1
|
Abstract
PURPOSE OF REVIEW Fever is common after acute brain injury and is associated with poor prognosis in this setting. RECENT FINDINGS Achieving normothermia is feasible in patients with ischemic or hemorrhagic stroke, subarachnoid hemorrhage and traumatic brain injury. Pharmacological strategies (i.e. paracetamol or nonsteroidal anti-inflammatory drugs) are frequently ineffective and physical (i.e. cooling devices) therapies are often required. There are no good quality data supporting any benefit from therapeutic strategies aiming at normothermia in all brain injured patients when compared with standard of care, where mild-to-moderate fever is tolerated. However, recent guidelines recommended fever control in this setting. SUMMARY As fever is considered a clinically relevant secondary brain damage, we have provided an individualized therapeutic approach to treat it in brain injured patients, which deserved further validation in the clinical setting.
Collapse
Affiliation(s)
- Elisa Gouvea Bogossian
- Department of Intensive Care, Erasmus Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | |
Collapse
|
2
|
Singer D. Pediatric Hypothermia: An Ambiguous Issue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11484. [PMID: 34769999 PMCID: PMC8583576 DOI: 10.3390/ijerph182111484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023]
Abstract
Hypothermia in pediatrics is mainly about small body size. The key thermal factor here is the large surface-to-volume ratio. Although small mammals, including human infants and children, are adapted to higher heat losses through their elevated metabolic rate and thermogenic capacity, they are still at risk of hypothermia because of a small regulatory range and an impending metabolic exhaustion. However, some small mammalian species (hibernators) use reduced metabolic rates and lowered body temperatures as adaptations to impaired energy supply. Similar to nature, hypothermia has contradictory effects in clinical pediatrics as well: In neonates, it is a serious risk factor affecting respiratory adaptation in term and developmental outcome in preterm infants. On the other hand, it is an important self-protective response to neonatal hypoxia and an evidence-based treatment option for asphyxiated babies. In children, hypothermia first enabled the surgical repair of congenital heart defects and promotes favorable outcome after ice water drowning. Yet, it is also a major threat in various prehospital and clinical settings and has no proven therapeutic benefit in pediatric critical care. All in all, pediatric hypothermia is an ambiguous issue whose harmful or beneficial effects strongly depend on the particular circumstances.
Collapse
Affiliation(s)
- Dominique Singer
- Division of Neonatology and Pediatric Critical Care Medicine, University Medical Center Eppendorf, 20246 Hamburg, Germany
| |
Collapse
|
3
|
D'Eramo RE, Nadpara PA, Sandler M, Taylor PD, Brophy GM. Intravenous Versus Oral Acetaminophen Use in Febrile Neurocritical Care Patients. Ther Hypothermia Temp Manag 2021; 12:155-158. [PMID: 34550800 DOI: 10.1089/ther.2021.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The use of intravenous (IV) acetaminophen (APAP) for fever has not been thoroughly studied in neurocritical care (NCC) patients, in whom a temperature of ≥38°C is associated with poor outcomes and treatment to normothermia is common practice. This retrospective study evaluated NCC patients admitted between May 1, 2012, and April 30, 2013, and received at least one dose of IV or oral (PO) APAP for a body temperature of ≥38°C. The primary aim of this study was to compare the reduction in body temperature (RIT) between IV and PO APAP, calculated as the change in temperature before and 0.5, 1, 2, 3, and 6 hours after administration. Descriptive statistics were used to assess use characteristics, and Kruskal-Wallis and Mann-Whitney U tests were used for between-group differences. There were 142 NCC patients who received a total of 405 IV APAP and 253 PO APAP doses. Seventy percent of all APAP doses resulted in a temperature of <38°C within 6 hours. The median oral body temperature before APAP was 38.8°C and 38.6°C for IV and PO APAP, respectively (p < 0.01). The median RIT at 0.5 (IV 0.25°C vs. PO 0.2°C), 1 (IV 0.4°C vs. PO 0.2°C), 2 (IV 0.7°C vs. PO 0.5°C), 3 (IV 0.9°C vs. PO 0.6°C), and 6 (IV 1°C vs. PO 0.8°C) hours was significantly greater for IV APAP than for PO APAP at all time points (p < 0.05). Patients with an acute ischemic stroke and patients with an intracerebral hemorrhage had a statistically significantly greater RIT with IV APAP therapy. IV APAP administered to febrile NCC patients was associated with a significantly greater RIT than PO, but 70% of all APAP doses resulted in a body temperature of <38°C within 6 hours. Further prospective studies are needed to determine if IV APAP improves clinical outcomes.
Collapse
Affiliation(s)
- Robert E D'Eramo
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA.,Department of Pharmacy, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Pramit A Nadpara
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA
| | - Melissa Sandler
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Perry D Taylor
- Department of Pharmacy, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Gretchen M Brophy
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA.,Department of Pharmacy, Virginia Commonwealth University Health, Richmond, Virginia, USA
| |
Collapse
|
4
|
Kim YM, Jeung KW, Kim WY, Park YS, Oh JS, You YH, Lee DH, Chae MK, Jeong YJ, Kim MC, Ha EJ, Hwang KJ, Kim WS, Lee JM, Cha KC, Chung SP, Park JD, Kim HS, Lee MJ, Na SH, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care. Clin Exp Emerg Med 2021; 8:S41-S64. [PMID: 34034449 PMCID: PMC8171174 DOI: 10.15441/ceem.21.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Suk Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minjung Kathy Chae
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Yoo Jin Jeong
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Min Chul Kim
- Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Eun Jin Ha
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Jin Hwang
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Myung Lee
- Department of General Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, Kyoungbook University College of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - on behalf of the Steering Committee of 2020 Korean Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
- Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of General Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Kyoungbook University College of Medicine, Daegu, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Greer DM, Ritter J, Helbok R, Badjatia N, Ko SB, Guanci M, Sheth KN. Impact of Fever Prevention in Brain-Injured Patients (INTREPID): Study Protocol for a Randomized Controlled Trial. Neurocrit Care 2021; 35:577-589. [PMID: 33761119 DOI: 10.1007/s12028-021-01208-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple studies demonstrate that fever/elevated temperature is associated with poor outcomes in patients with vascular brain injury; however, there are no conclusive studies that demonstrate that fever prevention/controlled normothermia is associated with better outcomes. The primary objective of the INTREPID (Impact of Fever Prevention in Brain-Injured Patients) trial is to test the hypothesis that fever prevention is superior to standard temperature management in patients with acute vascular brain injury. METHODS INTREPID is a prospective randomized open blinded endpoint study of fever prevention versus usual care in patients with ischemic or hemorrhagic stroke. The fever prevention intervention utilizes the Arctic Sun System and will be compared to standard care patients in whom fever may spontaneously develop. Ischemic stroke, intracerebral hemorrhage or subarachnoid hemorrhage patients will be included within disease-specific time-windows. Both awake and sedated patients will be included, and treatment is initiated immediately upon enrollment. Eligible patients are expected to require intensive care for at least 72 h post-injury, will not be deemed unlikely to survive without severe disability, and will be treated for up to 14 days, or until deemed ready for discharge from the ICU, whichever comes first. Fifty sites in the USA and worldwide will participate, with a target enrollment of 1176 patients (1000 evaluable). The target temperature is 37.0 °C. The primary efficacy outcome is the total fever burden by °C-h, defined as the area under the temperature curve above 37.9 °C. The primary secondary outcome, on which the sample size is based, is the modified Rankin Scale Score at 3 months. All efficacy analyses including the primary and key secondary endpoints will be primarily based on an intention-to-treat population. Analysis of the as-treated and per protocol populations will also be performed on the primary and key secondary endpoints as sensitivity analyses. DISCUSSION The INTREPID trial will provide the first results of the impact of a pivotal fever prevention intervention in patients with acute stroke ( www.clinicaltrials.gov ; NCT02996266; registered prospectively 05DEC2016).
Collapse
Affiliation(s)
- David M Greer
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Collamore 3, Suite 338, 72 East Concord Street, Boston, MA, USA.
| | - Jaime Ritter
- Becton Dickenson & Company, Franklin Lakes, NJ, USA
| | - Raimund Helbok
- Department of Neurology, Neurology Medical University of Innsbruck, Anichstreet 65, 6020, Innsbruck, Austria
| | - Neeraj Badjatia
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, USA
| | - Sang-Bae Ko
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Collamore 3, Suite 338, 72 East Concord Street, Boston, MA, USA
| | - Mary Guanci
- Neurocritical Care Unit, Massachusetts General Hospital, Lunder Building 6th Floor, 55 Fruit Street, Boston, MA, USA
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, 15 York Street, LCI 1003, New Haven, CT, USA
| |
Collapse
|
6
|
Chiwaula CH, Kanjakaya P, Chipeta D, Chikatipwa A, Kalimbuka T, Zyambo L, Nkata S, Jere DL. Introducing evidence based practice in nursing care delivery, utilizing the Iowa model in intensive care unit at Kamuzu Central Hospital, Malawi. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2020.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
7
|
Feasibility and Safety of Transnasal High Flow Air to Reduce Core Body Temperature in Febrile Neurocritical Care Patients: A Pilot Study. Neurocrit Care 2020; 31:280-287. [PMID: 30919302 DOI: 10.1007/s12028-019-00702-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fever is an important determinant of prognosis following acute brain injury. Current non-pharmacologic techniques to reduce fever are limited and induce a shivering response. We investigated the safety and efficacy of a novel transnasal unidirectional high flow air device in reducing core body temperature in the neurocritical care unit (NCCU) setting. METHODS This pilot study included seven consecutive patients in the NCCU who were febrile (> 37.5 °C) for > 24 h despite standard non-pharmacologic and first-line antipyretic agents. Medical grade high flow air was delivered transnasally using a standard continuous positive airway pressure machine with a positive pressure of 20 cmH2O for 2 h. Core esophageal and tympanic temperature were continuously monitored. RESULTS Mean age was 40 ± 14 yo, and 72% (5/7 patients) were men. Five patients had intracerebral or intraventricular hemorrhage, one subject had transverse myelitis, and the remaining patient had anoxic brain injury due to a cardiac arrest. After 2 h of cooling, core temperature was significantly lower than the baseline pre-cooling temperature (37.3 ± 0.5 °C vs. 38.4 ± 0.6 °C; p < 0.002). Mean transnasal airflow rate was 57.5 ± 6.5 liters per minute. Five of the seven subjects were normothermic at the end of the 2-h period. One subject with severe hyperthermia (39.7 °C) and the other with multiple interruptions to therapy due to technical reasons did not cool. The core temperature within 30 min of cessation of airflow increased and was similar to the pre-cooling baseline temperature (38.3 ± 0.4 °C vs. 38.4 ± 0.6 °C, p = NS). Rate of core cooling was 0.6 ± 0.15 °C per hour at this flow rate. No shivering response was observed. No protocol-related adverse events occurred. CONCLUSIONS High flow transnasal air in a unidirectional fashion lowers core body temperature in febrile patients in the NCCU setting. No adverse events were seen, and the process showed no signs of shivering or any other serious side effects during short-term exposure. This pilot study should inform further investigation.
Collapse
|
8
|
Systemic Hyperthermia in Traumatic Brain Injury-Relation to Intracranial Pressure Dynamics, Cerebral Energy Metabolism, and Clinical Outcome. J Neurosurg Anesthesiol 2020; 33:329-336. [PMID: 32433101 DOI: 10.1097/ana.0000000000000695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Systemic hyperthermia is common after traumatic brain injury (TBI) and may induce secondary brain injury, although the pathophysiology is not fully understood. In this study, our aim was to determine the incidence and temporal course of hyperthermia after TBI and its relation to intracranial pressure dynamics, cerebral metabolism, and clinical outcomes. MATERIALS AND METHODS This retrospective study included 115 TBI patients. Data from systemic physiology (body temperature, blood pressure, and arterial glucose), intracranial pressure dynamics (intracranial pressure, cerebral perfusion pressure, compliance, and pressure reactivity), and cerebral microdialysis (glucose, pyruvate, lactate, glycerol, glutamate, and urea) were analyzed during the first 10 days after injury. RESULTS Overall, 6% of patients did not have hyperthermia (T>38°C) during the first 10 days after injury, whereas 20% had hyperthermia for >50% of the time. Hyperthermia increased from 21% (±27%) of monitoring time on day 1 to 36% (±29%) on days 6 to 10 after injury. In univariate analyses, higher body temperature was not associated with higher intracranial pressure nor lower cerebral perfusion pressure, but was associated with lower cerebral glucose concentration (P=0.001) and higher percentage of lactate-pyruvate ratio>25 (P=0.02) on days 6 to 10 after injury. Higher body temperature and lower arterial glucose concentration were associated with lower cerebral glucose in a multiple linear regression analysis (P=0.02 for both). There was no association between hyperthermia and worse clinical outcomes. CONCLUSION Hyperthermia was most common between days 6 and 10 following TBI, and associated with disturbances in cerebral energy metabolism but not worse clinical outcome.
Collapse
|
9
|
Treating Paroxysmal Sympathetic Hyperactivity With Enteral Baclofen in Anoxic Brain Injury. Neurologist 2020; 25:24-25. [DOI: 10.1097/nrl.0000000000000258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Effect of selective brain cooling versus core cooling on achieving target temperature among patients with severe traumatic brain injury. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
11
|
Abstract
Pharmacologic and nonpharmacologic interventions are available to treat patients who experience serious elevations in intracranial pressure (ICP). In some cases, patients may experience ICP that is refractory to treatment. Significant negative effects on cerebral blood flow, tissue oxygenation, and cerebral metabolism occur as a result of intracranial hypertension, leading to secondary brain injury. In part 2 of this series, nonpharmacologic interventions for ICP and ICP refractory to treatment are discussed. Interventions include neurologic monitoring (bedside assessment and multimodal monitoring), ventilatory support, fluid and electrolyte maintenance, targeted temperature management, and surgical intervention. Technology is always evolving, and the focus of multimodal monitoring here includes devices to monitor ICP, brain tissue oxygen tension, and cerebral blood flow and cerebral microdialysis monitors. Nursing care of these patients includes perspicacious assessment and integration of data, monitoring ventilatory and hemodynamic functioning, and appropriate patient positioning. Nurses must collaborate with the interprofessional care team to ensure favorable patient outcomes while utilizing an evidence-based guideline for the management of ICP.
Collapse
|
12
|
Effect of Body Temperature on Cerebral Autoregulation in Acutely Comatose Neurocritically Ill Patients. Crit Care Med 2019; 46:e733-e741. [PMID: 29727362 DOI: 10.1097/ccm.0000000000003181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Impaired cerebral autoregulation following neurologic injury is a predictor of poor clinical outcome. We aimed to assess the relationship between body temperature and cerebral autoregulation in comatose patients. DESIGN Retrospective analysis of prospectively collected data. SETTING Neurocritical care unit of the Johns Hopkins Hospital. PATIENTS Eighty-five acutely comatose patients (Glasgow Coma Scale score of ≤ 8) admitted between 2013 and 2017. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS Cerebral autoregulation was monitored using multimodal monitoring with near-infrared spectroscopy-derived cerebral oximetry index. Cerebral oximetry index was calculated as a Pearson correlation coefficient between low-frequency changes in regional cerebral oxygenation saturation and mean arterial pressure. Patients were initially analyzed together, then stratified by temperature pattern over the monitoring period: no change (< 1°C difference between highest and lowest temperatures; n = 11), increasing (≥ 1°C; n = 9), decreasing (≥ 1°C; n = 9), and fluctuating (≥ 1°C difference but no sustained direction of change; n = 56). Mixed random effects models with random intercept and multivariable logistic regression analysis were used to assess the association between hourly temperature and cerebral oximetry index, as well as between temperature and clinical outcomes. Cerebral oximetry index showed a positive linear relationship with temperature (β = 0.04 ± 0.10; p = 0.29). In patients where a continual increase or decrease in temperature was seen during the monitoring period, every 1°C change in temperature resulted in a cerebral oximetry index change in the same direction by 0.04 ± 0.01 (p < 0.001) and 0.02 ± 0.01 (p = 0.12), respectively, after adjusting for PaCO2, hemoglobin, mean arterial pressure, vasopressor and sedation use, and temperature probe location. There was no significant difference in mortality or poor outcome (modified Rankin Scale score of 4-6) between temperature pattern groups at discharge, 3, or 6 months. CONCLUSIONS In acute coma patients, increasing body temperature is associated with worsening cerebral autoregulation as measured by cerebral oximetry index. More studies are needed to clarify the impact of increasing temperature on cerebral autoregulation in patients with acute brain injury.
Collapse
|
13
|
Abstract
Neurological diseases frequently demanding admittance to a dedicated neurological intensive care unit (neurocritical care) comprise space-occupying ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, status epilepticus, bacterial meningitis, myasthenic crisis and Guillain-Barré syndrome. Due to often necessary analgesia, sedation and mechanical ventilation, neuromonitoring should ideally be employed. This consists of bedside invasive and non-invasive methods for monitoring cerebral perfusion, oxygenation, metabolism and neurophysiology. Modern treatment principles in neurocritical care mainly aim at avoiding or attenuating secondary neurological brain damage, in particular directed at sufficient perfusion and oxygenation. These include measures such as neuroprotective ventilation, stabilization of the circulation, decreasing intracranial pressure in brain edema and space-occupying processes, anticonvulsive treatment, temperature management and targeted disease-specific treatment.
Collapse
Affiliation(s)
- Julian Bösel
- Klinik für Neurologie, Klinikum Kassel, Mönchebergstr. 41-43, 34125, Kassel, Deutschland.
| |
Collapse
|
14
|
Naiman M, Markota A, Hegazy A, Dingley J, Kulstad E. Retrospective Analysis of Esophageal Heat Transfer for Active Temperature Management in Post-cardiac Arrest, Refractory Fever, and Burn Patients. Mil Med 2019; 183:162-168. [PMID: 29635598 PMCID: PMC6490293 DOI: 10.1093/milmed/usx207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 01/02/2018] [Indexed: 01/16/2023] Open
Abstract
Core temperature management is an important aspect of critical care; preventing unintentional hypothermia, reducing fever, and inducing therapeutic hypothermia when appropriate are each tied to positive health outcomes. The purpose of this study is to evaluate the performance of a new temperature management device that uses the esophageal environment to conduct heat transfer. De-identified patient data were aggregated from three clinical sites where an esophageal heat transfer device (EHTD) was used to provide temperature management. The device was evaluated against temperature management guidelines and best practice recommendations, including performance during induction, maintenance, and cessation of therapy. Across all active cooling protocols, the average time-to-target was 2.37 h and the average maintenance phase was 22.4 h. Patients spent 94.9% of the maintenance phase within ±1.0°C and 67.2% within ±0.5°C (574 and 407 measurements, respectively, out of 605 total). For warming protocols, all of the patient temperature readings remained above 36°C throughout the surgical procedure (average 4.66 h). The esophageal heat transfer device met performance expectations across a range of temperature management applications in intensive care and burn units. Patients met and maintained temperature goals without any reported adverse events.
Collapse
Affiliation(s)
- Melissa Naiman
- Collaborative for Advanced Research, Design, and Evaluation, University of Illinois at Chicago, 2121W. Taylor Street #540, Chicago, IL 60612
| | - Andrej Markota
- Medical Intensive Care Unit, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Ahmed Hegazy
- Department of Anesthesia & Perioperative Medicine, University Hospital, Rm. C3-108, London, ON, Canada N6A 5A5
| | - John Dingley
- Welsh Centre for Burns, ABM University Health Board, Morriston Hospital, Swansea SA6 6NL, UK
| | - Erik Kulstad
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| |
Collapse
|
15
|
Mauricio ECB, Lopes MCBT, Batista REA, Okuno MFP, Campanharo CRV. Results of the implementation of integrated care after cardiorespiratory arrest in a university hospital. Rev Lat Am Enfermagem 2018; 26:e2993. [PMID: 30020334 PMCID: PMC6053291 DOI: 10.1590/1518-8345.2308.2993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/26/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to identify the care measures performed after cardiorespiratory arrest (CRA) and to relate them to the neurological status and survival at four moments: within the first 24 hours, at the discharge, six months after discharge, and one year after discharge. METHOD retrospective, analytical and quantitative study performed at the Emergency Department of a university hospital in São Paulo. Eighty-eight medical records of CRA patients who had a return of spontaneous circulation sustained for more than 20 minutes were included and the post-CRA care measures performed in the first 24 hours were identified, as well as its relationship with survival and neurological status. RESULTS the most frequent post-CRA care measures were use of advanced airway access techniques and indwelling bladder catheterization. Patients who had maintained good breathing and circulation, temperature control and who were transferred to intensive care unit had a better survival in the first 24 hours, after six months and one year after discharge. Good neurological status at six months and one year after discharge was associated with non-use of vasoactive drugs and investigation of the causes of the CRA. CONCLUSION the identification of good practices in post-CRA care may help to reduce the mortality of these individuals and to improve their quality of life.
Collapse
Affiliation(s)
| | | | - Ruth Ester Assayag Batista
- PhD, Full Professor, Escola Paulista de Enfermagem, Universidade
Federal de São Paulo, São Paulo, SP, Brazil
| | - Meiry Fernanda Pinto Okuno
- PhD, Assistant Professor, Escola Paulista de Enfermagem,
Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
16
|
Rahmig J, Kuhn M, Neugebauer H, Jüttler E, Reichmann H, Schneider H. Normothermia after decompressive surgery for space-occupying middle cerebral artery infarction: a protocol-based approach. BMC Neurol 2017; 17:205. [PMID: 29202815 PMCID: PMC5715533 DOI: 10.1186/s12883-017-0988-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/23/2017] [Indexed: 01/17/2023] Open
Abstract
Background Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. Methods We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression. Results We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12). Conclusions Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed. Electronic supplementary material The online version of this article (10.1186/s12883-017-0988-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jan Rahmig
- Department of Neurology, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Matthias Kuhn
- Institute of Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | | | - Eric Jüttler
- Department of Neurology, University of Ulm, Ulm, Germany.,Department of Neurology, Ostalb-Klinikum Aalen, Aalen, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hauke Schneider
- Department of Neurology, University Hospital, Technische Universität Dresden, Dresden, Germany. .,Department of Neurology, Klinikum Augsburg, Augsburg, Germany.
| |
Collapse
|
17
|
Zoerle T, Carbonara M, Zanier ER, Ortolano F, Bertani G, Magnoni S, Stocchetti N. Rethinking Neuroprotection in Severe Traumatic Brain Injury: Toward Bedside Neuroprotection. Front Neurol 2017; 8:354. [PMID: 28790967 PMCID: PMC5523726 DOI: 10.3389/fneur.2017.00354] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 12/23/2022] Open
Abstract
Neuroprotection after traumatic brain injury (TBI) is an important goal pursued strenuously in the last 30 years. The acute cerebral injury triggers a cascade of biochemical events that may worsen the integrity, function, and connectivity of the brain cells and decrease the chance of functional recovery. A number of molecules acting against this deleterious cascade have been tested in the experimental setting, often with preliminary encouraging results. Unfortunately, clinical trials using those candidate neuroprotectants molecules have consistently produced disappointing results, highlighting the necessity of improving the research standards. Despite repeated failures in pharmacological neuroprotection, TBI treatment in neurointensive care units has achieved outcome improvement. It is likely that intensive treatment has contributed to this progress offering a different kind of neuroprotection, based on a careful prevention and limitations of intracranial and systemic threats. The natural course of acute brain damage, in fact, is often complicated by additional adverse events, like the development of intracranial hypertension, brain hypoxia, or hypoperfusion. All these events may lead to additional brain damage and worsen outcome. An approach designed for early identification and prompt correction of insults may, therefore, limit brain damage and improve results.
Collapse
Affiliation(s)
- Tommaso Zoerle
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Anesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy
| | - Marco Carbonara
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Anesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy
| | - Elisa R Zanier
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Fabrizio Ortolano
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Anesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy
| | - Giulio Bertani
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Unit of Neurosurgery, Milan, Italy
| | - Sandra Magnoni
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Anesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy
| | - Nino Stocchetti
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Anesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy.,Department of Pathophysiology and Transplants, University of Milan, Milan, Italy
| |
Collapse
|
18
|
Ousey KJ, Edward KL, Lui S, Stephenson J, Duff J, Walker KN, Leaper DJ. Perioperative warming therapy for preventing surgical site infection in adults undergoing surgery. Hippokratia 2016. [DOI: 10.1002/14651858.cd011731.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Karen J Ousey
- University of Huddersfield; School of Human and Health Sciences; Ramsden Building, Queensgate Huddersfield West Yorkshire UK HD1 3DH
| | - Karen-Leigh Edward
- Australian Catholic University; Department of Nursing; Young St Fitzroy Victoria Australia 3065
| | - Steve Lui
- University of Huddersfield; School of Human and Health Sciences; Ramsden Building, Queensgate Huddersfield West Yorkshire UK HD1 3DH
| | - John Stephenson
- University of Huddersfield; School of Human and Health Sciences; Ramsden Building, Queensgate Huddersfield West Yorkshire UK HD1 3DH
| | - Jed Duff
- University of Tasmania; School of Health Sciences; Darlinghurst NSW Australia 2011
| | - Kim N Walker
- University of Tasmania; School of Health Sciences; Darlinghurst NSW Australia 2011
| | - David J Leaper
- Imperial College; St Marys Hospital; Norfolk Place London UK W2 1PG
| |
Collapse
|
19
|
Smith M. Therapeutic hypothermia and acute brain injury. ANAESTHESIA & INTENSIVE CARE MEDICINE 2016. [DOI: 10.1016/j.mpaic.2016.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
20
|
Targeted Temperature Management and Acute Brain Injury: An Update from Recent Clinical Trials. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0164-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Kim YM, Park KN, Choi SP, Lee BK, Park K, Kim J, Kim JH, Chung SP, Hwang SO. Part 4. Post-cardiac arrest care: 2015 Korean Guidelines for Cardiopulmonary Resuscitation. Clin Exp Emerg Med 2016; 3:S27-S38. [PMID: 27752644 PMCID: PMC5052921 DOI: 10.15441/ceem.16.130] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung Pill Choi
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyungil Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| |
Collapse
|
22
|
Traumatic brain injury: physiological targets for clinical practice in the prehospital setting and on the Neuro-ICU. Curr Opin Anaesthesiol 2016; 28:517-24. [PMID: 26331713 DOI: 10.1097/aco.0000000000000233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Over many years, understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. The present review revisits the evidence for these targets and therapies. RECENT FINDINGS Achieving oxygen, carbon dioxide, blood pressure, temperature and glucose targets remain a key goal of therapy in TBI, as does the role of effective prehospital care. Physician led air ambulance teams reduce mortality. Normobaric hyperoxia is dangerous to the injured brain; as are both high and low carbon dioxide levels. Hypotension is life threatening and higher targets have now been suggested in TBI. Both therapeutic normothermia and hypothermia have a role in specific groups of patients with TBI. Although consensus has not been reached on the optimal intravenous fluid for resuscitation in TBI, vigilant goal-directed fluid administration may improve outcome. Osmotherapeutic agents such as hypertonic sodium lactate solutions may also have a role alongside conventional agents. SUMMARY Maintaining physiological targets in several areas remains part of protocol led care in the acute phase of TBI management. As evidence accumulates however, the target values and therefore therapies may be set to change.
Collapse
|
23
|
Engrand N, Welschbillig S, Taylor G. Comment on: Therapeutic hypothermia for severe adult community-acquired bacterial meningitis. Clin Neurol Neurosurg 2016; 145:102-3. [DOI: 10.1016/j.clineuro.2016.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
|
24
|
Seguin P, Launey Y, Nesseler N, Malledant Y. Faut-il contrôler la fièvre dans les infections sévères ? MEDECINE INTENSIVE REANIMATION 2016; 25:266-273. [PMID: 32288743 PMCID: PMC7117820 DOI: 10.1007/s13546-015-1168-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Abstract
Le contrôle de la fièvre lors des sepsis graves est couramment utilisé en réanimation, respectivement dans 66 et 70 % des états septiques graves et des chocs septiques. Pourtant, les preuves formelles quant au bénéfice d’une telle stratégie manquent. On peut s’interroger à la lumière de travaux expérimentaux parfois anciens et d’études observationnelles plus récentes des risques d’un contrôle sur le cours évolutif de l’infection, le devenir du patient, ainsi que sur l’innocuité des traitements appliqués pour obtenir le contrôle. Néanmoins, dans certaines situations, la fièvre peut être délétère, en lien avec une consommation en oxygène (O2) accrue et le risque d’ischémie tissulaire et/ou une réaction inflammatoire focale exacerbée. Chez des patients septiques, le contrôle de la fièvre fait appel à des moyens physiques (refroidissement externe et/ou interne) et/ou pharmacologiques (essentiellement le paracétamol et/ou des anti-inflammatoires non stéroïdiens). Malgré les incertitudes quant au bénéfice ou non à contrôler la température, il faut certainement s’affranchir des températures extrêmes (hypoou hyperthermie) et évaluer individuellement le rapport bénéfice/risque.
Collapse
Affiliation(s)
- P. Seguin
- Service d’anesthésie-réanimation 1, réanimation chirurgicale, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, F-35000 Rennes, France
| | - Y. Launey
- Service d’anesthésie-réanimation 1, réanimation chirurgicale, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, F-35000 Rennes, France
| | - N. Nesseler
- Service d’anesthésie-réanimation 1, réanimation chirurgicale, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, F-35000 Rennes, France
| | - Y. Malledant
- Service d’anesthésie-réanimation 1, réanimation chirurgicale, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, F-35000 Rennes, France
| |
Collapse
|
25
|
Giuliani E, Magnoni S, Fei M, Addis A, Zanasi R, Stocchetti N, Barbieri A. A Novel Cooling Device for Targeted Brain Temperature Control and Therapeutic Hypothermia: Feasibility Study in an Animal Model. Neurocrit Care 2016; 25:464-472. [PMID: 26927280 PMCID: PMC5138276 DOI: 10.1007/s12028-016-0257-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Therapeutic hypothermia (i.e., temperature management) is an effective option for improving survival and neurological outcome after cardiac arrest and is potentially useful for the care of the critically ill neurological patient. We analyzed the feasibility of a device to control the temperature of the brain by controlling the temperature of the blood flowing through the neck. Methods A lumped parameter dynamic model, with one-dimensional heat transfer, was used to predict cooling effects and to test experimental hypotheses. The cooling system consisted of a flexible collar and was tested on 4 adult sheep, in which brain and body temperatures were invasively monitored for the duration of the experiment. Results Model-based simulations predicted a lowering of the temperature of the brain and the body following the onset of cooling, with a rate of 0.4 °C/h for the brain and 0.2 °C/h for the body. The experimental findings showed comparable cooling rates in the two body compartments, with temperature reductions of 0.6 (0.2) °C/h for the brain and 0.6 (0.2) °C/h for the body. For a 70 kg adult human subject, we predict a temperature reduction of 0.64 °C/h for the brain and 0.43 °C/h for the body. Conclusions This work demonstrates the feasibility of using a non-invasive method to induce brain hypothermia using a portable collar. This device demonstrated an optimal safety profile and represents a potentially useful method for the administration of mild hypothermia and temperature control (i.e., treatment of hyperpyrexia) in cardiac arrest and critically ill neurologic patients. Electronic supplementary material The online version of this article (doi:10.1007/s12028-016-0257-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- E Giuliani
- Neuron Guard S.r.l., Via L. Castelvetro 15, 41124, Modena, Italy.
| | - S Magnoni
- Department of Anesthesiology and Intensive Care, Ospedale Fondazione IRCCS, Ca' Granda, Milan, Italy
| | - M Fei
- Neuron Guard S.r.l., Via L. Castelvetro 15, 41124, Modena, Italy
| | - A Addis
- CRABCC, Biotechnology Research Center for Cardiothoracic Applications, Rivolta d'Adda, CR, Italy
| | - R Zanasi
- Department of Engineering, University of Modena and Reggio Emilia, Modena, Italy
| | - N Stocchetti
- Department of Anesthesiology and Intensive Care, Ospedale Fondazione IRCCS, Ca' Granda, Milan, Italy.,Milan University, Milan, Italy
| | - A Barbieri
- Department of Anesthesiology and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
26
|
Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, Zimmerman JL. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S465-82. [PMID: 26472996 PMCID: PMC4959439 DOI: 10.1161/cir.0000000000000262] [Citation(s) in RCA: 1013] [Impact Index Per Article: 112.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
27
|
Hegazy AF, Lapierre DM, Butler R, Althenayan E. Temperature control in critically ill patients with a novel esophageal cooling device: a case series. BMC Anesthesiol 2015; 15:152. [PMID: 26481105 PMCID: PMC4615396 DOI: 10.1186/s12871-015-0133-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mild hypothermia and fever control have been shown to improve neurological outcomes post cardiac arrest. Common methods to induce hypothermia include body surface cooling and intravascular cooling; however, a new approach using an esophageal cooling catheter has recently become available. METHODS We report the first three cases of temperature control using an esophageal cooling device (ECD). The ECD was placed in a similar fashion to orogastric tubes. Temperature reduction was achieved by connecting the ECD to a commercially available external heat exchange unit (Blanketrol Hyperthermia - Hypothermia System). RESULTS The first patient, a 54 year-old woman (86 kg) was admitted after resuscitation from an out-of-hospital non-shockable cardiac arrest. Shortly after admission, she mounted a fever peaking at 38.3 °C despite administration of cold intravenous saline and application of cooling blankets. ECD utilization resulted in a temperature reduction to 35.7 °C over a period of 4 h. She subsequently recovered and was discharged home at day 23. The second patient, a 59 year-old man (73 kg), was admitted after successful resuscitation from a protracted out-of hospital cardiac arrest. His initial temperature was 35 °C, but slowly increased to 35.8 °C despite applying a cooling blanket and ice packs. The ECD was inserted and a temperature reduction to 34.8 °C was achieved within 3 h. The patient expired on day 3. The third patient, a 47 year-old man (95 kg) presented with a refractory fever secondary to necrotizing pneumonia in the postoperative period after coronary artery bypass grafting. His fever persisted despite empiric antibiotics, antipyretics, cooling blankets, and ice packs. ECD insertion resulted in a decrease in temperature from 39.5 to 36.5 °C in less than 5 h. He eventually made a favorable recovery and was discharged home after 59 days. In all 3 patients, device placement occurred in under 3 min and ease-of-use was reported as excellent by nursing staff and physicians. CONCLUSIONS The esophageal cooling device was found to be an effective temperature control modality in this small case series of critically ill patients. Preliminary data presented in this report needs to be confirmed in large randomized controlled trials comparing its efficacy and safety to standard temperature control modalities.
Collapse
Affiliation(s)
- Ahmed F Hegazy
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, N6A 5A5, ON, Canada.
| | - Danielle M Lapierre
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, N6A 5A5, ON, Canada.
| | - Ron Butler
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, N6A 5A5, ON, Canada.
| | - Eyad Althenayan
- Department of Medicine, Division of Critical Care, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, N6A 5A5, ON, Canada.
| |
Collapse
|
28
|
Ousey KJ, Edward KL, Lui S, Stephenson J, Duff J, Walker KN, Leaper DJ. Perioperative warming therapy for preventing surgical site infection in adults undergoing surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
29
|
Bösel J, Möhlenbruch M, Sakowitz OW. [News and perspectives in neurocritical care]. DER NERVENARZT 2015; 85:928-38. [PMID: 25096787 DOI: 10.1007/s00115-014-4040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neurocritical care is an ever-evolving discipline and its implementation in intensive care leads to reduction in mortality and to improvement of functional outcome in patients with devastating injuries to the nervous system. However, the decisive elements of the complete field of neurocritical care remain relatively unclear, as well as the exact ways to optimize them. During recent years new insights have been gained and new exciting studies have been initiated from which results are soon to be expected. This review focuses on the following management aspects: neuromonitoring, airway and ventilation, endovascular therapy, cerebrospinal fluid drainage, decompressive craniectomy, hematoma evacuation, blood pressure, and targeted temperature management. The application of these measures to brain diseases and injuries frequently treated in neurointensive care units will be addressed in the context of current studies.
Collapse
Affiliation(s)
- J Bösel
- Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland,
| | | | | |
Collapse
|
30
|
van der Jagt M, Haitsma I. An injured brain needs cooling down: no. Intensive Care Med 2015; 41:1129-31. [PMID: 25952828 DOI: 10.1007/s00134-015-3844-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Mathieu van der Jagt
- Department of Intensive Care, Erasmus Medical Center Rotterdam, Room H-611, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands,
| | | |
Collapse
|
31
|
Bengualid V, Talari G, Rubin D, Albaeni A, Ciubotaru RL, Berger J. Fever in trauma patients: evaluation of risk factors, including traumatic brain injury. Am J Crit Care 2015; 24:e1-5. [PMID: 25727281 DOI: 10.4037/ajcc2015856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The role of fever in trauma patients remains unclear. Fever occurs as a response to release of cytokines and prostaglandins by white blood cells. Many factors, including trauma, can trigger release of these factors. OBJECTIVES To determine whether (1) fever in the first 48 hours is related to a favorable outcome in trauma patients and (2) fever is more common in patients with head trauma. METHOD Retrospective study of trauma patients admitted to the intensive care unit for at least 2 days. Data were analyzed by using multivariate analysis. RESULTS Of 162 patients studied, 40% had fever during the first 48 hours. Febrile patients had higher mortality rates than did afebrile patients. When adjusted for severity of injuries, fever did not correlate with mortality. Neither the incidence of fever in the first 48 hours after admission to the intensive care unit nor the number of days febrile in the unit differed between patients with and patients without head trauma (traumatic brain injury). About 70% of febrile patients did not have a source found for their fever. Febrile patients without an identified source of infection had lower peak white blood cell counts, lower maximum body temperature, and higher minimum platelet counts than did febrile patients who had an infectious source identified. The most common infection was pneumonia. CONCLUSIONS No relationship was found between the presence of fever during the first 48 hours and mortality. Patients with traumatic brain injury did not have a higher incidence of fever than did patients without traumatic brain injury. About 30% of febrile patients had an identifiable source of infection. Further studies are needed to understand the origin and role of fever in trauma patients.
Collapse
Affiliation(s)
- Victoria Bengualid
- Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital
| | - Goutham Talari
- Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital
| | - David Rubin
- Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital
| | - Aiham Albaeni
- Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital
| | - Ronald L. Ciubotaru
- Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital
| | - Judith Berger
- Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital
| |
Collapse
|
32
|
Kochanek PM, Jackson TC. It might be time to let cooler heads prevail after mild traumatic brain injury or concussion. Exp Neurol 2015; 267:13-7. [PMID: 25732932 DOI: 10.1016/j.expneurol.2015.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/09/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Patrick M Kochanek
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA; Safar Center for Resuscitation Research, 3434 Fifth Avenue, Pittsburgh, PA 15260, USA.
| | - Travis C Jackson
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA; Safar Center for Resuscitation Research, 3434 Fifth Avenue, Pittsburgh, PA 15260, USA.
| |
Collapse
|