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@#BACKGROUND: Targeted temperature management (TTM), as a therapeutic temperature control strategy for cardiac arrest (CA), is recommended by guidelines. However, the relationship between post-rewarming fever (PRF) and the prognosis of CA patients is unclear. Therefore, we aim to summarize the studies regarding the influence of PRF on patients with CA. METHODS: EMBASE, PubMed, and Cochrane Central databases were searched from inception to March 13, 2022. Randomized clinical trials (RCTs) and cohort studies on PRF in CA patients were included. According to the heterogeneity, the meta-analysis was performed using a random effects model or fixed effects model to calculate the pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The outcome data were unfavorable neurological outcome and mortality. RESULTS: The meta-analysis included 11 observational studies involving 3,246 patients. The results of the meta-analysis show that PRF (body temperature >38.0 °C) has no effect on the neurological outcome of CA patients (OR 0.71, 95% CI 0.43-1.17, I2 82%) and has a significant relationship with lower mortality (OR 0.63; 95% CI 0.49-0.80, I2 39%). However, PRF with a stricter definition (body temperature >38.5 °C ) was associated with worse neurological outcome (OR 1.44, 95% CI 1.08-1.92, I2 45%) and higher mortality (OR 1.71, 95% CI 1.25-2.35, I2 47%). CONCLUSION: This study suggests that PRF >38.0 °C may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM. However, PRF >38.5 °C is a potential prognostic factor for worse outcomes in CA patients.
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Objective:To understand the current situation of knowledge, attitude and practice about target temperature management (TTM) in patients with severe traumatic brain injury (STBI) among intensive care unit ICU nurses and analyze the influencing factors, so as to provide a reference for conducting ICU nurses′ TTM training for patients with STBI.Methods:Applying the method of cross-sectional study, from November to December 2022, a stratified whole-group sampling method was used, stratified by first-, second-, and third-level hospitals, and a self-designed questionnaire on the current status of ICU nurses′TTM for patients with STBI was used to investigate the current status of knowledge, attitude, and practice of neurosurgical ICU, emergency ICU, and comprehensive ICU nurses in 22 second- and third-level hospitals in 11 cities in Gansu Province, and multiple linear regression analysis was used to analyze the factors influencing ICU nurses′ knowledge, attitude, and practice scores.Results:A total of 543 valid questionnaires were returned, and the scores of ICU nurses on the TTM total score, knowledge, attitude and practice dimensions of STBI patients were (76.75 ± 10.42), (7.38 ± 2.74), (39.57 ± 4.87), (29.80 ± 7.18) points respectively. The results of multiple linear regression analysis showed that the factor influencing ICU nurses′ scores on the TTM knowledge dimension for STBI patients was having attended TTM-related training ( t = 2.16, P<0.05); the factors influencing ICU nurses′ scores on the TTM attitude dimension for STBI patients were college, bachelor′s degree and the position of nurse practitioner ( t = 2.65, 2.91, 2.14, all P<0.05); and the factors influencing ICU nurses′ scores on the TTM practice dimension for STBI patients were the age group of 36 to 45 years old, the department having TTM-related criteria and having knowledge of TTM-related guidelines ( t = -2.46, 2.64, 3.85, all P<0.05). Conclusions:ICU nurses have a more positive attitude toward TTM in patients with STBI, but the level of knowledge and practice needs to be improved. Managers should conduct relevant training according to the current situation and influencing factors to improve ICU nurses′ knowledge and practice of TTM in patients with STBI, ensuring the effectiveness and safety of TTM.
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Targeted temperature management mainly affects the progression of sepsis by inhibiting inflammatory response, protecting mitochondrial function and reducing metabolism, which can improve survival, the prognosis and outcome of sepsis to some extent.Targeted temperature management has a positive impact on the occurrence and development of sepsis, which may be an adjuvant treatment method of sepsis.This review summarized the mechanism studies on the impact of targeted temperature management on sepsis in recent years, and summarized the existing problems, so as to provide reference for carrying out practical research on targeted temperature management for patients with sepsis.
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Objective:To explore the effect of perioperative whole-course closed-loop temperature management system for prevention of hypothermia in elderly patients with femoral neck fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 120 elderly patients with femoral neck fracture admitted to Chengdu First People's Hospital from January 2020 to December 2020. There were 48 males and 72 females, aged 60-79 years［（68.3±5.0）years］. All patients underwent total hip arthroplasty. Heat warming with the whole-course closed-loop temperature management system was applied in 40 patients（closed-loop group）, with the medical heating mattress in 40 patients（heat preservation group）, and with the quilt in 40 patients（control group）. The core body temperature of the three groups was recorded 8 minutes after wearing the temperature sensor（T0）, immediately after induction of anesthesia（T1）, 30 minutes after induction of anesthesia（T2）, 60 minutes after induction of anesthesia（T3）, at the end of surgery（T4）, and 20 minutes after entering the postanesthesia care unit（PACU）（T5）. The thrombin time（TT）, prothrombin time（PT）and activated partial thromboplastin time（APTT）were compared among groups before operation and at T4. The incidence of intraoperative hypothermia, incidence of shivering during PACU, incidence of surgical site infection, extubation time（from the day of drug withdrawal to the time of tracheal tube removal）, length of hospital stay（from the day of operation to the time of discharge）and adverse reactions related to the devices were compared among groups.Results:There was no statistically significant difference in core body temperature among three groups at T0（ P>0.05）. The core body temperature in closed-loop group［（36.61±0.28）℃］was higher than that in heat preservation group［（36.45±0.28）℃］and control group［（36.44±0.27）℃］at T1（ P<0.05）, but no statistically significant difference was found in core body temperature between heat preservation group and control group（ P>0.05）. The core body temperature in closed-loop group［（36.46±0.28）℃,（36.40±0.30）℃,（36.45±0.37）℃,（36.50±0.27）℃］was higher than that in heat preservation group［（36.32±0.31）℃,（36.24±0.26）℃,（36.28±0.30）℃,（36.24±0.31）℃］and control group［（36.12±0.30）℃,（35.98±0.28）℃,（35.73±0.31）℃,（35.81±0.32）℃］at T2-T5（ P<0.05）, and a higher temperature was found in heat preservation group than control group（ P<0.05）. The core body temperature in closed-loop group was increased at T1 compared to that at T0（ P<0.05）, while there was no statistical difference at T0 and T1 in heat preservation group and control group（ P>0.05）. The core body temperature in closed-loop group showed no significant difference at T2-T5 and T0（ P>0.05）, while the core temperature in heat preservation group and control group was decreased at T2-T5 compared to that at T0（ P<0.05）. The core body temperature in closed-loop group was within the set target temperature range. There was no statistically significant difference in TT, PT and APTT among the three groups before operation（ P>0.05）. At T4, the levels of TT, PT and APTT in closed-loop group［（18.9±1.7）seconds,（11.9±0.7）seconds,（35.5±3.3）seconds］and heat preservation group［（18.8±1.7）seconds,（11.6±0.8）seconds,（32.8±2.7）seconds］were shorter than those in control group［（20.9±1.3）seconds,（13.0±0.8）seconds,（35.7±3.4）seconds］（ P<0.05）. At T4, the levels of APTT in closed-loop group and heat preservation group were longer than those before operation（ P<0.05）. At T4, the levels of TT, PT and APTT in control group were longer than those before operation（ P<0.05）. There was no significant difference in the incidence of intraoperative hypothermia or shivering during PACU between closed-loop group［18%（7/40）, 3%（1/40）］and heat preservation group［33%（13/40）, 8%（3/40）］（ P>0.05）, which were lower than those in control group［75%（30/40）, 33%（13/40）］（ P<0.05）. There was no significant difference in the extubation time between closed-loop group［（12.5±3.6）minutes］and heat preservation group［（13.2±3.9）minutes］（ P>0.05）, which was shorter than that in control group［（16.6±4.0）minutes］（ P<0.05）. The incidence of surgical site infection and length of hospital stay were statistically insignificant among the three groups（ P>0.05）. No adverse reactions such as allergic reaction or pressure ulcers occurred in the three groups. Conclusion:For the elderly patients with femoral neck fracture, the perioperative whole-course closed-loop temperature management system can effectively maintain the core body temperature, improve coagulation function, prevent hypothermia, reduce shivering and shorten the extubation time, without increasing the risk of other adverse events, so the system can be safely used in clinical practice.
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Traumatic brain injury(TBI) is one of leading causes of death and disability in children.Targeted temperature management(TTM) may reduce unfavorable outcomes of TBI patients, and many studies have made much effort for developing a norm in managing temperature in TBI patients.TTM, including therapeutic hypothermia, has been recognized as one of candidate methods of neuroprotective treatment.However, the efficacy of hypothermia for patients with severe TBI is not clear.In this article, we will review studies on the potential effects of hypothermia, discuss the possible pathophysiology of neuroprotection with therapeutic hypothermia in PICU, and explore the role of TTM in pediatric severe TBI.
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Targeted temperature management (TTM) is referred to as the reducing of the core body temperature to a specific temperature to repair or mitigate tissue damage caused by inadequate blood perfusion. It is a promising treatment method. However, as it is widely used in clinical practice, more and more disputes have been made about the scope and effect of TTM. This paper will review the mechanism of TTM,the method of its implementation and its application in the disease, so as to provide references for further understanding of TTM and optimizing the clinical application of TTM.
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Objective Targeted temperature management (TTM) is often used in neuro-critical care to minimize secondary neurologic injury and improve outcomes. Evidence-based implementation guideline of TTM was generated from clinical questions relevant to TTM implementation for neuro-critical care by experts recruited by the American Neuro-critical Care Society. Interpretation of this guideline would help the readers to understand the implementation of TTM, bring benefits to standardization of TTM application, and contribute to the solving of specific issues related to TTM implementation.
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Cardiac arrest (CA) is a fatal condition with low resuscitation rate and high mortality rate. Most of the survivors have neurological sequelae affecting their quality of life. Targeted temperature management (TTM) has been suggested by a number of studies to increase the survival rate and improve neurological outcome of CA. It is highly recommended by the International Liaison Committee on Resuscitation (ILCOR) for unconscious patients after resuscitation. In this review, we discuss the pathological mechanism of brain injury in CA and applications of TTM in adults with CA, with the aim of providing valuable information for clinical application.
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Objective To evaluate the efficacy and safety of heated gel mattress(HGM) for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods Systematic searches on PubMed, EMBASE, Cochrane Library, Web of Science CBM,CNKI,Wanfang and VIP were performed for randomized controlled trials or quasi-randomized control trials which explored the effects of HGM on prevention of hypothermia in premature infants relative to conventional alternatives. Studies were screened according to inclusion and exclusion criteria,extracting data and assessing quality. Then, Meta-analysis and trial sequential analysis were performed by using RevMan 5.3 and TSA v0.9 software developed at the Copenhagen Clinical Trials Center in Denmark, independently. Results This systematic review included 10 studies which comprised 7 randomized controlled trials and 3 quasi-randomized control trials, encompassing 773 patients. The results of Meta-analysis showed that in HGM group admission temperature on neonatal intensive care unit (standardized mean difference was 0.63, 95% confidence interval was 0.40-0.87, P=0.00), incidence of hypothermia (relative risk was 0.73, 95% confidence interval was 0.57-0.93, P=0.01) and hyperthermia (relative risk was 1.82, 95% confidence interval was 1.31-2.54, P=0.00) compared with the control group had significantly statistical difference;however, there was no significant difference in admission temperature on EM or TWM group, mortality, sepsis, retinopathy of prematurity, intraventricular hemorrhage III/IV between two groups. TSA confirmed that the pooled results of admission temperature on NICU and hyperthermia were stable and reliable; but the combination of low-temperature incidence and mortality indicators suggested that the sample size was insufficient. Conclusions HGM is an effective rewarming intervention that can improve body temperature of hypothermic preterm infants during transport, reduce the incidence of hypothermia but not decrease the incidence of morbidity and complications. However, it is recommended that clinical monitoring of body temperature should be performed dynamically to decrease the potential risk of high fever and complications. In addition, due to the limitation of quantity and quality of included studies, its cost-effectiveness and far-reaching influence on long-term follow-up outcomes need further evaluation through clinical multicenter, large sample, high-quality research.
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Objective To evaluate the effect of mild hypothermia combined with hypbaric oxygen (HBO) treatment on secondary brain injury in patients with severe craniocerebral injury.Methods A prospective study was conducted in this study.Forty-two patients with severe craniocerebral injury admitted to hospital within 8 hours were randomly divided into sub-hypothermia combined with HBO treatment group and conventional HBO control group,21 cases in either group.Cerebral hemorrhage and brain edema were calculated by reviewed head CT on the 1st day,15th day and 30th day after injury.GCS (Glasgow Coma Scale) score was calculated at the same time.The number of cases of cerebral infarction was counted in the two groups.GOS (Glasgow Outcome Score) prognosis was scored for both groups of patients six months after injury.Two groups of sample rates were compared using a chi-square test with continuous correction,The intergroup comparisons were analyzed by independent sample t test by using SPSS version 13.0 software.Differences were considered statistically significant if P ＜ 0.05.Results (1) The amount of cerebral hemorrhage and edema in the treatment group were significantly lower than those in the control group on the 15th day and 30th day after injury [(21.71 ±4.3) vs.(26.33 ±5.23);(14.33 ± 1.93) vs.(16.86 ±2.86),P ＜0.05].(2) The GCS score of the treatment group was higher than that of the control group on the 15th day and 30th day after injury [(4.62 ±0.49) vs.(2.49 ±0.56);(9.76 ± 1.37) vs.(8.57 ± 0.92),P ＜ 0.05];(3) There were 2 cases of traumatic cerebral infarction in the treatment group and 9 cases in the control group (x2 =4.434,P =0.035).The GOS score in the treatment group was higher than that in the control group six months after injury [(4.29 ± 0.84) vs.(3.38 ± 0.74),P =0.001].Conclusions Mild hypothermia combined with hyperbaric oxygen treatment can reduce the secondary brain injury and improve the prognosis of patients with severe craniocerebral injury.It is worth further study,the mechanism of hypothermia remains to be further studied.
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Cardiac arrest (CA) is the most serious clinical emergency situation and cardiopulmonary-cerebral resuscitation (CPCR) performed on site with high quality is the optional therapy for its management. It has been reported that prolonging the resuscitation time after 30-minute failed conventional cardiopulmonary resuscitation (CPR) could improve the in-hospital survival rate of CA patients, and how to improve the out-hospital survival rate and survival quality of these patients is a research hot focus at present. A male patient admitted to Emergency Center of Shihezi People's Hospital reported in Xinjiang in this study had two CAs. In 2002, he experienced Adams-Strokes syndrome due to acute myocardial infarction (AMI) and survived after 35-minute of successful CPR. The criminal vessel was judged to re-canalize clinically 2 hours after thrombolytic therapy with urokinase, and he was cured and discharged from hospital 25 days later. In 2016, the second CA insult him and after the 185-minute CPR, he survived but experienced the post-CA syndrome. As long as 7-day continuous mild hypothermia was performed, the temperature of displacement fluids in continuous blood purification (CBP) was adjusted to 35 ℃ to achieve the goal of brain protection management requirements. He was cured and discharged from hospital 75 days later. During the 9-month follow-up, he did well in activities of daily living and could engage in routine housework. This paper introduces the treatment process of the patient in detail, and provides experience for clinical treatment.
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Objective To evaluate the association between bradycardia and neurological sequel in patients with restoration of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) during targeted body temperature management (TTM).Methods Forty-three unconscious patients with ROSC after CPR were treated with TTP.The patients were cooled with therapeutic hypothermia to body temperature target range (32-34°C) after cardiac arrest and divided into bradycardia and control groups depending on the lowest heart rate less than 50 beats/min and more than or equal to 50 beats/min respcetively at that time.The bispectral index (BIS) and the neuron-specific enolase (NSE) values were respectively recorded at the following intervals,0h (h0)、24h (h24)、48h (h48)、72h (h72) after ICU admission.Neurological outcome was defined according to the Pittsburgh cerebral performance category (CPC) at 3 months after ICU discharge.Results Compared with the control group,during TTM the bispectral index levels were significantly higher in the bradycardia group at h0,h48,h72 after admission,(h0 bradycardia group 73.0 ± 12.3;control group 58.0 ± 18.6,P ＜0.01)、(h48 bradycardia group 71.4 ± 21.2;control group 46.3 ± 18.9,P ＜ 0.01)、(h72 bradycardia group 78.6 ± 24.6;control group 51.8 ± 24.1,P =0.01).The neuron-specific enolase level in bradycardia group was significantly lower than that in control group on day3 (118.8 ± 118.8 ng/mL vs.248.3 ± 191.9 ng/mL,P =0.02).The level of CPC in the bradycardia group was significantly higher than that in the control group (P =0.046).Conclusions Patients with bradycardia during TTM had favorable neurological outcome,which could provide evidence for clinical treatment and prognostic evaluation of the patients.
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Therapeutic temperature management (TTM) was strongly recommended by the 2015 International Liaison Committee on Resuscitation as a component of post-resuscitation care. It has been known to be effective in improving the survival rate and neurologic functional outcome of patients after cardiac arrest. In an effort to increase local adoption of TTM as a standard of post-resuscitation care, this paper discusses and makes recommendations on the treatment for local providers.
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Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups. We enrolled 22 patients with poor-grade SAH (Hunt & Hess Scale 4, 5 and modified Fisher Scale 3, 4). In the TH group, 10 of 11 (90.9%) patients had a core body temperature of 95% of the 48-hour treatment period. Fewer patients in the TH than control group (n = 11, each) had symptomatic vasospasms (18.1% vs. 36.4%, respectively) and DCI (36.3% vs. 45.6%, respectively), but these differences were not statistically significant. At 3 months, 54.5% of the TH group had a good-to-moderate functional outcome (0–3 on the modified Rankin Scale [mRS]) compared with 9.0% in the control group (P = 0.089). Mortality at 1 month was 36.3% in the control group compared with 0.0% in the TH group (P = 0.090). Mild TH is feasible and can be safely used in patients with poor-grade SAH. Additionally, it may reduce the risk of vasospasm and DCI, improving the functional outcomes and reducing mortality. A larger randomized controlled trial is warranted.
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Humans , Aneurysm , Body Temperature , Brain Injuries , Brain Ischemia , Embolization, Therapeutic , Heart Arrest , Hypothermia, Induced , Mortality , Pilot Projects , Prospective Studies , Rewarming , Subarachnoid Hemorrhage , Vasospasm, IntracranialABSTRACT
OBJECTIVE: The effect of induced hypothermia on severe acute carbon monoxide (CO) poisoning remains to be addressed further. We investigated the effect of induced hypothermia on severe acute CO poisoning. METHODS: Retrospective chart review was conducted for patients who diagnosed as severe acute CO poisoning in emergency department and underwent induced hypothermia from May 2013 to May 2014. Hospital courses with critical medication and major laboratory results were investigated through the chart review. RESULTS: Among total 227 patients with acute CO poisoning during the period of study, patients with severe acute CO poisoning were 15. All patients underwent induced hypothermia with a temperature goal 33°C. Initial and follow-up levels of S100B protein after induced hypothermia were 0.47 μg/L (interquartile range, 0.11 to 0.71) and 0.10 μg/L (interquartile range, 0.06 to 0.37), respectively (P = 0.01). The mean Glasgow Coma Scales at emergency department admission was 6.87 ± 3.36. Except 1 patient who expired after cardiopulmonary resuscitation, Glasgow Coma Scales at 30-day of hospital discharge were 15 in 10 patients (71.4%), 14 in 1 patient (7.1%), 13 in 1 patient (7.1%), and 6 in 2 patients (14.2%). Seven patients (46.7%) developed delayed neurologic sequelae. Four patients showed mild types of delayed neurologic sequelae and 3 showed moderate to severe types of delayed neurologic sequelae. CONCLUSION: Most of patients underwent induced hypothermia had a good recovery from severe acute CO poisoning. Therefore, induced hypothermia may be considered as a possible treatment in severe acute CO poisoning.
Subject(s)
Humans , Carbon Monoxide Poisoning , Carbon Monoxide , Carbon , Cardiopulmonary Resuscitation , Coma , Emergency Service, Hospital , Follow-Up Studies , Hypothermia, Induced , Poisoning , Retrospective Studies , Weights and MeasuresABSTRACT
Sepsis is one of the serious illnesses leading to high mortality in ICU.Some animal experiments and clinical trails show that target temperature management has a protective effect on target organ function in sepsis,but the optimal timing,length of targeted temperature managment continued,intervention measures,and optimal target temperature obtained in sepsis remains in the great controversy.Whether the patients with sepsis would be truly benefited from the body temperature management is still worthy issue for further study.The aim of this article reviews is to trace the recent research progress on the body temperature management in sepsis.