Therapeutic hypothermia and temperature management最新文献

We aimed to evaluate the efficacy of peritoneal dialysis (PD) in hypoxic-ischemic acute kidney injury (AKI) in newborns with hypoxic-ischemic encephalopathy (HIE) who underwent therapeutic hypothermia (TH). This was a retrospective study including the newborns with HIE/TH who developed hypoxic-ischemic AKI and underwent PD between January 2022 and June 2024. The blood test results obtained before starting PD were compared with the blood test results obtained just before the decision to terminate PD or, in case of death, with the final blood test results obtained before death. Twenty-one newborns were included in the study. Four (19%) of these newborns were diagnosed with moderate HIE, and 17 (81%) were diagnosed with severe HIE. The median gestational age of the patients was 38 (36-39) weeks, and the mean birth weight was 3083 ± 494 g. The median postnatal day when PD started was 3 (2-4) days and its duration was 7 (4-10) days. All patients had fluid overload as an indication for PD dialysis, and fluid overload was accompanied by hyperkalemia in 8 (38.1%) patients. After PD, blood pH, bicarbonate, and sodium values increased significantly (p ≤ 0.001, 0.009, <0.001, respectively), and potassium, phosphorus, and creatinine values decreased significantly (p ≤ 0.001, <0.001, 0.031, respectively) compared with the predialysis values. PD corrects acidosis and electrolyte imbalance and may be considered as a successful renal replacement therapy for hypoxic-ischemic AKI in neonates with HIE/TH, especially in units with limited resources.

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 aimed to analyze the causative factors of histological chorioamnionitis (HCA) in parturients with intrapartum fever, assess the implications for maternal and neonatal outcomes, and develop a predictive model to enhance clinical decision-making. A retrospective analysis was performed on 408 parturients with intrapartum fever at Fujian Provincial Maternal and Child Health Hospital from January 2022 to June 2023. Based on post-delivery placental pathology, the data were categorized into HCA (249 cases) and non-HCA groups (159 cases). Variables were first screened using univariate analysis, followed by multivariate logistic regression to identify high-risk factors and develop a predictive model. The model's accuracy was validated using Bootstrap resampling and receiver operating characteristic (ROC) curve analysis. Significant differences were found between the HCA and non-HCA groups in terms of duration of premature rupture of membranes (≥24 hours), peak body temperature during labor (≥38°C), and levels of white blood cell count and C-reactive protein (CRP) at the onset of fever (p < 0.05). The predictive model showed strong accuracy, with an ROC area under the curve of 0.715. Intrapartum fever linked with HCA markedly exacerbates maternal and neonatal outcomes. Key risk factors for HCA include a peak labor temperature ≥38°C, CRP levels at fever onset, and grade III contamination of amniotic fluid. The developed model accurately predicts the HCA risk, enabling enhanced clinical interventions.

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.

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.

The study aimed to explore the effect of the training scheme guided by Knowles' adult learning theory model on perioperative hypothermia prevention-related knowledge, practice, and behavior in operating room nurses. Operating room nurses of a teaching hospital were included from February to May 2023. Under the guideline of the adult learning theory, we accessed the score of the knowledge, attitude, and practice in operating room nurses about the prevention of the inadvertent perioperative hypothermia (IPH) before and after trainings through qualitative interviews and questionnaire surveys. There were statistically significant differences in scores of knowledge, attitude, and practice of IPH prevention in operating room nurses before and after training. The training program guided by adult learning theory could significantly increase the scores of IPH prevention-related knowledge of operating room nurses, improve the attitude of perioperative hypothermia prevention, and advance the compliance with IPH prevention interventions. Clinical Trial Registration number: 2023IIT109.

Cryotherapy, a therapeutic technique involving localized cooling of the body, has gained popularity for postsurgical rehabilitation. It induces a reduction in cellular metabolism, vasoconstriction, and pain relief, making it an attractive option for managing postoperative (PO) shoulder pain. This systematic review aimed to assess the effectiveness of cryotherapy in PO shoulder patients, focusing on pain, range of motion, functionality, and temperature changes. The review included six randomized clinical trials, involving a total of 233 patients who underwent various shoulder surgeries. Cryotherapy was applied using different methods, including Cryo/Cuff, Cryoton^®, Polar Care 300, and ice packs. Results indicated that cryotherapy was generally effective in reducing PO shoulder pain. However, one study found no significant difference in pain outcomes between the cryotherapy group and control group. Furthermore, three studies demonstrated a decrease in intra-articular and skin temperatures with cryotherapy application. A risk of bias analysis revealed some concerns in the overall risk of bias for five studies, with one study considered to have a high risk of bias. Although publication bias assessment was not conducted due to the limited number of included studies, it was noted that the studies exhibited heterogeneity in terms of population, intervention methods, and outcome measures. In conclusion, cryotherapy appears to be a promising adjunctive treatment for PO shoulder pain, although the existing evidence has some limitations, including small sample sizes and methodological concerns. More high-quality studies are needed to establish the full extent of cryotherapy's effectiveness in PO shoulder rehabilitation, especially regarding its impact on functionality and range of motion.

In this study, it was aimed to understand the barriers and solutions for operating room (OR) nurses and anesthesiologists to implement evidence-based recommendations to prevent intraoperative inadvertent hypothermia (IIH). A qualitative, inductive, and descriptive study was conducted. This qualitative interview study was conducted face-to-face with 19 participants working in OR units between February and March 2023. The interviews were analyzed using qualitative content analysis. The COREQ checklist was followed. Two main themes and five sub-themes were identified as a result of content analysis. According to the participants, barriers to IIH prevention interventions are caused by individual and organizational inefficiencies and personal opinions, and the main solution is education. Participants reported many factors that hinder IIH prevention practices. The individual characteristics of OR staff and the opinions and behavior of the institution are very important for IIH prevention.

To investigate the effects of different amounts of lavage fluids on vital signs, inflammatory response, main organ function, and electrolytes on dogs with seawater-immersed open abdominal injury by portable peritoneal lavage device. Twenty dogs were randomly divided into four groups according to different irrigation volume and irrigation time, they were divided into group A (50 mL/min, 1 hour, 3 L), group B (50 mL/min, 1.5 hours, 4.5 L), group C (50 mL/min, 2 hours, 6 L) and group D (50 mL/min, 3 hours, 9 L). Seawater-immersed open abdominal injury dog model was developed and portable peritoneal lavage device was used for lavaging and rewarming. The change of blood pressure, body temperature, heart beat rate, serum tumor necrosis factor-α, interleukin-6, superoxide dismutase, and other indicators of each group were observed before and after immersion, and immediately, 1, 3, and 5 days after lavage. Immediately after lavage, the body temperature, mean arterial pressure, and heart rate of each group gradually recovered to normal, and the recovery rate of group C was faster than that of group A and group B. The indicator of central venous pressure (CVP) continued to decrease immediately after lavaging. CVP in group C was lower than that of groups A and B (p < 0.05, respectively). The inflammatory response was enhanced in all groups after immersion and after lavage, and reached the highest level at 1 day after lavage. The level of interleukin-1β in group C was significantly lower than that in group A (p < 0.05) and no significant difference when compared with other groups on 1 day after lavage. Three days after lavage, all indexes gradually decreased to the level of preinjury. Alanine transaminase (ALT) and lactic dehydrogenase reached the highest level on 1 day after lavage, and the level of ALT in group C was lower than that in group A (p < 0.05). On 1 and 3 days after lavage, the level of Na⁺ in group C was lower than those in group A (p < 0.05) and no significant difference compared with those in group B and group D. Application of the portable abdominal lavage device with 6 L of lavage fluid (group C) has the best effect of treatment for seawater-immersed open abdominal injury, which can maintain better vital signs and reduce inflammation.

Asphyxial cardiac arrest (ACA) survivors face lasting neurological disability from hypoxic ischemic brain injury. Sex differences in long-term outcomes after cardiac arrest (CA) are grossly understudied and underreported. We used rigorous targeted temperature management (TTM) to understand its influence on survival and lasting sex-specific neurological and neuropathological outcomes in a rodent ACA model. Adult male and female rats underwent either sham or 5-minute no-flow ACA with 18 hours TTM at either ∼37°C (normothermia) or ∼36°C (mild hypothermia). Survival, temperature, and body weight (BW) were recorded over the 14-day study duration. All rats underwent neurological deficit score (NDS) assessment on days 1-3 and day 14. Hippocampal pathology was assessed for cell death, degenerating neurons, and microglia on day 14. Although ACA females were less likely to achieve return of spontaneous circulation (ROSC), post-ROSC physiology and biochemical profiles were similar between sexes. ACA females had significantly greater 14-day survival, NDS, and BW recovery than ACA males at normothermia (56% vs. 29%). TTM at 36°C versus 37°C improved 14-day survival in males, producing similar survival in male (63%) versus female (50%). There were no sex or temperature effects on CA1 histopathology. We conclude that at normothermic conditions, sex differences favoring females were observed after ACA in survival, NDS, and BW recovery. We achieved a clinically relevant ACA model using TTM at 36°C to improve long-term survival. This model can be used to more fully characterize sex differences in long-term outcomes and test novel acute and chronic therapies.