An interpretation of an evidence-based guideline from the American Neuro-critical Care Society about the implementation of targeted temperature management / 中华危重病急救医学

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.

Respuesta hemodinámica a la circulación extracorpórea con normotermia en la cirugía cardiovascular pediátrica / Hemodynamic response to extracorporeal circulation with normothermia in pediatric cardiovascular surgery

Introducción: El empleo de la normotermia durante la circulación extracorpórea en pediatría fue iniciado por Lecompte en 1995. Objetivo: Evaluar la respuesta hemodinámica con el empleo de la normotermia como método de protección de órganos durante la circulación extracorpórea en niños. Método: Se distribuyeron aleatoriamente 100 pacientes mayores de 30 días. En normotermia (n=45) se utilizó temperatura de 36 0C, hematocrito mayor de 30 % y flujo de perfusión entre 2,8 y 3,5 L/min/m². En hipotermia (n= 55), hematocrito entre 25 y 30 % y flujo de perfusión entre 2,2 y 2,8 L/min/m². Resultados: Ambos grupos fueron homogéneos en edad, peso y riesgo ajustado para los procedimientos quirúrgicos. La respuesta hemodinámica fue significativamente mejor con la normotermia, según valores de ácido láctico, saturación venosa central de oxígeno e índice cardíaco al final de la circulación extracorpórea y a las 8 horas de ingreso en la unidad de cuidados intensivos. Conclusiones: La normotermia durante la circulación extracorpórea en niños es segura y eficaz.

Introduction: The use of normothermia during extracorporeal circulation in Pediatrics was started by Lecompte in 1995. Objective: To assess the hemodynamic response with the use or normothermia as a protection method for organs over the extracorporeal circulation in children. Method: One hundred patients aged over 30 days were randomly distributed. In normothermia (n =45) temperature was of 36ºC, hematocrit more than 30 % and the perfusion flow between 2,2 and 2,8 L/min/m². Results: Both groups were homogenous in age, weight and risk adjusted for surgical procedures. Hemodynamic response was significantly better with normothermia according the lactic acid values, oxygen central venous saturation and heart rate at the end of extracorporeal circulation and at 8 h post-admission in the intensive care unit (ICU). Conclusions: The normothermia in Pediatric cardiovascular surgery with extracorporeal circulation perfusion is sure and efficacy.

The Systemic Effects of Hypothermic and Normothermic Cardiopulmonary Bypass in Cardiac Surgery / 대한흉부외과학회지

BACKGROUND: This study was prospectively designed to determine the physiologic effects of normothermic CPB and to compare its influences with hypothermic CPB. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomly assigned to moderate hypothermic (hypothermic group nasopharyngeal temperature 26~28 degreeC, n=18) or normothermic (normothermic group, nasopharyngeal temperature>35.5 degreeC, n=18) CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after the start of CPB (CPB-10), and immediately after CPB stop (CPB-off) for determining total leukocyte counts, neuron-specific enolase (NSE), interleukin-6 (IL-6), endothelin-1 (ET-1), cortisol, troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, blood urea nitrogen (BUN), and the pulmonary index (PI, PaO2/FiO2). Other parameters such as urine output, mechanical ventilating period, ICU-staying period, postoperative complications and hospitalized days were also evaluated. RESULT: Total leukocyte counts, increased rate in NSE, in IL-6 and in cortisol at CPB-10 and CPB-off were significantly higher in normothermic group than in hyphothermic group. Urine output during CPB was lower in normothermic group than in hyphothermic group. The duration of mechanical ventilation, ICU-stay, and hospitalization were longer in normothermic group than in hyphothermic group. CONCLUSION: These findings suggested that normothermic CPB caused higher inflammatory and stress responses than hypothermic CPB during cardiac surgery using cold crystalloid cardioplegia. However, further studies with large number of cases should be carried out to validate this hypothesis.

Anesthetic Management for the Open Heart Surgery in a Patient with Cold Agglutinin Disease: Case report / 대한마취과학회지

Cold agglutinins are serum autoantibodies activated at reduced body temperatures to produce red blood cell agglutination and hemolysis. They are commonly found in the sera of healthy people but rarely become clinically important, because most of them exist at very low titers, and exert their greatest effect at low temperatures. By contrast, during open heart surgery, systemic hypothermia and cold cardioplegia are commonly used, and cold agglutinins can be a appreciable threat. This report describes a patient with documented cold agglutinins who successfully underwent atrial septal defect closure and patent ductus arteriosus ligation by normothermic cardiopulmonary bypass in an effort to avoid the adverse effects of hypothermia.

Effects of Intraoperative Hypothermia on the Incidence of Post-operative Infection and Responses of Peripheral White Blood Cells / 대한마취과학회지

BACKGROUND: Hypothermia occurs commonly during surgery. An increased incidence of hypothermia- induced morbidity of surgical patients has been reported. Immunosuppression has also been demonstrated after major surgery. Therefore, we investigated the rate of infection and the changes of white blood cells depending on body temperature during a gastrectomy. METHODS: Sixty patients were randomly divided into be warmed intraoperatively with a circulating warm water mattress (group 1) or warm intravenous fluid/humidifier filter/circulating warm water mattress (group 2). Core temperature was recorded every 15 min during surgery and every 30 min in the recovery room. Blood samples for measurement of white blood cells were obtained preoperatively, immediately, post-op day 1 and day 2 after surgery. RESULTS: Group 1 began to have a decrease in temperature at 30 min after surgery and a significantly lower temperature than group 2 during the surgery and 60 min in the recovery room (P<0.05). Compared with preoperative values, surgery caused an increase in neutrophils, and a decrease in lymphocytes in both groups (P<0.05). Compared with group 2, more concentrations of neutrophils and less concentration of lymphocytes and monocytes were found in group 1 on the post-operative 2nd day (P<0.05). Fever above 37.3degrees C was found in 17 of 30 patients in group 1, but in only 14 of 30 patients in group 2. Pneumonia (one patient), urinary tract infection (one) and surgical wound infection (two) were only found in group 1, but the incidence of infection was not statistically significant between the groups. CONCLUSIONS: Intraoperative hypothermia was associated with a delayed recovery of changes in white blood cells.

Open heart operations using disposable plastic oxygenators, 5% dextrose in distilled water prime, normothermia, and a sigmamotor pump (T-M2)

Open heart operations were successfully performed on six consecutive patients at the Philippine General Hospital. Total cardiopulmonary bypass was accomplished using disposable plastic oxygenators, five percent dextrose in distilled water prime, normothermia and a single sigmamotor pump (T-M2). The technic of perusion, clinical material, physiologic data gathered and the financial costs of these operations were discussed. All the patients survived their operations. No complication could be attributable to the method of cardiopulmonary bypass employed. The technic of cardiopulmonary bypass described appears practical, safe, and relatively inexpensive. This method of bypass has been adopted for use by the Department of Surgery for all types of open heart operations. (Author)

Myocardial protective effects of continuous infusion with normothermic oxygenated crystalloid solution or blood cardioplegia during normothermic cardtopulmonary bypass / 中华麻醉学杂志

The myocardial protective effect of continuous infusion with normothermic oxygenated crystalloid solution or blood cardioplegia during normothermic CPB was studied in 15 dogs. Ultrastructure. levels of adenine nucleotides,lipid peroxide (LPO),water content of heart musle,hemodynamics were observed. Dogs were randomly divided into three groups. Group Ⅰ: intermittent infusion with cold crystsalloid cardioplegia during hypothermic CPB (n=5); Group Ⅱ: continuous infusion with normothermic oxygenated blood cardioplegia during normothermic CPB(n=5); Group Ⅲ: continuous infusion with normothermic oxygenatde crystalloid cardioplegia duriug normothermic CPB((n=5). The normal mitochandria contents and glycogen stores in group Ⅱ and Ⅲ were significantly higher than those in group Ⅰ(P