther.2022.0048","DOIUrl":"https://doi.org/10.1089/ther.2022.0048","url":null,"abstract":"<p><p>Hypoxic-ischemic encephalopathy (HIE) and associated multiorgan injury are significant causes of morbidity and mortality in term and near-term neonates. Therapeutic hypothermia (TH) is the current standard of care for neuroprotection in neonates with HIE. In our experience, the majority of babies born with HIE were found in nontertiary care facilities in our region, where effective methods of cooling during transport to tertiary care centers are desirable. Most centers initiate passive TH at referral hospitals, while active cooling is typically initiated during transport. The objective of this study was to evaluate the effectiveness of three methods of cooling during transport of neonates with HIE in southern Alberta. In this prospective cohort study, 186 neonates with HIE were transported between January 2013 and December 2021. Among the 186 neonates, 47 were passively cooled, 36 actively cooled with gel packs, and 103 cooled with a servo-controlled cooling device. The clinical characteristics were comparable for the three groups, with no difference in adverse events. Fifteen neonates (8%) died and 54 neonates (29%) suffered radiologically determined brain injury. Servo-controlled cooling was found to be superior to other methods in maintaining a target temperature without significant fluctuation during transport and with temperature in the target range on arrival at tertiary care facilities. The rate of overcooling was also lower in the servo-controlled group compared with other groups. There were no statistically significant differences between the groups in relation to mortality and brain MRI changes associated with HIE. Adjusting for GA, 10-minute Apgar score, base excess, HIE stage, and need for intubation during transport, passive cooling increased the odds of temperature fluctuation outside the range by 12-fold and gel pack cooling by 13-fold compared with servo-controlled cooling. The use of servo-controlled TH devices should be the preferred practice wherever feasible. (REB17-1334_REN3).</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":"13 3","pages":"141-148"},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10176391","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":"Comparison of Pregnancy and Neonatal Outcomes Between Fresh Embryo Transfer and Frozen-Thawed Embryo Transfer.","authors":"Man Chen,&nbsp;Zhi-Ling Li,&nbsp;Hong Lin,&nbsp;Ru-Bin Xia,&nbsp;Yu-Lian Wang","doi":"10.1089/ther.2022.0045","DOIUrl":"https://doi.org/10.1089/ther.2022.0045","url":null,"abstract":"<p><p>This study compared the pregnancy and neonatal outcomes between fresh embryo transfer and frozen-thawed embryo transfer (FET). These patients were split into two groups: the fresh embryo transfer group and the FET group. The general conditions, pregnancy outcomes, and neonatal outcomes between these groups were compared. The influencing factors of fetal macrosomia occurrence were explored as well. Compared with the fresh embryo transfer group, the FET group had a significantly higher mean age (32.59 ± 4.77 vs. 31.90 ± 4.71, <i>p</i> < 0.05) and lower multiple pregnancy rate (21.2% vs. 26.9%, <i>p</i> < 0.05). There was no significant difference in the incidence of congenital anomalies of neonates between the two groups (1.32% vs. 0.37%, <i>p</i> > 0.05). In the FET group, compared with the fresh embryo transfer group, the mean birth weight of singleton live births, the cesarean section rate, and the incidence of fetal macrosomia were significantly increased, while the incidence of low birth weight was significantly decreased. The logistic analysis showed that the occurrence of fetal macrosomia was primarily associated with the embryo transfer protocol (odds ratio [OR] = 2.769, 95% confidence interval [CI]: 1.246-6.154, <i>p</i> < 0.05), endometrial thickness (OR = 1.144, 95% CI: 1.043-1.256, <i>p</i> < 0.05), and gestational age (OR = 1.710, 95% CI: 1.338-2.184, <i>p</i> < 0.05). Macrosomia (OR = 2.938, 95% CI: 1.436-6.010, <i>p</i> = 0.003) and multiple pregnancy (OR = 3.574, 95% CI: 2.616-4.882, <i>p</i> < 0.001) significantly increased the cesarean section rate. The risk of fetal macrosomia and congenital anomalies in the offspring of the fresh embryo transfer group was lower than that in the offspring of the FET group, we preferred to fresh embryo transfer for patients with assisted reproductive technologies. FET should be used as supplementary therapeutic strategy with strengthened pregnancy management and screening to reduce the occurrence of birth defects in newborns.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":"13 3","pages":"120-125"},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10231868","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":"Rosalind Franklin Society Proudly Announces the 2022 Award Recipient for <i>Therapeutic Hypothermia and Temperature Management</i>.","authors":"Elena Cavazzoni","doi":"10.1089/ther.2023.29098.rfs2022","DOIUrl":"https://doi.org/10.1089/ther.2023.29098.rfs2022","url":null,"abstract":"","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":"13 3","pages":"91"},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10168895","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 Commentary on the Effect of Targeted Temperature Management in Patients Resuscitated from Cardiac Arrest.","authors":"Michael Holzer, Jeanne E Poole, Jean-Baptiste Lascarrou, Ken Fujise, Graham Nichol","doi":"10.1089/ther.2022.0041","DOIUrl":"10.1089/ther.2022.0041","url":null,"abstract":"<p><p>The members of the International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force have written a comprehensive summary of trials of the effectiveness of induced hypothermia (IH) or targeted temperature management (TTM) in comatose patients after cardiac arrest (CA). However, in-depth analysis of these studies is incomplete, especially since there was no significant difference in primary outcome between hypothermia versus normothermia in the recently reported TTM2 trial. We critically appraise trials of IH/TTM versus normothermia to characterize reasons for the lack of treatment effect, based on a previously published framework for what to consider when the primary outcome fails. We found a strong biologic rationale and external clinical evidence that IH treatment is beneficial. Recent TTM trials mainly included unselected patients with a high rate of bystander cardiopulmonary resuscitation. The treatment was not applied as intended, which led to a large delay in achievement of target temperature. While receiving intensive care, sedative drugs were likely used that might have led to increased neurologic damage as were antiplatelet drugs that could be associated with increased acute stent thrombosis in hypothermic patients. It is reasonable to still use or evaluate IH treatment in patients who are comatose after CA as there are multiple plausible reasons why IH compared to normothermia did not significantly improve neurologic outcome in the TTM trials.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":"13 3","pages":"102-111"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177869","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}