Short-term neurological injury in newborns infants with overcooling in passive hypothermia and transferred to reference hospital in Colombia.

AIM: The aim of the study was to determine whether overcooling (temperature <33°C) during passive hypothermia when transporting neonates with perinatal asphyxia increased the risk of short-term neurological injury. METHODS: A retrospective observational study was performed. Newborns transferred to the LaCardio neonatal unit between January 2021 and April 2022 with moderate and severe perinatal asphyxia and who received passive hypothermia during transport were included. A temperature of <33°C was considered overcooling. A composite outcome of neurological injury was defined by the presence of abnormalities on brain magnetic resonance imaging, video telemetry, seizure before discharge or both. RESULTS: The study included 101 newborns. A total of 18 neonates had a temperature <33°C after transportation. Neurological injuries were present in 21.8% of the temperature <33°C group and 78.2% of the temperature ≥33°C group. Temperature <33°C at the end of transport (aOR 9.2, 95% CI 1.1-77.3) were associated with neurological injury before discharge from the unit. CONCLUSION: During transportation, overcooling in neonates with asphyxia increases the risk of neurological injury before discharge from the neonatal unit. It is important to qualify the transport team with adequate training and equipment for therapeutic hypothermia.

The safety and efficacy of hypothermia combining mechanical thrombectomy or thrombolysis in the treatment of ischemic stroke: A systematic meta-analysis.

BACKGROUND: Stroke is a major global public health problem, affecting 13.7 million people worldwide. Previous studies have found a neuroprotective effect of hypothermia therapy and the efficacy and safety of combined hypothermia and mechanical thrombectomy or thrombolysis in the treatment of ischemic stroke have also attracted attention. OBJECTIVE: In the present research, the authors conducted a meta-analysis to comprehensively assess the safety and efficacy of hypothermia combining mechanical thrombectomy or thrombolysis in the treatment of ischemic stroke. METHODS: Articles published from January 2001 to May 2022 were searched from Google Scholar, Baidu Scholar and PubMed to evaluate the clinical significance of hypothermia treatment in ischemic stroke. Complications, short-term mortality, and the modified Rankin Scale (mRS) in the full text was extracted. RESULTS: 89 publications were selected and 9 among them were included in this study with sample size of 643. All selected studies are in accordance with the inclusion criteria. Forest plot of clinical characteristics was as follows: complications (RR = 1.132, 95% CI 0.942‒1.361, p = 0.186, I2 = 37.2%), mortality within 3 months (RR = 1.076, 95% CI 0.694‒1.669, p = 0.744, I2 = 0.00%), mRS ≤ 1 at 3 months (RR = 1.138, 95% CI 0.829‒1.563, p = 0.423, I2 = 26.0%), mRS ≤ 2 at 3 months (RR = 1.672, 95% CI 1.236‒2.263, p = 0.001, I2=49.6%) and mRS ≤ 3 at 3 months (RR = 1.518, 95% CI 1.128‒2.043, p = 0.006, I2 = 0.00%). The funnel plot suggested that there was no significant publication bias in the meta-analysis on complications, mortality within 3 months, mRS ≤ 1 at 3 months and mRS ≤ 2 at 3 months. CONCLUSION: In summary, the results showed that hypothermia treatment was correlated with mRS ≤ 2 at 3 months, but not linked with complications and mortality within 3 months.

Accuracy of the defining characteristics of the nursing diagnosis hypothermia in patients on hemodialysis.

OBJECTIVE: to analyze the accuracy of the defining characteristics of hypothermia in patients on hemodialysis. METHODS: a diagnostic accuracy study was assembled within a cross-sectional study with 124 patients from two dialysis centers. A latent class model was used for data analysis. RESULTS: the nursing diagnosis hypothermia was present in 13 (10.48%) study participants. The most prevalent defining characteristics were hypoxia (100%), decrease in blood glucose level (83.1%), hypertension (65.3%), piloerection (45.2%), and skin cool to touch (41.1%). The defining characteristics acrocyanosis (99.96%) and cyanotic nail beds (99.98%) had a high sensitivity. Acrocyanosis (91.8%), skin cool to touch (64.8%), and peripheral vasoconstriction (91.8%) had high specificity. CONCLUSION: specific and sensitive indicators of hypothermia work as good clinical indicators for confirming this diagnosis in patients on hemodialysis. The study findings can assist nurses in their clinical reasoning for a correct inference of hypothermia.

Hipotermia perioperatoria / Perioperative hypothermia

Perioperative hypothermia is a common complication of general anesthesia, but it can also occur in patients undergoing regional anesthesia. It signifiicantly increases perioperative morbidity and mortality. Complications such as increased incidence of surgical site infection, delayed healing, coagulation abnormalities, increased surgical bleeding, perioperative cardiac events, decreased metabolism of drugs involved in anesthesia and a great discomfort in the immediate postoperative period (due to shivering), have been identified. The decrease in the patient's core temperature is due to a combination of physiological events related to the surgical anesthetic act. These include deterioration of the effector responses of the hypothalamus (tending to conserve heat), heat distribution between the central compartment and the periphery, and net heat loss to a generally colder environment, such as the surgical ward. Hypothermia is often an undetected complication of the anesthetic act due to the lack of regular temperature monitoring. It is not considered a basic standard of care, despite the fact that in recent years new guidelines and recommendations have emerged, which suggest its implementation in all patients in whom the duration of their surgery is expected to last longer than 1 hour. The measures aimed at keeping the patient normothermic can be classified as passive, within which the simplest is to cover the patient for as long as possible during their presence in the ward, and active, which are those that transfer heat to the body, within the which the most effective is the use of convective heat blankets. It has recently been suggested that prewarming the patient before inducing anesthesia is an efficient strategy to avoid hypothermia, decreasing temperature differences between core and peripheral tissues. However, the effectiveness of this measure remain to be evaluated with prospective, randomized trials. In the context of the emergency patient, although hypothermia shows the same characteristics as in the elective patient, it becomes more relevant in three clinical settings: patient with major burns, patient in hemorrhagic shock and the polytraumatized patient. In these scenarios, keeping the patient normothermic will prevent a series of serious complications, which can strongly affect mortality.

La hipotermia perioperatoria es una complicación frecuente de la anestesia general, pero que también se puede presentar en pacientes sometidos a anestesia regional. Se relaciona con un aumento significativo de la morbilidad y mortalidad perioperatorias, donde se han identificado complicaciones como aumento de la incidencia de infección del sitio quirúrgico, retardo de la cicatrización, alteraciones de la coagulación, aumento del sangrado quirúrgico, de los eventos cardiacos perioperatorios, disminución del metabolismo de drogas implicadas en la anestesia y sensación de gran incomodidad del paciente en el posoperatorio inmediato, por la presencia de calosfríos. La disminución de la temperatura central del paciente se debe a un combinación de eventos fisiológicos relacionados con el acto anestésico quirúrgico, con deterioro de las respuestas efectoras del hipotálamo tendientes a conservar calor, fenómenos distributivos de calor entre el compartimiento central y la periferia del propio paciente y pérdida de calor neta hacia un medio ambiente en general más frío, como lo es el pabellón quirúrgico. El hecho de que la hipotermia sea muchas veces considerada una complicación no detectada del acto anestésico, se debe a que aún la monitorización regular de la temperatura no se considera un estándar básico de cuidado, pese a que en los últimos años han surgido nuevas guías y recomendaciones, que sugieren que ésta sea implementada en todo paciente en que se proyecte una duración de la cirugía mayor a 1 hora. Las medidas tendientes a mantener al paciente normotérmico, pueden ser clasificadas en pasivas, dentro de las cuales la más simple es cubrir al paciente el mayor tiempo posible durante su presencia en pabellón y activas, que son aquellas que transfieren calor al cuerpo, dentro de las cuales la más efectiva es el uso de mantas de calor convectivo. Recientemente, se ha sugerido que una de las estrategias eficientes para evitar la HPO es el precalentamiento del paciente, que permite que sus tejidos periféricos estén a mayor temperatura al momento de inducir la anestesia, sin embargo, la efectividad de esta medida debe ser evaluada con estudios prospectivos y aleatorizados más concluyentes. La hipotermia en el contexto del paciente de urgencia, si bien presenta las mismas características que en el paciente electivo, cobra mayor relevancia en tres escenarios clínicos: el gran quemado, el paciente en hemorrágico y el paciente politraumatizado, escenarios en que mantener al paciente normotérmico, implicará evitar una serie de complicaciones graves, que pueden incidir fuertemente en la mortalidad.

Central serotonin prevents hypotension and hypothermia and reduces plasma and spleen cytokine levels during systemic inflammation.

An exceptionally high mortality rate is observed in sepsis and septic shock. Systemic administration of lipopolysaccharide (LPS) has been used as an experimental model for sepsis resulting in an exacerbated immune response, brain neurochemistry adjustments, hypotension, and hypothermia followed by fever. Central serotonergic pathways not only modulate systemic inflammation (SI) but also are affected by SI, including in the anteroventral region of the hypothalamus (AVPO), which is the hierarchically most important region for body temperature (Tb) control. In this study, we sought to determine if central serotonin (5-HT) plays a role in SI induced by intravenous administration of LPS (1.5 mg/kg) in male Wistar rats (280-350 g) by assessing 5-HT levels in the AVPO, mean arterial pressure, heart rate, and Tb up to 300 min after LPS administration, as well as assessing plasma and spleen cytokine levels, nitric oxide (NO) plasma levels, and prostaglandin (PG) E2 levels in the AVPO at 75 min and 300 min after LPS administration. We observed reduced AVPO 5-HT levels, hypotension, tachycardia, hypothermia followed by fever, as well as observing increased plasma NO, plasma and spleen cytokines and AVPO PGE2 levels in SI. Intracerebroventricular (icv) administration of 5-HT 30 min before LPS administration prevented hypotension and hypothermia, which were accompanied by reduced plasma NO, as well as plasma TNF-α, IL-1ß, IL-6, and IL-10 and spleen TNF-α and IL-10 levels. We suggest that SI reduced 5-HT levels in the AVPO favor an increased pro-inflammatory status both centrally and peripherally that converge to hypotension and hypothermia. Moreover, our results are consistent with the notion that exogenous 5-HT given icv prevents hypotension and hypothermia probably activating the splenic anti-inflammatory pathway.

Forced Air Warming System: Evaluation of Internal System Contamination.

BACKGROUND: Despite the indisputable need to prevent peri-operative hypothermia, some evidence in the literature questions the possible role of forced air warming systems as a risk factor for the occurrence of surgical site infection. The objective of the study is to evaluate the micro-biologic safety of a forced air warming systems (FAW) in relation to the risk of emission of micro-organisms in the surgical environment. METHODS: A quantitative, descriptive-exploratory laboratory study performed in a large hospital. An evaluation of possible internal contamination was performed by collecting air from the hose onto plates containing Trypticase Soy Agar. The experiment was performed in triplicate two months after replacing the filter and again after six months using a random sample of 50% of the FAW in use, which corresponded to 13 FAW and a total of 75 samples. RESULTS: Among the 39 samples analyzed in the first stage, only nine (23.1%) plates presented microbial growth of one or two colonies, while only six (16.7%) plates of the 36 evaluated samples in the second phase had growth of one or two colonies. CONCLUSIONS: This study showed small microbial growth of culture after 48 hours after filter replacement. New investigations that correlate the findings of micro-biology analysis and the occurrence of surgical site infection should be conducted.

Livedo reticularis by hypothermia during anesthesia for dental treatment in Down's syndrome patient / Livedo reticular por hipotermia durante anestesia para tratamento odontológico em paciente com síndrome de Down

Abstract Background: Livedo reticularis is a benign dermatological condition characterized by ischemic areas permeated by erythematous-cyanotic areas in a lacy pattern, and may be transient or permanent and is frequently associated with body exposure to cold. Cutaneous arterial vasospasm promotes ischemia, and venous dilation of the congested areas occurs by tissue hypoxia or autonomic dysfunction. Patients with Down's syndrome, due to their physiological peculiarities, constitute a representative part of those who require dental care under general anesthesia, and livedo reticularis has a reported incidence of 8-12% in Down's syndrome patients. Objectives: To describe the physiological livedo reticularis in a Down's syndrome patient, with the onset during the anesthetic-surgical procedure. Case report: 5-year-old female patient with Down's syndrome, admitted for dental treatment under balanced general anesthesia with sevoflurane, fentanyl, and atracurium. Transoperative hypothermia occurred with axillary temperature reaching 34.5 °C after 30 min after the beginning of anesthesia. At the end of the procedure, red-purplish skin lesions interspersed with areas of pallor were observed exclusively on the ventromedial aspect of the right forearm, with no systemic signs suggestive of allergic reactions. The established diagnosis was physiological livedo reticularis. There was a total fading of the lesions within 5 days. Conclusion: This report evidences the need for thermal control of patients undergoing anesthesia, as well as the manifestation of livedo reticularis as a consequence of transoperative hypothermia.

Resumo Justificativa: O livedo reticular representa quadro dermatológico benigno, caracterizado por áreas isquêmicas permeadas por áreas eritematocianóticas em padrão rendilhado, pode ser transitório ou permanente e frequentemente é associado à exposição corporal ao frio. O vasoespasmo arterial cutâneo promove a isquemia e a dilatação venosa das áreas congestas e ocorre por hipóxia tecidual ou por disfunção autonômica. Os portadores da síndrome de Down, devido às suas peculiaridades fisiológicas, constituem uma representativa parcela daqueles que necessitam de atendimento odontológico sob anestesia geral e o livedo reticular tem incidência relatada de 8% a 12% em pacientes com síndrome de Down. Objetivos: Descrever quadro de livedo reticular fisiológico em paciente portador de síndrome de Down, com aparecimento durante o ato anestésico-cirúrgico. Relato do caso: Paciente de cinco anos, sexo feminino, síndrome de Down, admitida para tratamento odontológico sob anestesia geral balanceada, com emprego de sevoflurano, fentanil e atracúrio. Houve ocorrência de hipotermia transoperatória, a temperatura axilar atingiu 34,5 ºC após 30 minutos do início da anestesia. Ao término do procedimento, notaram-se lesões cutâneas vermelho-arroxeadas, intercaladas com áreas de palidez, exclusivamente na face ventromedial do antebraço direito, sem sinais sistêmicos sugestivos de reações alérgicas. O diagnóstico firmado foi de livedo reticular fisiológico. Houve esmaecimento total das lesões em cinco dias. Conclusão: O relato apresentado evidencia a necessidade de controle térmico de pacientes submetidos a anestesias, bem como registra manifestação de livedo reticular em consequência de hipotermia transoperatória.

[Livedo reticularis by hypothermia during anesthesia for dental treatment in Down's syndrome patient]. / Livedo reticular por hipotermia durante anestesia para tratamento odontológico em paciente com síndrome de Down.

BACKGROUND: Livedo reticularis is a benign dermatological condition characterized by ischemic areas permeated by erythematous-cyanotic areas in a lacy pattern, and may be transient or permanent and is frequently associated with body exposure to cold. Cutaneous arterial vasospasm promotes ischemia, and venous dilation of the congested areas occurs by tissue hypoxia or autonomic dysfunction. Patients with Down's syndrome, due to their physiological peculiarities, constitute a representative part of those who require dental care under general anesthesia, and livedo reticularis has a reported incidence of 8% to 12% in Down's syndrome patients. OBJECTIVES: To describe the physiological livedo reticularis in a Down's syndrome patient, with the onset during the anesthetic-surgical procedure. CASE REPORT: 5-year-old female patient with Down's syndrome, admitted for dental treatment under balanced general anesthesia with sevoflurane, fentanyl, and atracurium. Transoperative hypothermia occurred with axillary temperature reaching 34.5°C after 30minutes after the beginning of anesthesia. At the end of the procedure, red-purplish skin lesions interspersed with areas of pallor were observed exclusively on the ventromedial aspect of the right forearm, with no systemic signs suggestive of allergic reactions. The established diagnosis was physiological livedo reticularis. There was a total fading of the lesions within 5 days. CONCLUSION: This report evidences the need for thermal control of patients undergoing anesthesia, as well as the manifestation of livedo reticularis as a consequence of transoperative hypothermia.

Compromiso de conciencia y bradicardia / Unconciousness and bradycardia

Resumen: Mujer de 71 años, institucionalizada con antecedentes de esquizofrenia y tabaquismo. Consulta en el servicio de urgencias tras ser encontrada a la intemperie comprometida de conciencia. Al llegar la ambulancia se constata mal perfundida, bradipsíquica y bradicárdica, siendo trasladada al servicio de Urgencia. A su ingreso el ECG mostró bradicardia sinusal con trastorno de la conducción intraventricular y prolongación del intervalo QT. Los exámenes de laboratorio al ingreso resultaron dentro de límites normales. La historia clínica y los trazados electrocardiográficos son presentados, siendo discutidos junto al manejo médico.

Abstracts: A 71year old woman, institutionalized with a history of schizophrenia and smoking. She was transported to a local emergency room after being found laying outside unconscious. She was hypoperfused, bradypsychic and bradycardic, being transferred to the emergency service. On admission, the ECG showed sinus bradycardia with intraventricular conduction delay and QT prolongation. Laboratory tests were normal. Clinical history, physical examination and ECG tracings are presented and management is discussed.

Variación de la temperatura central durante la cirugía colorrectal laparoscópica / Cangas in central temperature during laparoscopic colorectal surgery

Introducción: La hipotermia es una complicación que se produce con frecuencia en el posoperatorio de la cirugía laparoscópica. Múltiples factores potencian la disminución de la temperatura corporal por efecto directo del gas. Objetivo: Determinar las variaciones de la temperatura corporal en la intervención colorrectal laparoscópica y su influencia en la hipotermia intraoperatoria. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en pacientes con anestesia general para procedimiento laparoscópico colorrectal electivo con el propósito de identificar la incidencia y variaciones de la temperatura corporal. El estudio se realizó en el hospital Hermanos Ameijeiras entre enero de 2014 y enero de 2017. Resultados: De los 88 pacientes, 78,4 por ciento tenían entre 51 y 60 años. El sexo masculino, los pacientes con sobrepeso y la clasificación ASA II presentaron mayor frecuencia. La temperatura basal media fue de 36,4 oC. Luego de 30 min disminuyó a 35,5 oC, a la hora 35,4 oC, a 90 min 35,1 oC y al finalizar 34,9 oC. Del total, presentaron hipotermia intraoperatoria no intencionada 78,4 por ciento. En ninguno se constató hipotermia severa. El tiempo quirúrgico promedio fue de 183,1 min. Se verificaron 49 complicaciones asociadas a hipotermia. Conclusiones: Se identificaron las variaciones de la temperatura corporal en la intervención colorrectal laparoscópica y la tendencia de generar hipotermia durante el procedimiento quirúrgico(AU)

Introduction: Hypothermia is a complication that frequently occurs in the postoperative period of laparoscopic surgery. Multiple factors boost the decrease in body temperature due to the direct effect of gas. Objective: To determine the variations in body temperature in laparoscopic colorectal surgery and its influence on intraoperative hypothermia. Methods: A descriptive, longitudinal and prospective study was carried out with patients, using general anesthesia for elective laparoscopic colorectal procedures and with the purpose of identifying the incidence and variations of body temperature. The study was carried out at the Hermanos Ameijeiras Hospital, between January 2014 and January 2017. Results: Among the 88 patients, 78.4 percent were at ages 51-60 years. Male sex, overweight patients and ASA-II classification were more frequent. The average basal temperature was 36.4ºC. After 30 min, it decreased to 35.5ºC; after one hour, to 35.4 ºC; after 90 min, 35.1ºC; and at the end, to 34.9 ºC. From the total, 78.4 percent presented unintentional intraoperative hypothermia. None of them had severe hypothermia. The average surgical time was 183.1 min. There were 49 complications associated with hypothermia. Conclusions: Variations in body temperature were identified in the laparoscopic colorectal intervention, as well as the tendency to generate hypothermia during the surgical procedure(AU)

Impact of Hypothermic Stress During Special Operations Training of Chilean Military Forces.

Introduction: The Chilean Army considers processes that can optimize physical capacities for responding to the impact of situations and given stressors. The study of the effect of hypothermia as a stressor agent (HSA) and its relationship with cardiovascular, hematological, anthropometric, endocrine, and immunological parameters has not been fully addressed experimentally in military populations. Objective: To identify the endocrine, hematological, cardiovascular, and immunological changes caused by HSA and to associate these variables with body composition and physical fitness in the military special operation courses of the Chilean Army. Materials and Methods: Forty-two male subjects were exposed to remain in cold water (10.6 °C) in the context of regular military operations training, the longest time of exposure was determined by individual volitional limits. The measurements were taken in pre-hypothermia conditions, then 2 d later under acute hypothermia condition, and finally during the course period of lesser physical and psychological stressors where the baseline measurements were taken. The statistical analysis consisted of testing normality of the distribution through the Shapiro-Wilk test, assessing the equality of variances through the Levene test, and variance analysis by applying the ANOVA test (analysis of variance). The Bonferroni test was used for multiple comparison correction and the Pearson test for correlations between two variables. The level of significance was of p < 0.05. Results: The main finding of this study is that HSA has a significant impact at the cardiovascular level and produces an increment in the cell population of the immune and hematologic systems. Significant hormonal changes were observed: ACTH (r = 0.50, p < 0.002), cortisol (r = 0.32, p < 0.03), free testosterone (r = 0.13, p < 0.002), total testosterone r = 0.31, p < 0.002), and anthropometrics (r = -0.51, p < 0.05). However, there is no significant correlation between physical fitness and HAS. Conclusions: All subjects experienced hypothermia stress elicited by immersion in cold water. This was evidenced by the decrease in core temperature as well as cardiovascular, endocrine, anthropometric, and immunological changes. Individual differences exist between subjects and their resistance to hypothermia in cold water. These differences are not explained by the physical fitness profile but rather respond to a greater body adiposity index and minor changes in the adrenocorticotropic hormone and cortisol hormone. An acute hypothermia stress condition also affects the anabolic/catabolic environment. Finally, HSA produces an increase in the cell population of the immune system. The authors believe that this study allows to standardize HSA exposure times during regular military operations training by identifying the physiological impacts under this extreme environment. At present, the availability of intra-abdominal temperature measurement apparatus with capsule thermometers raises the interest of corroborating the findings of the current study through the use of such measuring devices. Likewise, an interesting line of research for the future would be to compare the HSA against a psychological evaluation with the purpose of identifying the stress management mechanisms among subjects of these characteristics and include heart rate variability measurements as an indicator of sympathetic stress.

Effect of mild hypothermia on renal ischemia/reperfusion injury after cardiopulmonary resuscitation in a swine model

Purpose: To investigate the effect of intravascular cooling on renal function after resuscitation. Methods: Twenty four pigs were randomized into three groups (n=8 in each group): therapeutic hypothermia group (TH group), normothermia group (NH group) and sham operation group (SHAM group). After 6 minutes of untreated VF, CPR was performed. Upon ROSC, the TH group received the intravascular cooling. The NH and SHAM group did not undergo therapeutic hypothermia. Haemodynamic parameters were recorded. The bloods were analyzed for serum creatinine (sCr), CysC and NGAL. The kidney was surgically removed observe pathologic changes under a light microscope. Results: The sCr increased in both TH and NH groups after ROSC, compared to baseline. Between two groups, the sCr and creatinine clearance (Cc) showed lower level in the TH group. The urine volume per hour in the TH group were higher during cooling. After resuscitation, NGAL and CysC in the NH group were higher than in the TH group. Under the light microscope, compared with the TH group, the renal injury was prominent in the NH group. Conclusion: Mild hypothermia had a protection to renal ischemia reperfusion injury after resuscitation.(AU)

Onda de Osborn asociada a hipotermia sin bradicardia presente. A propósito de un caso / Osborn´s wave associated to hypothermia without the presence of bradycardia. A propos of a case

La onda J de Osborn es una deflexión que se inscribe en el electrocardiograma (ECG) entre el complejo QRS y el inicio del segmento ST. La onda J tiene una alta sensibilidad y especificidad en la hipotermia, aunque no es patognomónica. Se han descrito casos en la hemorragia subaracnoidea, la hipercalcemia, la isquemia cardíaca aguda y la hipotermia severa. Se presenta el caso de un paciente masculino, alcohólico, encontrado en situación de bajo nivel de conciencia por sobredosificación de alcohol, que desarrolló un cuadro de hipotermia con la presencia de una onda de Osborn en el electrocardiograma sin bradicardia asociada (AU).

The Osborn´s J wave is a deflection inscribed in the electrocardiogram (ECG) between the QRS complex and the beginning of the ST segment. The J wave shows a high sensibility and specificity in the hypothermia, although it is not patognomonic. Cases have been described in subarachnoid hemorrhage, hypercalcemia, acute cardiac ischemia and severe hypothermia. The case of an alcoholic, male patient is presented. He was found in a situation of a low awareness level due to alcohol overdoses, and developed hypothermia with the presence of an Osborn´s wave in the electrocardiogram without associated bradycardia (AU).

Onda de Osborn asociada a hipotermia sin bradicardia presente. A propósito de un caso / Osborn´s wave associated to hypothermia without the presence of bradycardia. A propos of a case

La onda J de Osborn es una deflexión que se inscribe en el electrocardiograma (ECG) entre el complejo QRS y el inicio del segmento ST. La onda J tiene una alta sensibilidad y especificidad en la hipotermia, aunque no es patognomónica. Se han descrito casos en la hemorragia subaracnoidea, la hipercalcemia, la isquemia cardíaca aguda y la hipotermia severa. Se presenta el caso de un paciente masculino, alcohólico, encontrado en situación de bajo nivel de conciencia por sobredosificación de alcohol, que desarrolló un cuadro de hipotermia con la presencia de una onda de Osborn en el electrocardiograma sin bradicardia asociada (AU).

The Osborn´s J wave is a deflection inscribed in the electrocardiogram (ECG) between the QRS complex and the beginning of the ST segment. The J wave shows a high sensibility and specificity in the hypothermia, although it is not patognomonic. Cases have been described in subarachnoid hemorrhage, hypercalcemia, acute cardiac ischemia and severe hypothermia. The case of an alcoholic, male patient is presented. He was found in a situation of a low awareness level due to alcohol overdoses, and developed hypothermia with the presence of an Osborn´s wave in the electrocardiogram without associated bradycardia (AU).

Neurologic complications of acute environmental injuries.

Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.

Hipotermia terapéutica: programa para prevención del daño neurológico de la encefalopatía hipóxico isquémica en Buenos Aires / THERAPEUTIC HYPOTHERMIA: A MODEL TO PREVENT NEUROLOGIC DAMAGE BY ISCHEMIC HIPOXIC ENCEPHALOPATHY

Introducción: La hipotermia terapéutica (HT) es el estándar de cuidado para la encefalopatía hipóxico-isquémica (EHI). El servicio de neonatología implemento el programa de HT en el marco de la red perinatal de la Ciudad de Buenos Aires (RPCABA). Objetivos: Describir la implementación del programa de hipotermia en RPCABA. Reportar la mortalidad, complicaciones y efectos adversos asociados al tratamiento. Métodos: La implementación del programa se realizó en etapas: 1) 2009- 2010 Capacitación y entrenamiento en el uso del equipamiento. 2) 2010 hasta la actualidad: Tratamiento y seguimiento para los pacientes con EHI moderada o grave. Resultados: Hasta Marzo de 2017, 65 neonatos recibieron HT (7 con hipotermia corporal total y los 58 restantes hipotermia activa selectiva), 49 paciente fueron clasificados según la Escala Sarnat & Sarnat como EHI moderada y 16 como EHI grave. Conclusiones: Fue factible implementar el programa en nuestra unidad, auditarlo para mejorarlo y sostenerlo en el tiempo. El sistema de traslado pudo responder ante la activación del "código de hipotermia", cumpliendo tiempos, sosteniendo el tratamiento y el monitoreo adecuado. Creemos necesario mejorar la identificación de neonatos con diagnóstico de EHI en RPCABA. Se necesita nueva capacitación para evitar el subdiagnóstico de esta patología en los centros de nivel 2

Therapeutic hypothermia (TH) is nowadays the gold standard of care for the treatment of hypoxic- ischemic encephalopathy (HIE) in developed countries. The term encephalopathy refers to a diffuse disturbance of brain function, resulting in behavioral changes, altered consciousness or seizures. The brain is particularly vulnerable to even brief interruptions of blood flow or oxygen supply. If the brain´s oxygen supply is insufficient, consciousness is lost rapidly. If oxygenation is restored immediately, consciousness returns without sequelae. However, if oxygen deprivation lasts longer than 1 or 2 minutes, signs of an encephalopathy may persists for hours or permanently. Total ischemic anoxia lasting longer than about 4 minutes usually results in severe irreversible brain damage. The aim of the present report was to describe the implementation of the hypothermia program in a model for the perinatal system at the City of Buenos Aires, with the equipment Cool Cap® for selective hypothermia, and the equipment CFM Olympic 6000® and CFM OMB from Medix® by Natus®, these two to monitoreate the cerebral function. The results obtained are referred, with special consideration to mortality, complications and adverse effects associated with the treatment.

Terapia do controle da temperatura pós-parada cardiorrespiratório / Temperature control therapy after cardiorespiratory

O processo fisiopatológico secundário à parada cardiorrespiratória (PCR) com retorno da circulação espontânea (RCE), determina a síndrome pós-PCR, com lesão cerebral, disfunção miocárdica e reperfusão, em resposta à isquemia orgânica. A terapia do controle da temperatura (TCT) oferece mecanismos neuroprotetores, limitação da lesão miocárdica e redução da resposta inflamatória sistêmica. Dúvidas existem em relação aos benefícios, início e duração da TCT, porém, há evidências que apoiam a melhora da sobrevida e do prognóstico neurológico em populações selecionadas. Recomenda-se a TCT por 24 horas, com controle da temperatura na faixa de 32 °C a 36 °C para adultos que sobrevivem à PCR extra-hospitalar e permanecem em coma com ritmos iniciais de fibrilação/taquicardia ventricular, o que também é sugerido para os sobreviventes de PCR extra-hospitalar com ritmo inicial não chocável e de PCR intra-hospitalar em qualquer ritmo inicial. O início do resfriamento deve ser feito o mais precocemente possível, depreferência, até 12 horas após o RCE. O controle da temperatura corpórea deve ser incorporado aos cuidados dos pacientes críticos pós-PCR, a fim de reduzir as taxas de mortalidade e de sequelas neurológicas...

The secondary pathophysiological process to cardiorespiratory arrest (CRA) with return of spontaneous circulation (ROSC), determines the post-cardiorespiratory arrest syndrome with brain injury, myocardial reperfusion and dysfunction in response to systemic ischemia. The temperature control therapy (TCT) provides neuroprotective mechanisms, limitation of myocardial injury and reduction of systemic inflammatory response. There are still some questions regarding the benefits, timing and duration of TCT, however, there is evidence supporting improved survival and neurological outcome in selected populations. TCT is recommended for 24 hours, with temperature control in the range of 32 to 36 °C for comatose adults who survive after out-of-hospital cardiorespiratory arrest with initial rates of fibrillation/ ventricular tachycardia, which is also suggested for extra-hospital cardiorespiratory arrest survivors with early pace not shockable and intra-hospital cardiorespiratory arrest in any initial rate. The beginning of the cooling should be done as early as possible, ideally up to12 hours after ROSC. The control of body temperature should be incorporated into the careof the post-CRA critically ill patients in order to reduce mortality and neurological sequelae...

Complicações pós-operatórias relacionadas à hipotermia intraoperatória

Introdução: A hipotermia é um evento comum no período intraoperatório, em que acarreta consequências na recuperação do paciente, sendo um dos diagnósticos de enfermagem de maior frequência no pós-operatório. As complicações decorrentes da hipotermia afetam diversos sistemas do organismo, como o cardíaco, respiratório, tegumentar, digestório, imunológico e também o sistema de coagulação. A redução do desconforto térmico do paciente e, principalmente, o controle das complicações associadas à hipotermia intraoperatória, devem ser realizados em todo o período perioperatório com o uso de medidas preventivas e de tratamento da hipotermia. Objetivo: Este estudo teve como objetivo analisar as complicações apresentadas pelo paciente no período de pós-operatório relacionadas com a hipotermia intraoperatória...

Introduction: Hypothermia is a common event in the intraoperative period, which leads to consequences in the patient recovery, and it is one of the most frequent postoperative nursing diagnoses. Complications resulting from hypothermia affect several body systems, such as cardiac, respiratory, integumentary, digestive, immune and also the coagulation system. The reduction of patient´s thermal discomfort and the control of complications associated with intraoperative hypothermia, must be performed throughout the perioperative period with the use of preventive measures and treatment of hypothermia. Objective: The purpose of this study was to analyze the complications presented by the patient in the postoperative period associated to intraoperative hypothermia...