Therapeutic hypothermia and temperature management最新文献

Fever after brain injury is a known contributor to poor outcomes; however, temperature-modulating devices (TMDs), such as surface and intravascular systems, face significant limitations, including delayed deployment, invasiveness, patient discomfort, skin integrity issues, frequent induction of shivering, and the need for sedation, all of which hinder timely neuroprotective therapy and confound neurological assessments. This first in-human study evaluated the safety and tolerability of an intranasal TMD, which delivers thermoelectrically temperature-regulated air via a nasal cannula to affect the core temperature. Five healthy, awake adult volunteers (median age 34 years old, 57.1% men) underwent intranasal cooling with 5°C cooled air delivered at flow rates between 15 and 58 liters per minute. The primary endpoints were safety and tolerability. The reduction in core body temperature was recorded using an esophageal temperature probe. No pharmacological agents or sedatives were administered to the patient. All participants exhibited a consistent downward trend in core body temperature, with an average reduction of 0.7°C at 30 minutes and 1.2°C at 60 minutes. Notably, no shivering or adverse events related to the intranasal TMD were reported. Cooling was well-tolerated, with esophageal probe placement being the only limiting factor for full protocol completion in some subjects. Participants remained fully conscious and communicative throughout the therapy. This intranasal TMD achieved clinically relevant core cooling without triggering shivering or requiring sedation, thereby addressing the key barriers associated with traditional TMDs. These promising early results support further investigation of this intranasal TMD in patients with acute neurological injury. Future studies should explore its performance in critical care and prehospital environments, where time-sensitive neuroprotection is most impactful.

The study aimed to construct a temperature chain management scheme in patients undergoing Da Vinci Robot-assisted surgery in urological surgical patients by the Delphi method, providing a reference for the prevention and treatment of the inadvertent perioperative hypothermia. First, instructing by the Joanna Briggs Institute (JBI) Evidence-Based Healthcare model and systematically reviewing literature related to the prevention and treatment of perioperative hypothermia in Da Vinci robot-assisted surgery patients in the urological surgical patients from guideline-related websites and professional association websites. Second, carrying out the qualitative interviews, which were conducted with medical staff in the urology department and the Da Vinci robot-assisted surgery team in a teaching hospital. Third, a temperature chain management scheme draft was obtained by a panel meeting. Finally, using the Delphi method to evaluate the draft, demonstrating its scientificity and feasibility, and obtaining the final scheme. The temperature chain management scheme constructed by a Delphi method, embraced seven links from preoperative ward, preoperative transfer, anesthesia waiting room, operating room, postanesthesia recovery room, postoperative transfer, and postoperative ward. The enthusiasm degree of both rounds of expert consultation was 100%, with expert authority levels of 0.875 and 0.888, respectively, indicating good representativeness and authority. Kendall's coefficient in two rounds was 0.220 and 0.400, respectively, indicating a trend toward consensus among experts, which indicated the scheme had a high degree of credibility and feasibility. The temperature chain management scheme for Da Vinci robot-assisted surgery patients in the urology department, constructed by the Delphi method, is both scientific and feasible.

This study aims to equip clinicians with the necessary insights for identifying and managing pregnant women experiencing elevated maternal pyrexia during labor. It examines maternal and neonatal outcomes along with the factors associated with varying peak temperatures. A retrospective analysis was conducted on 319 pregnant women presenting with maternal pyrexia during labor. Participants were categorized into two groups based on peak temperature: Group A (n = 180, temperature <38°C) and Group B (n = 139, temperature ≥38°C). Basic characteristics, blood markers, and maternal and neonatal outcomes were compared between the two groups. (1) Group B exhibited a higher percentage of neutrophilic granulocytes (NE%) and C-reactive protein to lymphocyte ratio (CLR) compared with Group A (p < 0.05). (2) The rates of meconium-stained amniotic fluid, histological chorioamnionitis, hospitalization of neonates, and infections in neonates were greater in Group B than in Group A (p < 0.05). (3) Logistic regression analysis identified elevated CLR levels as a risk factor for peak temperatures exceeding 38°C, indicating that CLR could serve as a reliable predictor of maternal pyrexia above 38°C during labor. Higher maternal pyrexia peaks may exacerbate adverse maternal and neonatal outcomes, emphasizing the importance of timely clinical intervention. NE% and CLR could serve as valuable indicators for identifying underlying causes and predicting peak maternal pyrexia during labor.

This study aims to construct a Nomogram for intraoperative hypothermia (IH) in elderly patients undergoing robot-assisted urological tumor resection (RAUTR) and to evaluate the effect of the model by internal and external validation. Using convenient sampling to enroll patients in a large hospital from February 2022 to July 2024 as the modeling and validation cohort. Identifying the independent risk factors for IH by univariate and multivariate logistic regression, and developing a Nomogram by the R software. The Nomogram's discrimination and accuracy were tested by receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow (H-L) test, internal validation was performed with 1000 Bootstrap resamples and calibration curves. External evaluation was conducted on a validation cohort using ROC curves and H-L tests. The modeling cohort included 420 patients, with an IH rate of 39.8%. Univariate and multivariate logistic regression showed that baseline temperature (odds ratio [OR] = 0.087), preoperative psychological score (OR = 1.114), body mass index (BMI) (OR = 0.820), and anesthesia time (OR = 1.013) were independent risk factors for IH. The ROC curve of the Nomogram had an area under the curve of 0.844 (95% confidence interval [CI]: 0.807-0.881), a maximum Youden index of 0.563, a best cutoff value of 0.383, a sensitivity of 0.772, and a specificity of 0.791. The H-L test yielded a chi-square value of 10.173 and a p-value of 0.253. Internal validation with 1000 Bootstrap resamples showed a consistency coefficient of 0.844, the calibration curve fits well. A total of 120 patients were included in the validation cohort, including 45 with hypothermia (37.5%). The area under the ROC curve for the prediction of IH in the external validation cohort was 0.854 (95% CI: 0.781-0.927), and the H-L test yielded a chi-square value of 5.207 and a p-value of 0.735. The IH rate is high in elderly patients undergoing RAUTR. Baseline temperature, preoperative psychological score, BMI, and anesthesia time are independent risk factors. And the Nomogram could be used to predict IH.

This study aimed to evaluate the effects of therapeutic hypothermia (TH) and the warming phase on cardiovascular hemodynamics among neonates suffering from perinatal asphyxia. The reviewed literature on hemodynamic changes among neonates undergoing TH was obtained from the following databases: PubMed, Embase, POPLINE, Cochrane Reference Libraries, Google Scholar, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Search strategies included keywords, combinations, medical subject headings, and snowball searches of related articles. The following search terms were used: brain injury, hypoxic-ischemic encephalopathy, left ventricular (LV) dysfunction, right ventricular (RV) dysfunction, and TH. We selected publications evaluating RV and LV heart function and cerebral, renal, and visceral circulation function for analysis. There were 12 prospective studies, with a total of 361 patients in the study groups and 149 patients in the control groups. There were seven retrospective studies, with a total of 1637 patients. One study was a randomized controlled trial, one was a systematic review, and one was a Cochrane review. The limitations of the review are that most of the studies are observational, making it difficult to precisely assess the causes of the observed changes, whether they are related to asphyxia, hypothermia, or other pathology. The results of the observational studies were not consistent with those of the randomized trials for ethical reasons. The hemodynamic characteristics of the cardiovascular system during TH and the rewarming phase are significantly complex. Therefore, an in-depth understanding of the pathophysiological attributes associated with these aspects is essential to provide individualized therapeutic approaches for optimizing cerebral perfusion pressure and reducing secondary injuries.

The application value of mechanical thrombectomy (MT) in acute large-vessel occlusion cerebral infarction has been confirmed, but considering the poor prognosis of large-core infarction (LCI), the current guidelines and practices are based on anterior circulation small-core infarction. Reducing the perioperative complications of thrombectomy in LCIs is the key to saving more patients previously considered unsuitable for thrombectomy. Patients with acute anterior circulation cerebral infarction who were admitted to Suining Central Hospital of Sichuan Province from January 2022 to December 2023 and whose Alberta Stroke Program Early Computed Tomography Score value was 3-5 (the score range was 0-10, and the lower the score was, the larger the infarct area) or whose infarct core volume was ≥70 mL and who received MT were enrolled consecutively. The patients were grouped based on whether they were treated with mild hypothermia (mild hypothermia treatment group vs. conventional treatment group). Patients who were evaluated preoperatively for large-core cerebral infarction and underwent mild hypothermia treatment were performed immediately after MT. The clinical data of the patients were collected. The primary outcome events were the incidence of cerebral hernia within one week after the operation and the rate of requiring decompressive craniectomy (%). The secondary outcome was the modified Rankin scale (mRS) score at 90 days (the score range was 0-6, and the higher the score was, the greater the degree of functional disability). A total of 64 patients were included. Twenty-nine patients were assigned to the mild hypothermia treatment group, and 35 patients were assigned to the conventional treatment group. There was no significant difference in the baseline data between the two groups. The proportions of cerebral hernia and the need for decompressive craniectomy within one week after the operation were significantly lower in the mild hypothermia treatment group than in the conventional treatment group (31% vs. 57.1%, odds ratio [OR] 0.338, 95% confidence interval [CI] 0.120-0.948; p = 0.037). The proportion of patients who underwent decompressive craniectomy in the mild hypothermia treatment group was significantly lower (13.8% vs. 42.8%, OR 0.213, 95% CI 0.061-0.745, p = 0.011). There was no significant difference in the mRS score between the two groups at 90 days (4.31 ± 1.75 vs. 4.48 ± 1.57, p = 0.456) or in the proportion of patients with a good prognosis (mRS 0-3) between the two groups (OR 0.569, 95% CI 0.18-1.793, p = 0.333). Mild hypothermia treatment can reduce the incidence of early cerebral hernia and the need for decompressive craniectomy in patients with acute large-core cerebral infarction after MT; this treatment can be used as an important adjuvant treatment after thrombectomy for LCI, but may not change the long-term prognosis.

Temperature management plays a critical role in the neurological recovery of cardiac arrest survivors. While advanced device-based temperature control systems are prevalent in high-resource settings, their implementation in low-resource environments remains a challenge. This study aimed to examine the impact of fever prevention on neurological outcomes in cardiac arrest survivors managed without device-based temperature control. We conducted a retrospective study of adult in-hospital cardiac arrest survivors at an academic institution from 2013 to 2020. Patients were included if they were ≥18 years old, survived for at least 72 hours post-return of spontaneous circulation (ROSC), and experienced cardiac arrest in inpatient wards, intensive care units, or the emergency department. Fever was defined as a rectal temperature ≥37.5°C, and neurological outcomes were assessed using the Cerebral Performance Category (CPC) scale at 1 month post-ROSC. A good neurological outcome was defined as CPC 1 or 2. Statistical analyses included chi-square tests and logistic regression to identify predictors of outcomes. Of the 427 patients included, 58.8% experienced fever, and 12.8% achieved a good neurological outcome. Patients with fever were significantly less likely to have favorable outcomes (p < 0.01). Logistic regression revealed that each 1°C increase in body temperature beyond 37.5°C was associated with a 31% reduction in the likelihood of a good outcome (p < 0.01). Other predictors of poor outcomes included prolonged low-flow states and higher pre-arrest frailty scores. Fever is strongly associated with poor neurological outcomes in cardiac arrest survivors, particularly in low-resource settings without device-based temperature management. Effective fever prevention strategies, such as intravenous antipyretics and physical cooling methods, should be prioritized to improve outcomes.

To analyze the prevalence and factors related to inadvertent intraoperative hypothermia (IOH) in adults undergoing elective robot-assisted radical cystectomy surgery (RARC) under general anesthesia. A retrospective study observed data from June 2022 to August 2023 in two large teaching hospital. Collecting core temperature and potential influencing factors through electronic medical records. Univariate and multivariate logistic regression analyses were used to identify independent risk factors of IOH. 690 patients were included finally, with 266 (38.6) patients suffered IOH. The factors related to IOH embraced anesthesia induction time (odds ratio [OR]: 0.523; 95% confidence interval [CI]: 0.372-0.735; p < 0.05); age (OR: 0.984; CI: 0.970-0.970; p < 0.05); smoking (OR: 3.489; CI: 1.999-6.089; p < 0.05); intraoperative fluid volume (OR: 0.999; CI: 0.999-0.999; p < 0.05); surgery duration (OR: 0.996; CI: 0.994-0.998; p < 0.05); and baseline core temperature (OR: 1.859; CI: 1.165-2.965; p < 0.05). We emphasize the relatively high prevalence of IOH during elective RARC under general anesthesia and identify related factors, including lower baseline core temperature, age, longer surgery duration, surgery in the morning, larger intraoperative fluid volume, and smoking.

Core body temperature reflects core heat content, which is determined by the balance of heat production and heat loss. Studies and interventions focusing on temperature rarely measure metabolic heat production and heat loss. This study tests whether net heat balance (NHB) in humans can predict core temperature changes and secondarily whether NHB combined with skin surface temperatures (ST) can estimate core temperature. We conducted a laboratory study of healthy volunteers cooled with gel-adhesive circulating water pads with or without treatment with a drug (dexmedetomidine) to prevent shivering. We measured heat flux on the forehead, deltoid, anterior abdominal wall, and above the knee. We measured energy expenditure (W) using indirect calorimetry and core temperature (T) using deep gastrointestinal temperature. Thirteen participants (age 20-51 years; height 160-188 cm; mass 61-101 kg) participated in 21 protocol days. Mean (standard deviation [SD]) NHB ranged from +14 (26) W at baseline to -56 (25) W with drug and cooling pads. NHB predicted change in core temperature 60 minutes later (lagged regression slope: 0.33°C/100W; 95% confidence interval [CI] [0.2, 0.5]) (pseudo r² = 12.81%). Forehead ST had the narrowest limits of agreement [-2.6°C, -2.4°C] for predicting core temperature with a mean bias of -2.5°C. In conclusion, NHB of -100W predicts a 0.33°C/60 minutes decrease in core temperature. Forehead temperature is the most consistent peripheral site to predict core temperature. While a cooling device increases heat loss, energy expenditure (EE) also rises with surface cooling, minimizing NHB, and core temperature change unless a drug is utilized to suppress the increase in EE.

Preclinical studies show that therapeutic hypothermia (TH) effectively reduces cerebral ischemic injury. In contrast, TH has not been consistently beneficial in clinical trials of stroke and cardiac arrest, perhaps from suboptimal dosing (e.g., delay, depth, and duration), among other factors. This systematic review aimed to find an optimal depth of TH from in vivo adult preclinical studies of global and focal ischemia. To study depth, without other confounds, we examined studies that compared ≥2 depths of TH versus normothermic controls. Our primary outcomes were infarct size (focal ischemia) and hippocampal cell death (global ischemia), while secondary outcomes were behavior, edema, and striatal cell death. Studies were assessed with the SYRCLE Risk of Bias tool (e.g., use of blinding) and additional indices of translational rigor (e.g., use of aged animals). Thirty studies were included from a search of the PubMed database in 2025. Many studies were rated as exhibiting a high risk of bias with low translational rigor. Overall, TH provided considerable protection on all endpoints, sometimes up to 100%, but no consistent dose-response patterns emerged, nor was an optimal depth of cooling readily evident. To explore the latter finding, specifically sampling variability, we conducted Monte Carlo simulations using the pooled standard deviation of the preclinical studies to generate three populations based upon a theoretical 5% protection per 1°C relationship (37°C vs. 32°C vs. 27°C groups run 75 times). Dose-dependent effects were statistically detectable in only 36% of comparisons, which showed comparably noisy patterns of protection. Thus, the variable dose-dependent effects in the reviewed animal studies likely arise, at least partially, from sampling error owing to using small samples from variable populations (average n = 8/group in focal ischemia). Overall, these findings highlight weaknesses in the extant dose-response literature that limit our ability to precisely guide clinical trials.