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Phan DT, Phan TTV, Bui NT, Park S, Choi J, Oh J. A portable device with low-power consumption for monitoring mouse vital signs during in vivo photoacoustic imaging and photothermal therapy. Physiol Meas 2021; 41:125011. [PMID: 32674080 DOI: 10.1088/1361-6579/aba6a1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study was to monitor the physiological changes and cytotoxic effects of exogenous contrast agents during photoacoustic imaging (PAI) and photothermal therapy (PTT). In this paper, a low-power telemetric device for mouse vital signs monitoring was designed and demonstrated. APPROACH The power consumption was optimized through hardware and software co-design with a 17% increased operating time compared with typical operation. To demonstrate the feasibility of the monitoring device, PAI and PTT experiments with chitosan-polypyrrole nanocomposites (CS-PPy NCs) as exogenous contrast agents were conducted. Herein, the physiological variation in groups of mice with different CS-PPy NC concentrations was observed and analyzed. MAIN RESULTS The experimental results indicated the influence of CS-PPy NCs and anesthesia on mouse vital signs in PAI and PTT. Additionally, the association between core temperature, heart rate, and saturation of peripheral oxygen (SpO2) during PAI and PTT was shown. The strong near-infrared absorbance of exogenous contrast agents could account for the increase in mouse core temperature and tumor temperature in this study. Furthermore, high cross-correlation values between core temperature, heart rate, and SpO2 were demonstrated to explain the fluctuation of mouse vital signs during PAI and PTT. SIGNIFICANCE A design of a vital signs monitoring device, with low power consumption, was introduced in this study. A high cross correlation coefficient of mouse vital signs and the effects of CS-PPy NCs were observed, which explained the mouse physiological variation during the PAI and PTT experiments.
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Affiliation(s)
- Duc Tri Phan
- Interdisciplinary Program of Biomedical Mechanical and Electrical Engineering, Pukyong National University, Busan, South Korea
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Tashiro M, Hosokawa Y, Amao H, Tohei A. Duration of thermal support for preventing hypothermia induced by anesthesia with medetomidine-midazolam-butorphanol in mice. J Vet Med Sci 2020; 82:1757-1762. [PMID: 33055454 PMCID: PMC7804034 DOI: 10.1292/jvms.20-0256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hypothermia during anesthetic events is a common adverse effect of anesthesia in laboratory animals. In particular, small rodents such as mice is susceptible
to hypothermia during anesthetic events. Therefore, the animals will need additional thermal support by external heating devices during and after anesthesia. In
general, the time of recovery from anesthesia is typically longer in case of injectable anesthesia rather than inhalant anesthesia. However, the durations of
thermal support have been almost limited to 1 hr from administration of anesthesia in general. Our study objectives are two-fold: 1) to compare the levels of
hypothermia induced by injectable anesthesia with medetomidine-midazolam-butorphanol (MMB) and inhalant anesthesia with isoflurane (ISO); 2) to find the
adequate durations of thermal support for preventing hypothermia induced by their anesthesia in mice. Adult male ICR mice were anesthetized during 40 min
without and with the thermal support for 1 (both anesthetic groups), 2, 3, and 5 hr (in MMB group). Without thermal support, the decrease of body temperature in
MMB group were more severe than that in ISO group. The durations of thermal support completely prevented hypothermia at 5 hr-support in MMB group and that at 1
hr-support in ISO group. However, the other short durations did not prevent hypothermia at 1, 2 and 3 hr-support in MMB group. These results suggest that the
mice should be received thermal support over 5 hr after injection of MMB anesthesia to prevent hypothermia.
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Affiliation(s)
- Mizuho Tashiro
- Laboratory of Experimental Animal Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino, Tokyo 180-8602, Japan
| | - Yuki Hosokawa
- Laboratory of Experimental Animal Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino, Tokyo 180-8602, Japan
| | - Hiromi Amao
- Laboratory of Experimental Animal Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino, Tokyo 180-8602, Japan
| | - Atsushi Tohei
- Laboratory of Experimental Animal Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino, Tokyo 180-8602, Japan
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Intraoperative core temperature and infectious complications after colorectal surgery: A registry analysis. J Clin Anesth 2020; 63:109758. [PMID: 32222668 DOI: 10.1016/j.jclinane.2020.109758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/09/2020] [Accepted: 02/28/2020] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVE Moderate hypothermia (e.g., 34.5 °C) causes surgical site infections, but it remains unknown whether mild hypothermia (34.6 °C-35.9 °C) causes infection. Therefore, the objective of this study was to evaluate the relationship between intraoperative time-weighted average core temperature and a composite of serious wound and systemic infections in adults having colorectal surgery over a range of near-normal temperatures. DESIGN Retrospective, single center study. SETTING The operating rooms of the Cleveland Clinic Foundation from January 2005 to December 2014. PATIENTS Adult patients having colorectal surgery at least 1 h in length who received both general anesthesia and esophageal core temperature monitoring. INTERVENTION(S) Time weighted average intraoperative core temperature. MEASUREMENTS Our primary outcome was a composite of serious infections obtained from a surgical registry and billing codes. Average intraoperative esophageal temperatures and the composite of serious 30-day complications were assessed with logistic regression, adjusted for potential confounding factors. MAIN RESULTS A total of 7908 patients were included in the analysis. A 0.5 °C decrease in time-weighted average intraoperative core temperature ≤ 35.4 °C was associated with an increased odds of serious infection (OR = 1.38, P = .045); that is, hypothermia below 35.4 °C progressively worsened infection risk. Additionally, at higher core temperatures, the odds of serious infection increased slightly with each 0.5 °C increase in average temperature (OR = 1.10, P = .047). CONCLUSIONS Below 35.5 °C, hypothermia was associated with increased risk of serious infectious complications. Why composite complications increased at higher temperatures remains unclear, but the highest temperatures may reflect febrile patients who had pre-existing infections. Avoiding time-weighted average core temperatures <35.5 °C appears prudent from an infection perspective, but higher temperatures may be needed to prevent other hypothermia-related complications.
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Kersemans V, Gilchrist S, Wallington S, Allen PD, Gomes AL, Dias GM, Cornelissen B, Kinchesh P, Smart SC. A Carbon-Fiber Sheet Resistor for MR-, CT-, SPECT-, and PET-Compatible Temperature Maintenance in Small Animals. Tomography 2019; 5:274-281. [PMID: 31245549 PMCID: PMC6588203 DOI: 10.18383/j.tom.2019.00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A magnetic resonance (MR)-, computed tomography (CT)-, single-photon emission computed tomography (SPECT)-, and positron emission tomography (PET)-compatible carbon-fiber sheet resistor for temperature maintenance in small animals where space limitations prevent the use of circulating fluids was developed. A 250 Ω carbon-fiber sheet resistor was mounted to the underside of an imaging cradle. Alternating current, operating at 99 kHz, and with a power of 1-2 W, was applied to the resistor providing a cradle base temperature of ∼37°C. Temperature control was implemented with a proportional-integral-derivative controller, and temperature maintenance was demonstrated in 4 mice positioned in both MR and PET/SPECT/CT scanners. MR and CT compatibility were also shown, and multimodal MR-CT-PET-SPECT imaging of the mouse abdomen was performed in vivo. Core temperature was maintained at 35.5°C ± 0.2°C. No line-shape, frequency, or image distortions attributable to the current flow through the heater were observed on MR. Upon CT imaging, no heater-related artifacts were observed when carbon-fiber was used. Multimodal imaging was performed and images could be easily coregistered, displayed, analyzed, and presented. Carbon fiber sheet resistors powered with high-frequency alternating current allow homeothermic maintenance that is compatible with multimodal imaging. The heater is small, and it is easy to produce and integrate into multimodal imaging cradles.
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Affiliation(s)
- Veerle Kersemans
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Stuart Gilchrist
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Sheena Wallington
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Philip D Allen
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Ana L Gomes
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Gemma M Dias
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Bart Cornelissen
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Paul Kinchesh
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Sean C Smart
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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Hankenson FC, Marx JO, Gordon CJ, David JM. Effects of Rodent Thermoregulation on Animal Models in the Research Environment. Comp Med 2018; 68:425-438. [PMID: 30458902 DOI: 10.30802/aalas-cm-18-000049] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
To best promote animal wellbeing and the efficacy of biomedical models, scientific, husbandry, and veterinary professionals must consider the mechanisms, influences, and outcomes of rodent thermoregulation in contemporary research environments. Over the last 2 decades, numerous studies have shown that laboratory mice and rats prefer temperatures that are several degrees warmer than the environments in which they typically are housed within biomedical facilities. Physiologic changes to rodents that are cage-housed under standard temperatures (20 to 26 °C) are attributed to 'cold stress' and include alterations in metabolism, cardiovascular parameters, respiration, and immunologic function. This review article describes common behavioral and physiologic adaptations of laboratory mice and rats to cold stress within modern vivaria, with emphasis on environmental enrichment and effects of anesthesia and procedural support efforts. In addition, potential interventions and outcomes for rodents are presented, relative to the importance of repeating and reproducing experiments involving laboratory rodent research models of human disease.
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Affiliation(s)
- F Claire Hankenson
- Campus Animal Resources, Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - James O Marx
- University Laboratory Animal Resources, Department of Pathobiology, School of Veterinary Medicine; University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher J Gordon
- Toxicity Assessment Division, Neurotoxicology Branch, United States Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - John M David
- Comparative Medicine, Pfizer, La Jolla, California, USA
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Turhan AH, Atıcı A, Sürmeli S. Effects of hypothermia on lung inflammation in a rat model of meconium aspiration syndrome. Acta Cir Bras 2018; 33:483-490. [PMID: 30020309 DOI: 10.1590/s0102-865020180060000002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/12/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effects of hypothermia treatment on meconium-induced inflammation. METHODS Fifteen rats were instilled with human meconium (MEC, 1.5 mL/kg, 65 mg/mL) intratracheally and ventilated for 3 hours. Eight rats that were ventilated and not instilled with meconium served as a sham group. In MEC-hypothermia group, the body temperature was lowered to 33±0.5°C. Analysis of the blood gases, interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α in bronchoalveolar lavage (BAL) fluid samples, and histological analyses of the lungs were performed. RESULTS The BAL fluid TNF-α, IL-1β, IL-6 and IL-8 concentrations were significantly higher in the MEC-hypothermia group than in the MEC-normothermia (p < 0.001, p < 0.001, p = 0.001, p < 0.001, respectively) and sham-controlled groups (p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). CONCLUSION Meconium-induced inflammatory cytokine production is affected by the body temperature control.
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Affiliation(s)
- Ali Haydar Turhan
- Associate Professor, Department of Pediatrics, Division of Neonatology, School of Medicine, University of Başkent, Istanbul, Turkey. Scientific, intellectual, conception and design of the study; acquisition of data, analysis and interpretation of data; technical procedures; statistics analysis; manuscript preparation and writing
| | - Aytuğ Atıcı
- Professor, Department of Pediatrics, Division of Neonatology, School of Medicine, University of Mersin, Turkey. Scientific and intellectual content of the study, manuscript preparation
| | - Serra Sürmeli
- MD, Department of Pediatrics, Division of Neonatology, School of Medicine, University of Mersin, Turkey. Acquisition, analysis and interpretation of data; technical procedures
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Garami A, Steiner AA, Romanovsky AA. Fever and hypothermia in systemic inflammation. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:565-597. [PMID: 30459026 DOI: 10.1016/b978-0-444-64074-1.00034-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Systemic inflammation-associated syndromes (e.g., sepsis and septic shock) often have high mortality and remain a challenge in emergency medicine. Systemic inflammation is usually accompanied by changes in body temperature: fever or hypothermia. In animal studies, systemic inflammation is often modeled by administering bacterial lipopolysaccharide, which triggers autonomic and behavioral thermoeffector responses and causes either fever or hypothermia, depending on the dose and ambient temperature. Fever and hypothermia are regulated changes of body temperature, which correspond to mild and severe forms of systemic inflammation, respectively. Mediators of fever and hypothermia are called endogenous pyrogens and cryogens; they are produced when the innate immune system recognizes an infectious pathogen. Upon an inflammatory challenge, hepatic and pulmonary macrophages (and later brain endothelial cells) start to release lipid mediators, of which prostaglandin (PG) E2 plays the key role, and cytokines. Blood PGE2 enters the brain and triggers fever. At later stages of fever, PGE2 synthesized within the blood-brain barrier maintains fever. In both cases, PGE2 is synthesized by cyclooxygenase-2 and microsomal PGE2synthase-1. Mediators of hypothermia are not well established. Both fever and hypothermia are beneficial host defense responses. Based on evidence from studies in laboratory animals and clinical trials in humans, fever is beneficial for fighting mild infection. Based mainly on animal studies, hypothermia is beneficial in severe systemic inflammation and infection.
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Affiliation(s)
- Andras Garami
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
| | - Alexandre A Steiner
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Andrej A Romanovsky
- Thermoregulation and Systemic Inflammation Laboratory (FeverLab), Trauma Research, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
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Willis RN, Charles EJ, Guidry CA, Chordia MD, Davies SW, Yang Z, Sawyer RG. Effect of hypothermia on splenic leukocyte modulation and survival duration in severely septic rats. J Surg Res 2017; 215:196-203. [PMID: 28688647 DOI: 10.1016/j.jss.2017.03.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/06/2017] [Accepted: 03/30/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Therapeutic hypothermia (HT) in severe septic shock is associated with prolonged survival. We hypothesized that moderate HT would prolong survival and modulate the inflammatory response in rats with septic shock by exerting its therapeutic effect on splenic leukocytes. MATERIALS AND METHODS Severe septic shock was created in rats by cecal ligation and incision (CLI). One hour after CLI or laparotomy, rats were randomized to sham, normothermia (NT), or 4 h of HT followed by 2 h of rewarming. HT (31 ± 1°C) was induced using a cooling blanket and monitored via a rectal temperature probe. RESULTS Survival duration was 2.78 ± 1.0 h in NT rats and 8.33 ± 0.32 h in HT rats (n = 8/group, P < 0.0001). In separate groups, 3 h after CLI, the spleen weight was significantly smaller in NT rats (769 ± 100 mg) than in HT rats (947 ± 157 mg, P = 0.04). Fluorescent immunostaining of formyl peptide receptors on leukocytes in spleen tissue showed considerably higher formyl peptide receptor expression in HT rats than in NT rats. Significantly elevated proinflammatory cytokines and myeloperoxidase enzyme in plasma were found in NT rats compared with HT rats. Anti-inflammatory cytokine, interleukin-10, was significantly higher in HT rats. Both proinflammatory cytokines and plasma myeloperoxidase were significantly reduced in splenectomized NT rats. CONCLUSIONS Moderate hypothermic therapy significantly prolongs the survival duration of rats with severe septic shock. HT dampens the inflammatory response during septic shock by modulating the spleen to an anti-inflammatory mode and preventing the spleen from releasing activated splenic leukocytes into the blood.
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Affiliation(s)
- Rhett N Willis
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Eric J Charles
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
| | - Christopher A Guidry
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mahendra D Chordia
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Stephen W Davies
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Zequan Yang
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert G Sawyer
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Gilchrist S, Gomes AL, Kinchesh P, Kersemans V, Allen PD, Smart SC. An MRI-Compatible High Frequency AC Resistive Heating System for Homeothermic Maintenance in Small Animals. PLoS One 2016; 11:e0164920. [PMID: 27806062 PMCID: PMC5091850 DOI: 10.1371/journal.pone.0164920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/30/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To develop an MRI-compatible resistive heater, using high frequency alternating current (AC), for temperature maintenance of anaesthetised animals. MATERIALS AND METHODS An MRI-compatible resistive electrical heater was formed from narrow gauge wire connected to a high frequency (10-100 kHz) AC power source. Multiple gradient echo images covering a range of echo times, and pulse-acquire spectra were acquired with the wire heater powered using high frequency AC or DC power sources and without any current flowing in order to assess the sensitivity of the MRI acquisitions to the presence of current flow through the heater wire. The efficacy of temperature maintenance using the AC heater was assessed by measuring rectal temperature immediately following induction of general anaesthesia for a period of 30 minutes in three different mice. RESULTS Images and spectra acquired in the presence and absence of 50-100 kHz AC through the wire heater were indistinguishable, whereas DC power created field shifts and lineshape distortions. Temperature lost during induction of anaesthesia was recovered within approximately 20 minutes and a stable temperature was reached as the mouse's temperature approached the set target. CONCLUSION The AC-powered wire heater maintains adequate heat input to the animal to maintain body temperature, and does not compromise image quality.
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Affiliation(s)
- Stuart Gilchrist
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Ana L. Gomes
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Paul Kinchesh
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Veerle Kersemans
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Philip D. Allen
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Sean C. Smart
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
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Lee W, Kim I, Shin S, Park K, Yang K, Eun JW, Sul H, Jeong S. Expression profiling of microRNAs in lipopolysaccharide-induced acute lung injury after hypothermia treatment. Mol Cell Toxicol 2016; 12:243-253. [PMID: 32226458 PMCID: PMC7096978 DOI: 10.1007/s13273-016-0029-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/18/2016] [Indexed: 01/11/2023]
Abstract
We investigated the expression profiles of miRNAs in acute lung injury (ALI) rats after hypothermia treatment. ALI rats were induced with lipopolysaccharide (LPS) and maintained with hypothermia (HT) or normothermia (NT) for 6 hours. HT attenuated inflammatory cell infiltration in the lung and improved biochemical indicators of multi-organ dysfunction. Nineteen miRNAs were significantly differentially expressed in the HT group compared with the NT group. miR-142, miR-98, miR-541, miR-503, miR-653, miR- 223, miR-323 and miR-196b exhibited opposite patterns of expression between the two groups. These dysregulated miRNAs were mainly involved in the immune and inflammatory response on functional annotation analyses. This study shows that HT has lung protective effects and influences expression profiles of miRNAs in ALI. And dysregulated miRNAs after HT modulate the immune and inflammation in ALI. These results suggest that dysregulated miRNAs play a role in the mechanism of the lung protective effects of HT in ALI.
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Affiliation(s)
- Woonjeong Lee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Insoo Kim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soyoung Shin
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kicheol Park
- Clinical Research Institute, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keumjin Yang
- Clinical Research Institute, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung woo Eun
- Department of Pathology, Functional RNomics Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Haejoung Sul
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sikyoung Jeong
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kersemans V, Gilchrist S, Allen PD, Beech JS, Kinchesh P, Vojnovic B, Smart SC. A resistive heating system for homeothermic maintenance in small animals. Magn Reson Imaging 2015; 33:847-51. [PMID: 25863135 PMCID: PMC4462590 DOI: 10.1016/j.mri.2015.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/12/2015] [Accepted: 03/30/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE To develop an MR-compatible resistive heater for temperature maintenance of anaesthetized animals. MATERIALS AND METHODS An MR-compatible resistive electrical heater was formed from a tightly-wound twisted pair wire, interfaced to a homeothermic maintenance controller. Fat-suppressed images and localized spectra were acquired with the twisted pair heater and a near-identical single strand heater during operation at maximum power. Data were also acquired in the absence of heating to demonstrate the insensitivity of MR to distortions arising from the passage of current through the heater elements. The efficacy of temperature maintenance was examined by measuring rectal temperature immediately following induction of general anesthesia and throughout and after the acquisition of a heater artifact-prone image series. RESULTS Images and spectra acquired in the presence and absence of DC current through the twisted pair heater were identical whereas the passage of current through the single strand wire created field shifts and lineshape distortions. Temperature that is lost during anesthesia induction was recovered within approximately 10-20 minutes of induction, and a stable temperature is reached as the animal's temperature approaches the set target. CONCLUSION The twisted pair wire heater does not interfere with MR image quality and maintains adequate thermal input to the animal to maintain body temperature.
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Affiliation(s)
- Veerle Kersemans
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, OX3-7DQ, Oxford, United Kingdom.
| | - Stuart Gilchrist
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, OX3-7DQ, Oxford, United Kingdom.
| | - Philip D Allen
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, OX3-7DQ, Oxford, United Kingdom.
| | - John S Beech
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, OX3-7DQ, Oxford, United Kingdom.
| | - Paul Kinchesh
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, OX3-7DQ, Oxford, United Kingdom.
| | - Borivoj Vojnovic
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, OX3-7DQ, Oxford, United Kingdom.
| | - Sean C Smart
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, OX3-7DQ, Oxford, United Kingdom.
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Hypothermie thérapeutique après arrêt cardiaque et infections acquises en réanimation. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jo YH, Kim K, Lee JH, Rim KP, Cho IS. Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis. Clin Exp Emerg Med 2014; 1:120-125. [PMID: 27752563 PMCID: PMC5052836 DOI: 10.15441/ceem.14.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/05/2014] [Accepted: 07/17/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study was performed to investigate the effect of the rewarming rate on survival and acute lung injury in sepsis. METHODS Male Sprague-Dawley rats underwent cecal ligation and incision. After 1 hour of sepsis induction, normothermia (37°C±0.5°C, NT group) or hypothermia (32°C±0.5°C) was induced. Hypothermia was maintained for 4 hours and rats were divided into two groups according to the rewarming rate: RW1 group, 1 hour of rewarming; and RW2 group, 2 hours of rewarming. In the survival study, rats were observed for 12 hours after sepsis induction (n=6 per group). In the second experiment, rats were sacrificed 7 hours after sepsis induction, and lung tissues and plasma were harvested (n=10 per group). RESULTS In the survival study, the RW2 group survived longer than the RW1 group (P<0.05), but the RW1 and NT groups showed no significant difference in survival duration (P>0.05). The histological lung injury score and malondialdehyde concentrations in the lung tissues were significantly higher in the RW1 group than in the RW2 group (P<0.05). Plasma interleukin (IL)-6 concentration and the ratio of IL-6 to IL-10 were higher in the RW1 group than in the RW2 group (P<0.05). CONCLUSION Rapid rewarming after therapeutic hypothermia results in a shorter survival period and acute lung injury in sepsis, which could be associated with the inflammatory responses.
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Affiliation(s)
- You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Pil Rim
- Department of Emergency Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - In Soo Cho
- Department of Emergency Medicine, Kepco Medical Center, Seoul, Korea
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Oliveira JCCD, Oliveira CHD, Oliveira HED, Pereira A, Maraschin M, d'Acâmpora AJ. Effects of perioperative hypothermia and reactive oxygen species in the healing of colonic anastomosis in rats. Acta Cir Bras 2014; 29:742-7. [DOI: 10.1590/s0102-86502014001800008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/24/2014] [Indexed: 12/19/2022] Open
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Beurskens CJ, Horn J, de Boer AMT, Schultz MJ, van Leeuwen EM, Vroom MB, Juffermans NP. Cardiac arrest patients have an impaired immune response, which is not influenced by induced hypothermia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R162. [PMID: 25078879 PMCID: PMC4261599 DOI: 10.1186/cc14002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/26/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Induced hypothermia is increasingly applied as a therapeutic intervention in ICUs. One of the underlying mechanisms of the beneficial effects of hypothermia is proposed to be reduction of the inflammatory response. However, a fear of reducing the inflammatory response is an increased infection risk. Therefore, we studied the effect of induced hypothermia on immune response after cardiac arrest. METHODS A prospective observational cohort study in a mixed surgical-medical ICU. Patients admitted at the ICU after surviving cardiac arrest were included and during 24 hours body temperature was strictly regulated at 33°C or 36°C. Blood was drawn at three time points: after reaching target temperature, at the end of the target temperature protocol and after rewarming to 37°C. Plasma cytokine levels and response of blood leucocytes to stimulation with toll-like receptor (TLR) ligands lipopolysaccharide (LPS) from Gram-negative bacteria and lipoteicoic acid (LTA) from Gram-positive bacteria were measured. Also, monocyte HLA-DR expression was determined. RESULTS In total, 20 patients were enrolled in the study. Compared to healthy controls, cardiac arrest patients kept at 36°C (n = 9) had increased plasma cytokines levels, which was not apparent in patients kept at 33°C (n = 11). Immune response to TLR ligands in patients after cardiac arrest was generally reduced and associated with lower HLA-DR expression. Patients kept at 33°C had preserved ability of immune cells to respond to LPS and LTA compared to patients kept at 36°C. These differences disappeared over time. HLA-DR expression did not differ between 33°C and 36°C. CONCLUSIONS Patients after cardiac arrest have a modest systemic inflammatory response compared to healthy controls, associated with lower HLA-DR expression and attenuated immune response to Gram-negative and Gram-positive antigens, the latter indicative of an impaired immune response to bacteria. Patients with a body temperature of 33°C did not differ from patients with a body temperature of 36°C, suggesting induced hypothermia does not affect immune response in patients with cardiac arrest. TRIAL REGISTRATION ClinicalTrials.gov NCT01020916, registered 25 November 2009.
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Lugeder A, Klüppel D, Barndt I, Baderkhan A, Zeichen J. Perforiertes Magenulkus als kausale Ursache einer unklaren Bewusstlosigkeit? Notf Rett Med 2013. [DOI: 10.1007/s10049-013-1742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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de Oliveira JCC, de Oliveira CH, de Oliveira HE, Colombeli GL, De Bona Heck N, Pereira A, D'Acâmpora AJ. Effects of perioperative hypothermia on healing of anastomosis of the colon in rats. Int J Colorectal Dis 2013; 28:705-12. [PMID: 23588874 DOI: 10.1007/s00384-013-1695-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We evaluated the hypothesis that induced perioperative hypothermia in rats causes adverse effects on the healing of colonic anastomosis. MATERIALS AND METHODS Forty-eight Wistar rats were divided into eight groups of six animals that underwent laparotomy, sigmoid section, and anastomosis. Four groups were operated under normothermic conditions (36 ± 1 °C) and four under hypothermic conditions (32 ± 1 °C). The reoperations were performed on days 3, 7, and 14 post-surgery, and two groups where SHAM reoperated on day 3. We evaluated anastomotic bursting pressure and tissue hydroxyproline content; performed a histological analysis of inflammatory parameters and healing (inflammatory cell infiltrate, edema, fibrin, collagen deposition and apoptotic cells) with categorization scores = 0, 1, 2, 3; and examined the relative quantification gene expression (cDNA) of inflammatory cytokines [interleukin 1 (IL-1), interleukin 6 (IL-6), and interleukin 10 (IL-10)] and growth factors [vascular endothelial growth factor and insulin-like growth factor 1 (IGF-1)] by reverse transcription polymerase chain reaction. RESULTS Both of the hypothermic groups showed lower anastomotic burst pressure on days 7 and 14 post-surgery, reduced hydroxyproline content on day 14, reduction of inflammatory infiltrates and edema at day 3, and less collagen deposition on day 14. In animals that were hypothermic, the cytokine gene expression showed reduced IL-1 on day 3, reduced IL-6 on days 7 and 14, and reduced IL-10 on days 7 and 14 and a reduction in the growth factor IGF-1 on day 7. CONCLUSION Perioperative hypothermia had detrimental effects on the healing of colonic anastomosis in rats.
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Affiliation(s)
- João Carlos Costa de Oliveira
- Department of Surgery, Health Sciences Center, Federal University of Santa Catarina, Rua Prof. Maria Flora Pausewang, s/n, 88036-800 Trindade, Florianópolis, SC, Brazil.
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Abstract
Homeostasis refers to the capacity of the human body to maintain a stable constant state by means of continuous dynamic equilibrium adjustments controlled by a medley of interconnected regulatory mechanisms. Patients who sustain tissue injury, such as trauma or surgery, undergo a well-understood reproducible metabolic and neuroendocrine stress response. This review discusses 3 issues that concern homeostasis in the acute care of trauma patients directly related to the stress response: hyperglycemia, lactic acidosis, and hypothermia. There is significant reason to question the "conventional wisdom" relating to current approaches to restoring homeostasis in critically ill and trauma patients.
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Affiliation(s)
- Patrick J Neligan
- Department of Anaesthesia and Intensive Care, Galway University Hospitals, Galway, Ireland.
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Gaieski DF, Fuchs B, Carr BG, Merchant R, Kolansky DM, Abella BS, Becker LB, Maguire C, Whitehawk M, Levine J, Goyal M. Practical implementation of therapeutic hypothermia after cardiac arrest. Hosp Pract (1995) 2012; 37:71-83. [PMID: 20877174 DOI: 10.3810/hp.2009.12.257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Survival after out-of-hospital cardiac arrest (OHCA) remains unacceptably low. Therapeutic hypothermia (TH) is the most efficacious treatment option available for comatose survivors of cardiac arrest. However, clearly delineated instructions for how to induce, maintain, and conclude TH have not been published in a codified format. OBJECTIVE We assembled 11 clinicians from the University of Pennsylvania Schools of Medicine and Nursing for a day-long moderated discussion to review our institution's TH protocol and reach consensus on a step-by-step management plan of the comatose survivor of OHCA. We attempted to systematically work our way through the existing University of Pennsylvania TH protocol. The goal was to address critical decisions at each stage of care of the post-arrest patient, including whom to cool, how to cool, how long to cool, how to rewarm, neuroprognostication, and other fundamental aspects of patient management. We made every effort to include relevant scientific evidence with appropriate citations. However, given the paucity of data in certain areas, we have relied heavily on expert opinion. SUMMARY We present a step-by-step management plan for incorporation of TH in the care of the comatose survivor of OHCA, which can be adapted to a variety of clinical settings with diverse resources. This article is intended to supplement current care provided by health care providers and should be adopted in concert with current standards of post-arrest and intensive care unit care.
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Affiliation(s)
- David F Gaieski
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Ground Ravdin, Philadelphia, PA19104, USA.
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Rim KP, Kim K, Jo YH, Lee JH, Rhee JE, Kang KW, Suh GJ, Kwon WY, Lee MJ, Lee HS. Effect of therapeutic hypothermia according to severity of sepsis in a septic rat model. Cytokine 2012; 60:755-61. [PMID: 22980485 DOI: 10.1016/j.cyto.2012.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/26/2012] [Accepted: 08/13/2012] [Indexed: 11/19/2022]
Abstract
AIM OF STUDY The effects of therapeutic hypothermia (HT) during experimental sepsis may be influenced by disease severity. We experimentally investigated the effect of therapeutic HT on varying disease severity in a septic rat model. MATERIALS AND METHODS An adult male Sprague-Dawley rat model of intra-abdominal sepsis was used. To modify the disease severity, we used two different models; a moderate severe sepsis model (MSSM) and a severe septic shock model (SSSM). All rats were randomized to a hypothermia group (HT, 30-32°C) or a normothermia group (NT, 36-38°C) 1h after sepsis induction in each model. HT was maintained for 4h and rewarming was conducted for 2h. Survival time was recorded for up to 12h in the SSSM group and 24h in the MSSM group. Acute lung and liver injury, cytokine, and malondialdehyde (MDA) levels were investigated 7h after sepsis induction. Hemodynamic profiles were also evaluated. RESULTS In the SSSM, there were survival benefits and reduced acute lung and liver injury with therapeutic HT. Therapeutic HT was also associated with significantly reduced levels of plasma interleukin-6 and tissue malondialdehyde (MDA) levels in the liver and lung compared with the NT group in the SSSM. There was a tendency for the mean arterial pressure to be higher in the HT group compared to the NT group in the SSSM. In MSSM, however, there was no such beneficial effect. CONCLUSION In this rat model of severe septic shock, therapeutic HT showed beneficial effects. In contrast, therapeutic HT did not show protective effect in the moderate sepsis model.
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Affiliation(s)
- Kwang Pil Rim
- Department of Emergency Medicine, Seoul Medical Center, 316 Sinnae-dong, Jungnang-gu, Seoul 131-130, Republic of Korea
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Kelly CK, Hodgson DS, McMurphy RM. Effect of anesthetic breathing circuit type on thermal loss in cats during inhalation anesthesia for ovariohysterectomy. J Am Vet Med Assoc 2012; 240:1296-9. [PMID: 22607595 DOI: 10.2460/javma.240.11.1296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the effects of a nonrebreathing circuit versus a reduced volume circle anesthetic breathing circuit on body temperature change in cats during inhalation anesthesia for ovariohysterectomy. DESIGN Randomized, controlled clinical trial. ANIMALS 141 female domestic cats hospitalized for routine ovariohysterectomy. PROCEDURES Cats were randomly assigned to receive inhalation anesthetics from either a nonrebreathing circuit or a reduced volume circle system with oxygen flow rates of 200 and 30 mL/kg/min (90.9 and 13.6 mL/lb/min), respectively. Body temperatures were monitored throughout the anesthetic period via an intrathoracic esophageal probe placed orally into the esophagus to the level of the heart base. RESULTS No difference in body temperature was found between the 2 treatment groups at any measurement time. The duration of procedure had a significant effect on body temperature regardless of the type of anesthetic circuit used. CONCLUSIONS AND CLINICAL RELEVANCE Duration of the procedure rather than the type of anesthetic circuit used for inhalation anesthesia was more influential on thermal loss in cats undergoing ovariohysterectomy.
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Affiliation(s)
- Christopher K Kelly
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA.
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Perbet S, Mongardon N, Dumas F, Bruel C, Lemiale V, Mourvillier B, Carli P, Varenne O, Mira JP, Wolff M, Cariou A. Early-Onset Pneumonia after Cardiac Arrest. Am J Respir Crit Care Med 2011; 184:1048-54. [DOI: 10.1164/rccm.201102-0331oc] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Oberbaum M, Spira RM, Lukasiewicz E, Armon Y, Samuels N, Singer SR, Barak V, Izbicki G, Einav S, Hersch M. Effect of Traumeel S on cytokine profile in a cecal ligation and puncture (CLP) sepsis model in rats. J Altern Complement Med 2011; 17:909-13. [PMID: 21978221 DOI: 10.1089/acm.2011.0205] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sepsis results in significant morbidity and mortality, with current treatment options limited with respect to efficacy as well as safety. The complex homeopathic remedy Traumeel S has been shown to have both anti-inflammatory and immunostimulatory effects in the in vitro setting. OBJECTIVES The objective was to explore the effects of Traumeel S in an in vivo setting, using a cecal ligation and puncture (CLP) sepsis model in rats, evaluating the effects of the medication on cytokine activity. DESIGN Sepsis was induced in 30 rats using accepted CLP methodology. Following the procedure, rats were randomly allocated to receive an intraperitoneal injection of either Traumeel S (n=15) or normal saline (n=15). At 6 hours post-CLP, serum cytokines (interleukin [IL]-1β, tumor necrosis factor-α, IL-6, and IL-10) were evaluated. RESULTS IL-1β levels were significantly higher in the treatment group (p=0.03) with no significant differences found between the groups with respect to the other cytokines tested. CONCLUSIONS In contrast to in vitro studies, Traumeel significantly increased IL-1β levels in an in vivo model, without influencing other cytokines. IL-1β is a proinflammatory cytokine that has been shown to have a protective effect in the CLP rat model. Further research is warranted to examine this finding, as well as its clinical implications.
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Affiliation(s)
- Menachem Oberbaum
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era*. Crit Care Med 2011; 39:1359-64. [DOI: 10.1097/ccm.0b013e3182120b56] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
OBJECTIVE To develop a juvenile mouse model to establish effects of in vivo hypothermia on expression of the inflammation-modulating cytokines tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and interleukin-10. Although induced hypothermia is neuroprotective in some patients, the mechanisms of protection are not well understood and concerns remain over potential detrimental effects, particularly in the setting of infection. We previously showed that in vitro hypothermia increases production of tumor necrosis factor-alpha and interleukin-1beta in lipopolysaccharide-treated monocytes. DESIGN : Laboratory investigation. SETTING Research laboratory. SUBJECTS Juvenile (4-wk) male C57BL/6 mice. INTERVENTIONS : Mice were given chlorpromazine to suspend thermoregulation and lipopolysaccharide to stimulate cytokine production. Core temperature was maintained at 32 degrees C or 37 degrees C for 6 hrs by adjusting environmental temperature. In separate experiments, lipopolysaccharide-treated mice were kept in a cooling chamber without chlorpromazine treatment. MEASUREMENTS AND MAIN RESULTS Plasma and organs were collected for cytokine quantitation. Chlorpromazine-treated hypothermic mice had 2.3-fold and 1.8-fold higher plasma interleukin-6 and interleukin-10 levels at 6 hrs compared with identically treated normothermic mice (p < .05), whereas plasma tumor necrosis factor-alpha and interleukin-1beta were not significantly different at 2 hrs or 6 hrs. Liver tumor necrosis factor-alpha and interleukin-6 were significantly higher in hypothermic vs. normothermic mice, but lung and brain cytokines were not different. Lipopolysaccharide-treated mice kept in a cooling chamber without chlorpromazine treatment developed varying degrees of hypothermia with associated increases in plasma interleukin-6 and interleukin-10. A nonspecific marker of stress (plasma corticosterone) was not affected by hypothermia in lipopolysaccharide-treated mice. CONCLUSION Further studies are necessary to determine the mechanism and physiologic consequences of augmented systemic interleukin-6 and interleukin-10 expression during induced hypothermia.
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Adachi YU, Obata Y, Suzuki K, Katoh H, Itagaki T, Doi M, Sato S. Nafamostat prevents hypothermia and improves survival time after administration of lipopolysaccharide in a mouse surgical model. J Anesth 2009; 23:624-7. [PMID: 19921382 DOI: 10.1007/s00540-009-0792-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 05/11/2009] [Indexed: 11/30/2022]
Abstract
Lipopolysaccharide (LPS) is an endotoxin known to induce disseminated intravascular coagulation and multiple organ failure followed by septic shock in animals. Nafamostat is a synthetic protease inhibitor with anticoagulant effects. This study investigated the effect of systemic administration of nafamostat on thermogenic homeostasis and survival time in a mouse surgical model. Male C57Bl/6 mice were anesthetized with sevoflurane and implanted with intraabdominal telemetry transmitters. Following the surgery, three groups of animals were administered Escherichia coli LPS (0127: B8) subcutaneously at doses of 0.3, 1.0, or 3.0 mg kg(-1), and one group received saline without LPS. Three other groups received 3 mg.kg(-1) LPS with 1, 3, or 10 mg kg(-1) of nafamostat. In another group 10 mg kg(-1)1 of nafamostat only was administered. The times to the onset of hypothermia (body temperature < 30 degrees C) and death were determined. L LPS significantly shortened the duration of both normothermia and survival, and nafamostat prolonged the normothermic periods that were reduced b 3 mg.kg(-1) LPS. Survival time was significantly correlated with the duration of normothermia (n = 48; r (2) = 0.779; P < 0.000001). The results demonstrated the effect of systemic administration of nafamostat against LPS-induced hypothermia. Nafamostat prevented hypothermia, and the consequent normal thermoregulation may have prolonged the survival period.
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Affiliation(s)
- Yushi U Adachi
- Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu city, Japan
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Respiratory failure and abdominal sepsis: Time to focus on diaphragm is back*. Crit Care Med 2009; 37:2669-70. [DOI: 10.1097/ccm.0b013e3181b003ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morita Y, Oda S, Sadahiro T, Nakamura M, Oshima T, Otani S, Hirasawa H. The effects of body temperature control on cytokine production in a rat model of ventilator-induced lung injury. Cytokine 2009; 47:48-55. [DOI: 10.1016/j.cyto.2009.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 03/18/2009] [Accepted: 04/09/2009] [Indexed: 11/24/2022]
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Secher T, Vasseur V, Poisson DM, Mitchell JA, Cunha FQ, Alves-Filho JC, Ryffel B. Crucial role of TNF receptors 1 and 2 in the control of polymicrobial sepsis. THE JOURNAL OF IMMUNOLOGY 2009; 182:7855-64. [PMID: 19494310 DOI: 10.4049/jimmunol.0804008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sepsis is still a major cause of mortality in the intensive critical care unit and results from an overwhelming immune response to the infection. TNF signaling pathway plays a central role in the activation of innate immunity in response to pathogens. Using a model of polymicrobial sepsis by i.p. injection of cecal microflora, we demonstrate a critical role of TNFR1 and R2 activation in the deregulated immune responses and death associated with sepsis. A large and persistent production of TNF was found in wild-type (B6) mice. TNFR1/R2-deficient mice, compared with B6 mice, survive lethal polymicrobial infection with enhanced neutrophil recruitment and bacterial clearance in the peritoneal cavity. Absence of TNFR signaling leads to a decreased local and systemic inflammatory response with diminished organ injury. Furthermore, using TNFR1/R2-deficient mice, TNF was found to be responsible for a decrease in CXCR2 expression, explaining reduced neutrophil extravasation and migration to the infectious site, and in neutrophil apoptosis. In line with the clinical experience, administration of Enbrel, a TNF-neutralizing protein, induced however only a partial protection in B6 mice, with no improvement of clinical settings, suggesting that future TNF immunomodulatory strategies should target TNFR1 and R2. In conclusion, the present data suggest that the endogenous TNFR1/R2 signaling pathway in polymicrobial sepsis reduces neutrophil recruitment contributing to mortality and as opposed to pan-TNF blockade is an important therapeutic target for the treatment of polymicrobial sepsis.
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Affiliation(s)
- Thomas Secher
- Molecular Immunology and Embryology, University of Orleans and Centre National de la Recherche Scientifique, France
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Abstract
BACKGROUND Induced hypothermia is a promising neuroprotective treatment for acute ischemic stroke. Data from both global and focal ischemia animal models have been encouraging. However, only a few small clinical studies have investigated its use in humans. OBJECTIVE To review the background, possible mechanisms of action, and the preclinical and clinical data supporting the neuroprotective role of induced hypothermia following acute ischemic stroke. METHODS A literature search was performed using the PubMed database. Only papers in English were reviewed. RESULTS/CONCLUSIONS Induced hypothermia is effective as a neuroprotectant in animal models of acute ischemic stroke. Its multimodal mechanism of action makes it a very attractive method of neuroprotection. Although human studies suggest it is safe and feasible, larger randomized controlled trials are necessary to address clinical efficacy and to refine the methods and parameters of induced hypothermia protocols.
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Affiliation(s)
- Marc A Lazzaro
- Rush University Medical Center, Department of Neurological Sciences, 1725 W. Harrison Street, Suite 1121, Chicago, IL 60612, USA.
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Sedative effects of Mozartʼs music in the critically ill: Enjoy the hormonal symphony *. Crit Care Med 2007. [DOI: 10.1097/00003246-200712000-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huet O, Kinirons B, Dupic L, Lajeunie E, Mazoit JX, Benhamou D, Vicaut E, Duranteau J. Induced mild hypothermia reduces mortality during acute inflammation in rats. Acta Anaesthesiol Scand 2007; 51:1211-6. [PMID: 17850561 DOI: 10.1111/j.1399-6576.2007.01419.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hypothermia has been proposed as a therapeutic possibility in brain trauma, cardiac arrest and hemorrhagic shock. Experimental studies have shown that hypothermia may act by modulating the inflammatory response during endotoxemia. This study was carried out to test whether hypothermia could protect rats from endotoxemic insult. METHODS After general anesthesia and oro-tracheal intubation, Sprague-Dawley rats were randomly assigned to either a hypothermic group or normothermic group. In each group, rats received intraperitoneal lipopolysaccharide (LPS) (10 or 20 mg/kg). Blood samples were taken prior to and 2 h after LPS injection to measure blood gases, liver enzymes, muscular enzymes, tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) plasma levels. After 2 h of hypothermia, the rats were extubated and brought back to their cages. The mortality rate was observed for 7 days following endotoxemia. In a second set of experiments, hypothermia was induced 1 h after endotoxemia (10 mg/kg of intraperitoneal LPS) and the mortality rate was observed for the following 7 days. RESULTS The survival rate was significantly increased in the hypothermic group relative to the normothermic group, regardless of LPS dose. This increased survival rate was also observed when hypothermia was induced 1 h after endotoxemia. In the hypothermic group, IL-10 and the DeltaIL-10/DeltaTNF-alpha ratio were significantly increased relative to those in the normothermic group. CONCLUSION Induced mild hypothermia reduces mortality during endotoxemia in rats. The modulation of the inflammatory response, with an increase in anti-inflammatory cytokines, may be involved in this protective effect.
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Affiliation(s)
- O Huet
- Université Paris XI, Département d'Anesthésie Réanimation, Hôpital Bicêtre, Le Kremlin Bicêtre, France
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Abstract
Three important issues concerning homeostasis in the acute care of trauma patients that are related directly to the stress response are hyperglycemia, lactic acidosis, and hypothermia. Recently, there has been a resurgence of interest in investigating the effects of aggressive thermal and glucose concentration and volume resuscitation on outcomes in critically ill and trauma patients. Significant reason exists to question the "conventional wisdom" relating to current approaches to restoring homeostasis in this patient population.
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Affiliation(s)
- Dimitry Baranov
- Department of Anesthesiology and Critical Care, Hospital of University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Wong PF, Kumar S, Leaper DJ. Systemic Warming as an Adjunct to Resuscitation in Peritonitis: A Pilot, Randomized Controlled Trial. Surg Infect (Larchmt) 2007; 8:387-95. [PMID: 17635062 DOI: 10.1089/sur.2006.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bacterial peritonitis is accompanied by a high risk of sepsis and endotoxin production resulting in physiological derangements and a high mortality rate. Localized and systemic warming improves tissue perfusion, oxygen tension, and outcomes after surgery. The purpose of this study was to examine the effectiveness of systemic warming as an adjunct to standard antibiotic and fluid resuscitation in patients with peritonitis. METHODS In this pilot randomized controlled trial, patients presenting with an acute abdomen were randomized into control and warmed groups using sequential envelopes. Local Ethics Committee approval was obtained. Systemic warming was delivered using the Inditherm warming mattress set at 40 degrees C. Standard oxygen, fluid resuscitation, and antibiotics were delivered simultaneously. Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded on admission and 24 h later or just prior to surgery, whichever was earlier. RESULTS Thirty-three patients were recruited. The APACHE II scores on admission were comparable (median 9.0 [range 2-23] and 9.0 [0-20], respectively, for the control and warmed groups (p = 0.70; Mann-Whitney U test)). No patient showed any adverse effects of warming. There were statistically significant improvements in APACHE II scores (p = 0.028; Wilcoxon signed ranks test) and the magnitude of its change (p = 0.048; Mann-Whitney U test) in the warmed group compared with the control group. CONCLUSIONS Systemic warming may reduce physiological derangements and improve the prognosis in patients with intra-abdominal crisis. The technique may be used safely as an adjunct to standard resuscitation in peritonitis.
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Affiliation(s)
- Peng Foo Wong
- Department of Surgery, James Cook University Hospital, Middlesbrough, Cleveland, United Kingdom.
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Abstract
BACKGROUND AND OBJECTIVES Inadvertent perioperative hypothermia causes serious morbidity in surgical patients. However, recent reports suggest that patients might still be hypothermic after elective surgery. We thus surveyed intraoperative temperature monitoring and management practices in Europe. METHODS Postal survey of 801 representative hospitals from 17 European countries on the same day. The questions addressed the number of surgical procedures and type of anaesthesia performed, mode and site of temperature monitoring and method of patient warming. Mean and standard error of the mean or count and percentage were calculated. The t-test or contingency table analysis with the Fisher's exact test were used. RESULTS Eight thousand and eighty-three surgical procedures were assessed from 316 responding hospitals (39.4%). Overall, patient temperature monitored in 19.4% and 38.5% of the patients were actively warmed. Under general anaesthesia, body temperature was monitored in 25% and during regional anaesthesia in 6%, P = 0.0005. Nasopharyngeal temperature was most often taken under general anaesthesia, while tympanic temperature was preferred during regional anaesthesia. Under general anaesthesia, 43% of patients were actively warmed as compared to 28% with regional anaesthesia, P = 0.0005. Forced-air warming was the method of choice for both general and regional anaesthesia. CONCLUSIONS Intraoperative temperature monitoring is still uncommon and hence active patient warming is not a standard of care in Europe. Awareness of perioperative hypothermia is critical to its prevention, and thus temperature monitoring is a pre-requisite. The objective is to maintain normothermia in patients throughout surgery. A European practice guideline for perioperative patient temperature management is warranted.
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Affiliation(s)
- A Torossian
- University Hospital Marburg, Department of Anaesthesia and Intensive Care Medicine, Germany.
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Lindenblatt N, Menger MD, Klar E, Vollmar B. Systemic hypothermia increases PAI-1 expression and accelerates microvascular thrombus formation in endotoxemic mice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 10:R148. [PMID: 17062126 PMCID: PMC1751084 DOI: 10.1186/cc5074] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 08/15/2006] [Accepted: 10/24/2006] [Indexed: 11/19/2022]
Abstract
Introduction Hypothermia during sepsis significantly impairs patient outcome in clinical practice. Severe sepsis is closely linked to activation of the coagulation system, resulting in microthrombosis and subsequent organ failure. Herein, we studied whether systemic hypothermia accelerates microvascular thrombus formation during lipopolysacharide (LPS)-induced endotoxemia in vivo, and characterized the low temperature-induced endothelial and platelet dysfunctions. Methods Ferric-chloride induced microvascular thrombus formation was analyzed in cremaster muscles of hypothermic endotoxemic mice. Flow cytometry, ELISA and immunohistochemistry were used to evaluate the effect of hypothermia on endothelial and platelet function. Results Control animals at 37°C revealed complete occlusion of arterioles and venules after 759 ± 115 s and 744 ± 112 s, respectively. Endotoxemia significantly (p < 0.05) accelerated arteriolar and venular occlusion in 37°C animals (255 ± 35 s and 238 ± 58 s, respectively). This was associated with an increase of circulating endothelial activation markers, agonist-induced platelet reactivity, and endothelial P-selectin and plasminogen activator inhibitor (PAI)-1 expression. Systemic hypothermia of 34°C revealed a slight but not significant reduction of arteriolar (224 ± 35 s) and venular (183 ± 35 s) occlusion times. Cooling of the endotoxemic animals to 31°C core body temperature, however, resulted in a further acceleration of microvascular thrombus formation, in particular in arterioles (127 ± 29 s, p < 0.05 versus 37°C endotoxemic animals). Of interest, hypothermia did not affect endothelial receptor expression and platelet reactivity, but increased endothelial PAI-1 expression and, in particular, soluble PAI-1 antigen (sPAI-Ag) plasma levels. Conclusion LPS-induced endotoxemia accelerates microvascular thrombus formation in vivo, most probably by generalized endothelial activation and increased platelet reactivity. Systemic hypothermia further enhances microthrombosis in endotoxemia. This effect is associated with increased endothelial PAI-1 expression and sPAI-Ag in the systemic circulation rather than further endothelial activation or modulation of platelet reactivity.
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Affiliation(s)
- Nicole Lindenblatt
- Department of Experimental Surgery, University of Rostock, Schillingallee, Rostock 18055, Germany
- Department of General Surgery, University of Rostock, Schillingallee, Rostock, 18055, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, University of Saarland, Kirrberger Straße, Homburg-Saar, 66424, Germany
| | - Ernst Klar
- Department of General Surgery, University of Rostock, Schillingallee, Rostock, 18055, Germany
| | - Brigitte Vollmar
- Department of Experimental Surgery, University of Rostock, Schillingallee, Rostock 18055, Germany
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Abstract
OBJECTIVES The potential advantages of lowering core temperature during sepsis are to lower energy requirement and to activate various cell-protecting pathways. We experimentally investigated whether postconditioning temperature modifications influence survival duration during experimental sepsis. DESIGN A prospective, randomized, experimental animal study. SETTING University laboratory. SUBJECTS Eighteen male Sprague-Dawley rats (median 326 g, range 310-347 g). INTERVENTIONS After anesthesia, experimental sepsis was induced by cecal ligation and perforation. The animals were subsequently assigned a core temperature range: normothermia (37 degrees C), hyperthermia (42 degrees C), and mild hypothermia (32 degrees C). Anesthesia and analgesia were continuously maintained until death. MEASUREMENTS AND MAIN RESULTS Plasma lactate and pyruvate concentrations were measured at sepsis induction (H0), 4 hrs later (H4), and/or at the time of death. A significant increase in lactate concentration was observed at the time of death in the 42 degrees C group (p = .04). Lactate-to-pyruvate ratio increased in the 32 degrees C (at H4) and 42 degrees C (at the time of death) groups (p = .04). A linear correlation between a longer survival duration and a lower assigned core temperature was observed (from 61 +/- 10 mins at 42 degrees C to 289 +/- 17 mins at 37 degrees C and to 533 +/- 69 mins at 32 degrees C; R = .959, p < .0001). CONCLUSIONS The current results demonstrate that postconditioning hypothermia was associated with increased survival duration during experimental sepsis. Whether the observed benefits on survival duration are due to potential impacts on energy metabolism or to an anti-inflammatory effect of hypothermia requires further investigation.
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Affiliation(s)
- Erwan L'Her
- Medical Intensive Care Unit, University Hospital, Brest Cedex, France
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40
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Abstract
The best defense against postoperative infection is to use multiple strategies to minimize wound contamination, maintain wound tissue health, and provide rational antimicrobial strategies that do not promote the development of resistant bacteria and superinfections.
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Affiliation(s)
- Elizabeth M Santschi
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive Madison, Wisconsin 53706, USA.
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Shafi S, Elliott AC, Gentilello L. Is Hypothermia Simply a Marker of Shock and Injury Severity or an Independent Risk Factor for Mortality in Trauma Patients? Analysis of a Large National Trauma Registry. ACTA ACUST UNITED AC 2005; 59:1081-5. [PMID: 16385283 DOI: 10.1097/01.ta.0000188647.03665.fd] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Successful application of induced hypothermia (HT) after stroke and cardiac arrest has led to a resurgence of interest in its potential protective effects in trauma patients. Although clinical studies demonstrate an adverse effect, they consist of small studies from single institutions. We tested the hypothesis that HT is associated with improved survival in trauma patients by analyzing a large, national trauma database. METHODS The study included all patients in the National Trauma Data Bank (1994-2002) aged 18 to 55 years old with temperature at presentation to the emergency department and base deficit (BD) recorded. Hypothermic (temperature, <35 degrees C; n = 3267) patients and patients with normothermia (temperature, > or =35 degrees C; n = 35,283) patients were compared. Two analyses were conducted to control for the association between HT and injury severity. First, hypothermic and normothermic (NT) patients were stratified by injury severity score (ISS) and shock (blood pressure < or = 90 mm Hg). Next, logistic regression was used to control for effects of age, sex, mechanism, ISS, head, chest, and abdominal injuries, BP, Glasgow Coma Scale score, and BD, with survival as the dependent and HT as the predictor variable. RESULTS Although HT was more common in more seriously injured patients, stratified analysis revealed that hypothermic patients have significantly higher mortality than patients with the same severity of injury who remain NT. Even after controlling for injury severity and the other potential confounders listed above, HT remained a strong, independent predictor of mortality (odds ratio, 1.19; 95% confidence interval, 1.05-1.35). CONCLUSION There is no apparent protective effect of HT in trauma patients. HT itself, not just its association with shock, injury severity, and other cofactors lead to a significant increase in mortality in injured patients. Continued, aggressive efforts to prevent and treat HT are warranted.
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Affiliation(s)
- Shahid Shafi
- Department of Surgery, Division of Burn, Trauma and Surgical Critical Care, University of Texas Southwestern Medical School, Dallas, Texas 75390-9158, USA.
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Mergner D, Rosenberger P, Unertl K, Eltzschig HK. [Preoperative evaluation and perioperative management of patients with increased cardiovascular risk]. Anaesthesist 2005; 54:427-41. [PMID: 15815886 DOI: 10.1007/s00101-005-0846-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Due to the increasing age in western countries, combined with high rates of major surgical interventions in high-risk patients, perioperative reduction of cardiovascular complications becomes increasingly more important for perioperative physicians. After identifying patients with increased perioperative risk, specific interventions need to be considered to reduce their risk for cardiovascular complications, either by perioperative medical therapy or specific treatment options (e.g. coronary intervention). Several trials have demonstrated an effect of perioperative beta-blocker-therapy in reducing cardiovascular complications among high-risk patients. Additionally, several monitoring techniques are effective in detecting cardiovascular complications. Nevertheless, it remains unclear whether they are associated with a measurable improvement of outcome. Based on the ACC/AHA-guidelines, the present review describes a stepwise approach to surgical patients to identify perioperative risks, based on specific patient related risk factors, the kind of surgery and on the specific setting (emergency versus elective surgery). In addition, strategies to reduce perioperative cardiovascular complications are discussed.
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Affiliation(s)
- D Mergner
- Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum, Tübingen
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Mantz J, Paugam-Burtz C. Hypothermia, sepsis, and the granulocytes: Lessons to learn beyond the cytokines*. Crit Care Med 2004; 32:1974-5. [PMID: 15343036 DOI: 10.1097/01.ccm.0000139609.74207.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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