[Therapeutic hypothermia in neurocritical patients]

[Effects of induced hypothermia in critically ill children]

OBJECTIVE

To study the efficacy of induced hypothermia (IH) in children, its effect on hemodynamic, hematological, and biochemical parameters and its side effects.

DESIGN

Retrospective, observational study.

SETTING

Pediatric intensive care unit.

PATIENTS

Pediatric patients requiring induced hypothermia.

INTERVENTIONS

None.

DATA COLLECTED

The following variables were recorded prior to the initiation of IH and after 4, 24, 48, 72, and 120 hours: heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), diuresis, dose of inotropic, sedative, and muscle relaxant drugs, fluid balance, hematocrit, white cell count, white cell differential percentages, platelet count, blood levels of glucose, sodium, and potassium, C reactive protein, lactate, coagulation times, pressure ulcers, shivering, infections and death.

RESULTS

Thirty-one patients with a mean age of 20 months (SD: 39.8) were included in the study. The mean duration of IH was 3.97 days (range: 1 to 11 days). Among the IH effects, there was a significant fall in heart rate, with no changes in SBP, DBP, or diuresis. The blood tests revealed a progressive and significant fall in platelet count and an increase in C reactive protein levels. The fall in hematocrit and glucose and lactate levels was not significant. Positive cultures were detected in 25.8% of the patients during IH, most commonly from the bronchial aspirate (65%).

CONCLUSIONS

Induced hypothermia can be useful in some critically ill children. Tolerance is generally good and there are usually few side effects, which can be controlled through appropriate monitoring.

[Clinical course of induced hypothermia after cardiac arrest]

INTRODUCTION

Cardiac Arrest is a major health problem because of its high mortality and neurological effects due to hypoxia. Based on the Scientific Societies recommendations and Scientific Evidence, our hospital began to apply Mild Hypothermia in 2006. OBJECTIVE OF THIS CLINICAL COURSE: To standardize the application of the non-invasive Induction and Maintenance Hypothermia System (Arctic-Sun), to avoid the variability of the clinical practice, and to ensure patient quality of care and safety.

METHODOLOGY

A review was made of the literature and protocols of the Health Care Centers where hypothermia is used. The clinical records of the patients in whom this technique was used were analyzed. Meetings were held with the professionals in order to reach a consensus. STAFF: Doctors, Nurses and Nursing assistants.

TECHNIQUE

The activities in each phase were described: preparation and patient monitoring, cooling device, programming, induction and maintenance of hypothermia and controlled rewarming until normothermia is reached.

[Management of hemorrhage in patients with abdominal trauma: application of the European Guidelines for the management of bleeding following major trauma]

In patients with traumatic intraabdominal hemorrhage, urgent decisions must be made. Resuscitation measures must often be simultaneously combined with diagnostic actions and measures to control the source of the bleeding. Hemorrhages are usually complicated by coagulation disorders and the presence of acidosis and hypothermia. In these conditions, emergency measures are required that usually involve various specialists. However, given the paucity of the scientific evidence in this field, the intervention protocols differ from one center to another. The European Guidelines for the management of bleeding following major trauma has recently been published. These guidelines review aspects such as evaluation and initial management of bleeding, localization and control of the source of bleeding and replacement of blood products. In addition, recommendations based on the best available evidence to 2008 are made. This review describes the basic aspects of traumatic intraabdominal hemorrhage.