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Furrer F, Wendel-Garcia PD, Pfister P, Hofmaenner DA, Franco C, Sachs A, Fleischer J, Both C, Kim BS, Schuepbach RA, Steiger P, Camen G, Buehler PK. Perioperative targeted temperature management of severely burned patients by means of an oesophageal temperature probe. Burns 2023; 49:401-407. [PMID: 35513952 DOI: 10.1016/j.burns.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Hypothermia in severely burned patients is associated with a significant increase in morbidity and mortality. The use of an oesophageal heat exchanger tube (EHT) can improve perioperative body temperatures in severely burned patients. The aim of this study was to investigate the intraoperative warming effect of oesophageal heat transfer in severe burn patients. METHODS Single-centre retrospective study performed at the Burns Centre of the University Hospital Zurich. Between January 2020 and May 2021 perioperative temperature management with EHT was explored in burned patients with a total body surface area (TBSA) larger than 30%. Data from patients, who received perioperative temperature management by EHT, were compared to data from the same patients during interventions performed under standard temperature management matching for length and type of intervention. RESULTS A total of 30 interventions (15 with and 15 without EHT) in 10 patients were analysed. Patient were 38 [26-48] years of age, presented with severe burns covering a median of 50 [42-64] % TBSA and were characterized by an ABSI of 10 [8-12] points. When receiving EHT management patients experienced warming at 0.07 °C per minute (4.2 °C/h) compared to a temperature loss of - 0.03 °C per minute (1.8 °C/h) when only receiving standard temperature management (p < 0.0001). No adverse or serious adverse events were reported. CONCLUSION The use of an oesophageal heat transfer device was effective and safe in providing perioperative warming to severely burned patients when compared to a standard temperature management protocol. By employing an EHT as primary temperature management device perioperative hypothermia in severely burned patients can possibly be averted, potentially leading to reduced hypothermia-associated complications.
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Affiliation(s)
- Florian Furrer
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | | | - Pablo Pfister
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | | | - Carlos Franco
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
| | - Alexandra Sachs
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Juliane Fleischer
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Christian Both
- Department of Anesthesia, University Children's Hospital, Zurich, Switzerland
| | - Bong Sun Kim
- Department of Plastic and Hand Surgery, Burn Center, University Hospital Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Peter Steiger
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Giovanni Camen
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Philipp Karl Buehler
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
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2
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An Overview of the Implications for Perianesthesia Nurses in terms of Intraoperative Changes in Temperature and Factors Associated with Unintentional Postoperative Hypothermia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6955870. [PMID: 35444780 PMCID: PMC9015883 DOI: 10.1155/2022/6955870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
Abstract
Patients undergo surgery and anaesthesia on a daily basis across the United States and throughout the world. A major source of worry for these patients continues to be inadvertent hypothermia, once core temperature <36°C (96.8°F). Despite well-documented adverse physiological consequences, anaesthesia nurses continue to have a difficult task in keeping patient warmth pre-/peri-/post-surgical procedure. Thermostasis within postoperative patient necessitates the collaboration of many individuals. In order to provide safe and high-quality treatment, it is essential to use the most up-to-date data to guide therapeutic procedures targeted at achieving balance body temperature in surgical patients. Providing a review of the physiology of perioperative temperature variations and the comorbidities linked with accidental intraoperative hypothermia, this article will also provide preventive and treatment methods.
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3
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Montoya MM, Bustamante TG, Berjano E, Mickelsen SR, Daniels JD, Arango PH, Schieber J, Kulstad E. Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation. Int J Hyperthermia 2022; 39:1202-1212. [PMID: 36104029 PMCID: PMC9771690 DOI: 10.1080/02656736.2022.2121860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Proactive cooling with a novel cooling device has been shown to reduce endoscopically identified thermal injury during radiofrequency (RF) ablation for the treatment of atrial fibrillation using medium power settings. We aimed to evaluate the effects of proactive cooling during high-power short-duration (HPSD) ablation. METHODS A computer model accounting for the left atrium (1.5 mm thickness) and esophagus including the active cooling device was created. We used the Arrhenius equation to estimate the esophageal thermal damage during 50 W/ 10 s and 90 W/ 4 s RF ablations. RESULTS With proactive esophageal cooling in place, temperatures in the esophageal tissue were significantly reduced from control conditions without cooling, and the resulting percentage of damage to the esophageal wall was reduced around 50%, restricting damage to the epi-esophageal region and consequently sparing the remainder of the esophageal tissue, including the mucosal surface. Lesions in the atrial wall remained transmural despite cooling, and maximum width barely changed (<0.8 mm). CONCLUSIONS Proactive esophageal cooling significantly reduces temperatures and the resulting fraction of damage in the esophagus during HPSD ablation. These findings offer a mechanistic rationale explaining the high degree of safety encountered to date using proactive esophageal cooling, and further underscore the fact that temperature monitoring is inadequate to avoid thermal damage to the esophagus.
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Affiliation(s)
| | | | - Enrique Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Spain
| | | | - James D. Daniels
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Jay Schieber
- Illinois Institute of Technology, Chicago, IL, USA
| | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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4
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Limper U, Trojan S, Poels M, Schiefer JL, Wappler F, Sakka SG. Does an esophageal heat exchange system influence the reliability of transpulmonary thermodilution? J Crit Care 2021; 68:48-49. [PMID: 34922311 DOI: 10.1016/j.jcrc.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2021] [Accepted: 12/05/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Ulrich Limper
- Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Cologne, Germany; German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.
| | - Stefan Trojan
- Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Marcel Poels
- Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Jennifer L Schiefer
- Department of Plastic, Reconstructive and Hand Surgery, Burn Care Center, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Frank Wappler
- Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Samir G Sakka
- Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Cologne, Germany; Department of Intensive Care Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, Academic Teaching Hospital of the Johannes Gutenberg University Mainz, Koblenz, Germany
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5
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Kinter K, Alfaro R, Sutherland M, McKenney M, Elkbuli A. The Impact of Ambient Temperature Control Across Various Care Settings on Outcomes in Burn Patients: A Review Article. Am Surg 2021; 87:1859-1866. [PMID: 34382819 DOI: 10.1177/00031348211038561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ambient/room temperature settings in burn treatment areas vary greatly due to a lack of evidence-based guidelines to direct care. While it is generally understood that ambient/room temperature impacts patient body temperature and metabolism, the ideal settings for optimizing patient outcomes are unclear. The literature assessing this topic is scarce, with many of the articles having significant limitations. We aim to summarize the current evidence for ambient/room temperature control, to address gaps in current reviews addressing this topic, and to elucidate topics requiring further research. PubMed and Google Scholar databases were queried for studies which evaluated the effect of the ambient/room temperature on burn patient core body temperature, patient metabolism, and outcomes among those treated in trauma bays, burn ICUs, and operating rooms. Although existing literature lacks sufficient patient outcome data regarding specific ambient/room temperatures, we highlight physiological processes that are impacted by changes in room temperatures in an effort to describe strategies that can allow for improved patient core body temperature control and outcomes in burn care settings.
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Affiliation(s)
- Kevin Kinter
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Robert Alfaro
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
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Bonfanti N, Gundert E, Drewry AM, Goff K, Bedimo R, Kulstad E. Core warming of coronavirus disease 2019 (COVID-19) patients undergoing mechanical ventilation-A protocol for a randomized controlled pilot study. PLoS One 2020; 15:e0243190. [PMID: 33259540 PMCID: PMC7707531 DOI: 10.1371/journal.pone.0243190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, is spreading rapidly across the globe, with little proven effective therapy. Fever is seen in most cases of COVID-19, at least at the initial stages of illness. Although fever is typically treated (with antipyretics or directly with ice or other mechanical means), increasing data suggest that fever is a protective adaptive response that facilitates recovery from infectious illness. OBJECTIVE To describe a randomized controlled pilot study of core warming patients with COVID-19 undergoing mechanical ventilation. METHODS This prospective single-site randomized controlled pilot study will enroll 20 patients undergoing mechanical ventilation for respiratory failure due to COVID-19. Patients will be randomized 1:1 to standard-of-care or to receive core warming via an esophageal heat exchanger commonly utilized in critical care and surgical patients. The primary outcome is patient viral load measured by lower respiratory tract sample. Secondary outcomes include severity of acute respiratory distress syndrome (as measured by PaO2/FiO2 ratio) 24, 48, and 72 hours after initiation of treatment, hospital and intensive care unit length of stay, duration of mechanical ventilation, and 30-day mortality. RESULTS Resulting data will provide effect size estimates to guide a definitive multi-center randomized clinical trial. ClinicalTrials.gov registration number: NCT04426344. CONCLUSIONS With growing data to support clinical benefits of elevated temperature in infectious illness, this study will provide data to guide further understanding of the role of active temperature management in COVID-19 treatment and provide effect size estimates to power larger studies.
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Affiliation(s)
- Nathaniel Bonfanti
- Department of Emergency Medicine, University of Texas, Southwestern Medical Center, Dallas, TX, United States of America
- Department of Anesthesia/Critical Care, University of Texas, Southwestern Medical Center, Dallas, TX, United States of America
| | - Emily Gundert
- Department of Emergency Medicine, University of Texas, Southwestern Medical Center, Dallas, TX, United States of America
- Department of Anesthesia/Critical Care, University of Texas, Southwestern Medical Center, Dallas, TX, United States of America
| | - Anne M. Drewry
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Kristina Goff
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, Dallas, TX, United States of America
| | - Roger Bedimo
- Infectious Diseases Section, VA North Texas Health Care System, Dallas, TX, United States of America
- Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, TX, United States of America
| | - Erik Kulstad
- Department of Emergency Medicine, University of Texas, Southwestern Medical Center, Dallas, TX, United States of America
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7
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Mercado M, Leung L, Gallagher M, Shah S, Kulstad E. Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions. Biomed Eng Online 2020; 19:77. [PMID: 33046057 PMCID: PMC7552446 DOI: 10.1186/s12938-020-00821-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Esophageal thermal injury can occur after radiofrequency (RF) ablation in the left atrium to treat atrial fibrillation. Existing methods to prevent esophageal injury have various limitations in deployment and uncertainty in efficacy. A new esophageal heat transfer device currently available for whole-body cooling or warming may offer an additional option to prevent esophageal injury. We sought to develop a mathematical model of this process to guide further studies and clinical investigations and compare results to real-world clinical data. RESULTS The model predicts that the esophageal cooling device, even with body-temperature water flow (37 °C) provides a reduction in esophageal thermal injury compared to the case of the non-protected esophagus, with a non-linear direct relationship between lesion depth and the cooling water temperature. Ablation power and cooling water temperature have a significant influence on the peak temperature and the esophageal lesion depth, but even at high RF power up to 50 W, over durations up to 20 s, the cooling device can reduce thermal impact on the esophagus. The model concurs with recent clinical data showing an 83% reduction in transmural thermal injury when using typical operating parameters. CONCLUSIONS An esophageal cooling device appears effective for esophageal protection during atrial fibrillation, with model output supporting clinical data. Analysis of the impact of ablation power and heart wall dimensions suggests that cooling water temperature can be adjusted for specific ablation parameters to assure the desired myocardial tissue ablation while keeping the esophagus protected.
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Affiliation(s)
- Marcela Mercado
- Bioengineering Department, Engineering Faculty, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellin, Colombia.
| | - Lisa Leung
- St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Mark Gallagher
- St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | | | - Erik Kulstad
- Southwestern Medical Center, University of Texas, Dallas, TX, USA
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8
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Shah S, Mercado-Montoya M, Zagrodzky J, Kulstad E. Comparative study of strategies to prevent esophageal and periesophageal injury during atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 31:2548. [PMID: 32596933 DOI: 10.1111/jce.14621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Shailee Shah
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Marcela Mercado-Montoya
- Bioengineering Department, Engineering Faculty, Universidad de Antioquia (UdeA), Medellín, Colombia
| | - Jason Zagrodzky
- Department of Electrophysiology, St. David's South Austin Medical Center, Austin, Texas, USA
| | - Erik Kulstad
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
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9
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Mercado-Montoya M, Bonfanti N, Gundert E, Drewry AM, Bedimo R, Kostov V, Kostov K, Shah S, Kulstad E. The Use of Core Warming as a Treatment for Coronavirus Disease 2019 (COVID-19): an Initial Mathematical Model. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i1.3382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Increasing data suggest that elevated body temperature may be helpful in resolving a variety of diseases, including sepsis, acute respiratory distress syndrome (ARDS), and viral illnesses. SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19), may be more temperature sensitive than other coronaviruses, particularly with respect to the binding affinity of its viral entry via the ACE2 receptor. A mechanical provision of elevated temperature focused in a body region of high viral activity in patients undergoing mechanical ventilation may offer a therapeutic option that avoids arrhythmias seen with some pharmaceutical treatments. We investigated the potential to actively provide core warming to the lungs of patients with a commercially available heat transfer device via mathematical modeling, and examine the influence of blood perfusion on temperature using this approach. Methods: Using the software Comsol Multiphysics, we modeled and simulated heat transfer in the body from an intraesophageal warming device, taking into account the airflow from patient ventilation. The simulation was focused on heat transfer and warming of the lungs and performed on a simplified geometry of an adult human body and airway from the pharynx to the lungs. Results: The simulations were run over a range of values for blood perfusion rate, which was a parameter expected to have high influence in overall heat transfer, since the heat capacity and density remain almost constant. The simulation results show a temperature distribution which agrees with the expected clinical experience, with the skin surface at a lower temperature than the rest of the body due to convective cooling in a typical hospital environment. The highest temperature in this case is the device warming water temperature, and that heat diffuses by conduction to the nearby tissues, including the air flowing in the airways. At the range of blood perfusion investigated, maximum lung temperature ranged from 37.6°C to 38.6°C. Conclusions: The provision of core warming via commercially available technology currently utilized in the intensive care unit, emergency department, and operating room can increase regional temperature of lung tissue and airway passages. This warming may offer an innovative approach to treating infectious diseases from viral illnesses such as COVID-19, while avoiding the arrhythmogenic complications of currently used pharmaceutical treatments.
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Affiliation(s)
- Marcela Mercado-Montoya
- Universidad de Antioquia – Engineering Faculty – Bioengineering Department – Medellín, Colombia
| | - Nathaniel Bonfanti
- UT Southwestern Medical Center – Departments of Emergency Medicine and Anesthesia/Critical Care – Dallas (TX), USA
| | - Emily Gundert
- UT Southwestern Medical Center – Departments of Emergency Medicine and Anesthesia/Critical Care – Dallas (TX), USA
| | - Anne Meredith Drewry
- Washington University – School of Medicine – Department of Anesthesiology – St. Louis (MO), USA
| | - Roger Bedimo
- UT Southwestern Medical CenterVA North Texas Health Care System – UT Southwestern Medical Center – Dallas (TX), USA
| | - Victor Kostov
- Walter Payton College Preparatory High School – Chicago (IL), USA
| | | | - Shailee Shah
- Illinois Institute of Technology – Department of Bioengineering – Chicago (IL), USA
| | - Erik Kulstad
- UT Southwestern Medical Center – Department of Emergency Medicine – Dallas (TX), USA
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10
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Schroeder DC, Maul AC, Guschlbauer M, Finke SR, de la Puente Bethencourt D, Becker I, Padosch SA, Hohn A, Annecke T, Böttiger BW, Sterner-Kock A, Herff H. Intravascular Cooling Device Versus Esophageal Heat Exchanger for Mild Therapeutic Hypothermia in an Experimental Setting. Anesth Analg 2020; 129:1224-1231. [PMID: 30418241 DOI: 10.1213/ane.0000000000003922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Targeted temperature management is a standard therapy for unconscious survivors of cardiac arrest. To date, multiple cooling methods are available including invasive intravascular cooling devices (IVDs), which are widely used in the clinical setting. Recently, esophageal heat exchangers (EHEs) have been developed providing cooling via the esophagus that is located close to the aorta and inferior vena cava. The objective was to compare mean cooling rates, as well as differences, to target temperature during maintenance and the rewarming period of IVD and EHE. METHODS The study was conducted in 16 female domestic pigs. After randomization to either IVD or EHE (n = 8/group), core body temperature was reduced to 33°C. After 24 hours of maintenance (33°C), animals were rewarmed using a target rate of 0.25°C/h for 10 hours. All cooling phases were steered by a closed-loop feedback system between the internal jugular vein and the chiller. After euthanasia, laryngeal and esophageal tissue was harvested for histopathological examination. RESULTS Mean cooling rates (4.0°C/h ± 0.4°C/h for IVD and 2.4°C/h ± 0.3°C/h for EHE; P < .0008) and time to target temperature (85.1 ± 9.2 minutes for IVD and 142.0 ± 21.2 minutes for EHE; P = .0008) were different. Mean difference to target temperature during maintenance (0.07°C ± 0.05°C for IVD and 0.08°C ± 0.10°C for EHE; P = .496) and mean rewarming rates (0.2°C/h ± 0.1°C/h for IVD and 0.3°C/h ± 0.2°C/h for EHE; P = .226) were similar. Relevant laryngeal or esophageal tissue damage could not be detected. There were no significant differences in undesired side effects (eg, bradycardia or tachycardia, hypokalemia or hyperkalemia, hypoglycemia or hyperglycemia, hypotension, overcooling, or shivering). CONCLUSIONS After insertion, target temperatures could be reached faster by IVD compared to EHE. Cooling performance of IVD and EHE did not significantly differ in maintaining target temperature during a targeted temperature management process and in active rewarming protocols according to intensive care unit guidelines in this experimental setting.
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Affiliation(s)
- Daniel C Schroeder
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexandra C Maul
- Center for Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Maria Guschlbauer
- Center for Experimental Medicine, University Hospital of Cologne, Cologne, Germany.,Decentral Animal Facility, University Hospital of Cologne, Cologne, Germany
| | - Simon-Richard Finke
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Stephan A Padosch
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Andreas Hohn
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Annecke
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anja Sterner-Kock
- Center for Experimental Medicine, University Hospital of Cologne, Cologne, Germany
| | - Holger Herff
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
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11
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Grote R, Wetz A, Bräuer A, Menzel M. Short interruptions between pre-warming and intraoperative warming are associated with low intraoperative hypothermia rates. Acta Anaesthesiol Scand 2020; 64:489-493. [PMID: 31828757 DOI: 10.1111/aas.13521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/29/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prevention of inadvertent hypothermia is recommended for procedures >30 minutes because hypothermia increases the risk of myocardial ischemia, intraoperative blood loss, transfusion and wound complications. Therefore, short warming interruptions between pre-warming and intraoperative warming might result in lower hypothermia rates. The aim of this retrospective investigation was to determine whether the incidence of inadvertent intraoperative hypothermia was affected by the warming interruption. METHODS The lowest intraoperative body core temperature value and the warming interruption time were taken from anaesthesia records. Body core temperature was recorded continuously, and a patient was classified to be hypothermic if the lowest recorded temperature value was <36°C. Hypothermia rates and the correlation between warming interruption times and intraoperative hypothermia rates were calculated. RESULTS Five thousand eighty-four patients were analysed. The intraoperative hypothermia rate was 15.3%. Nineteen patients (0.4%) had a recorded temperature of <35.0°C. An increase in forced-air warming interruption time was significantly associated with an increase in intraoperative hypothermia rates (P < .0001). Patients with interruptions in forced-air warming >20 minutes showed significantly higher hypothermia rates than those with interruptions of ≤20 minutes (P < .0001). CONCLUSION Intraoperative hypothermia rates increased significantly with longer forced-air warming interruptions between pre-warming and intraoperative warming. Short warming interruptions can preserve the effect of pre-warming and are associated with low intraoperative hypothermia rates.
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Affiliation(s)
- Rolf Grote
- Department of Anaesthesiology, Emergency Medicine, Intensive Care Medicine and Pain Therapy Klinikum Wolfsburg Wolfsburg Germany
| | - Anna Wetz
- Department of Anaesthesiology University Hospital Göttingen Göttingen Germany
| | - Anselm Bräuer
- Department of Anaesthesiology University Hospital Göttingen Göttingen Germany
| | - Matthias Menzel
- Department of Anaesthesiology, Emergency Medicine, Intensive Care Medicine and Pain Therapy Klinikum Wolfsburg Wolfsburg Germany
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Abstract
Malignant hyperthermia (MH) is a rare but potentially lethal skeletal muscle disorder affecting calcium release channels. It is inherited in a mendelian autosomal dominant pattern with variable penetration. The initial clinical manifestations are of a hypermetabolic state with increased CO2 production, respiratory acidosis, increased temperature, and increased oxygen demands. If diagnosed late, MH progresses to multi-organ system failure and death. Current data suggest that mortality has improved to less than 5%. The gold standard for ruling out MH is the contracture test. Genetic testing is also available. MH-susceptible individuals should be clearly identified for safe administration of future anesthetics.
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Affiliation(s)
- Herodotos Ellinas
- Department of Anesthesiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Meredith A Albrecht
- Department of Anesthesiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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13
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Litman RS, Smith VI, Larach MG, Mayes L, Shukry M, Theroux MC, Watt S, Wong CA. Consensus Statement of the Malignant Hyperthermia Association of the United States on Unresolved Clinical Questions Concerning the Management of Patients With Malignant Hyperthermia. Anesth Analg 2019; 128:652-659. [DOI: 10.1213/ane.0000000000004039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Bader MK, Figueroa SA, Mathiesen C, Blissitt PA, Guanci MM, Hamilton LA, Fox L, Wavra T. Clinical Q & A: Translating Therapeutic Temperature Management from Theory to Practice. Ther Hypothermia Temp Manag 2019; 9:90-95. [PMID: 30724671 DOI: 10.1089/ther.2019.29056.mkb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mary Kay Bader
- 1 Neuroscience & Spine Institute (NSI), Mission Hospital, Mission Viejo, California
| | - Stephen A Figueroa
- 2 Division of Neurocritical Care, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Claranne Mathiesen
- 3 Medical Operations Neurosciences Service Line, Lehigh Valley Hospital, Allentown, Pennsylvania
| | - Patricia A Blissitt
- 4 Harborview Medical Center and Swedish Medical Center, University of Washington School of Nursing, Seattle, Washington
| | - Mary M Guanci
- 5 Neuroscience Intensive Care, Massachusetts General Hospital Boston, Massachusetts
| | - Leslie A Hamilton
- 6 Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee
| | - Liz Fox
- 7 Neurocritical Care, Stanford Health Care, Palo Alto, California
| | - Teresa Wavra
- 1 Neuroscience & Spine Institute (NSI), Mission Hospital, Mission Viejo, California
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