Therapeutic hypothermia and temperature management最新文献

Out-of-hospital cardiac arrest (OHCA) in children is a rare but catastrophic event, often resulting in significant neurological injury. Targeted temperature management (TTM), including therapeutic hypothermia (TH), has been proposed as a neuroprotective strategy. This systematic review and meta-analysis aims to evaluate the effects of different TTM strategies on survival and neurological outcomes in pediatric patients after OHCA. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Pooled outcomes were synthesized using odds ratios (OR) with 95% confidence intervals (CI), and the certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A total of nine studies encompassing 2107 pediatric patients were included. TH was associated with significantly higher odds of survival (OR: 1.72; 95% CI: 1.36-2.18; p < 0.0001) and favorable neurological outcome (OR: 1.64; 95% CI: 1.16-2.33; p = 0.006) compared to normothermia. Subgroup analysis demonstrated greater survival benefit at 12 months and improved neurological outcomes at 6-12 months. There were no statistically significant differences between groups in blood lactate levels, odds of arrhythmia, culture-proven infections, or length of hospital stay. The certainty of evidence for most outcomes was graded as low due to the predominance of nonrandomized studies and imprecision. TH as a TTM strategy following pediatric OHCA may offer survival and neurological advantage, particularly at longer-term follow-up, without a significant increase in adverse events. However, the low certainty of evidence highlights the need for further high-quality randomized trials to inform clinical practice and optimize neuroprotective care in this vulnerable population.

This study aimed to determine the effects of the thermal blanket on patients' vital signs, shivering level, chill status, and thermal comfort perception in preoperative and postoperative periods. The study was designed as a randomized controlled trial and included 44 female patients who had undergone elective gynecological surgery in a hospital in the south of Turkey. The experimental group (n = 22) was warmed using the passive warming method via a thermal blanket, and the control group (n = 22) was administered routine care via a cotton pique. The data collection tools included the "Patient Information Form," the "Patient Follow-Up Form," the "Shivering Level Diagnosis Form," and the "Thermal Comfort Perception Scale." Patients were warmed passively before (at least 10 minutes) and after surgery (at least 60 minutes) with a thermal blanket or cotton pique according to their groups. Patients' vital signs and oxygen saturation were recorded during the preoperative and postoperative periods at 15-minute intervals. The patients' shivering levels were recorded at 15-minute intervals, and chill status and thermal comfort perceptions were recorded at 30-minute intervals during the postoperative period. The data obtained in the research were analyzed using the SPSS 24.0 program. There were no statistically significant differences between the vital signs and oxygen saturation of the intervention and control groups during the first 60 minutes after surgery. The shivering level and coldness of the control group were higher in the postoperative period, but the difference between the groups was not statistically significant. There were no statistical differences between the groups in the time to reach 36.0°C (p > 0.05). Thermal comfort perception scores during the first 90 minutes were significantly higher in the intervention group (p < 0.05). The thermal blanket is not superior to the cotton pique used in standard care in maintaining body temperature, but it is effective in increasing thermal comfort perception.

The critical care unit at the University Hospital of Wales is a 38-bedded tertiary center. In 2023, the unit admitted 1251 unscheduled patients, of which 131 were out-of-hospital cardiac arrest (OOHCA) patients. The unit also participated in the Targeted Temperature Management 2 study and adopted the findings shortly after its publication in 2021. This gave us a unique exposure into the pitfalls associated with changing surface cooling protocols. The aim of this quality and safety initiative was to explore the causes of failure to comply with normothermic temperature targets in the OOHCA population, following a protocol change away from targeted therapeutic hypothermia. This article uses surface cooling data from OOHCA survivors. We discuss our findings from analysis of surface cooling data from 36 patients-13 pre-protocol change (targeted hypothermia) and 23 post-protocol change (targeted normothermia). Concerningly, following the change to targeted normothermia, rather than therapeutic hypothermia, the fever burden increased from an average of 2 to12 hours per patient. To address this problem, we reviewed the data and identified several causes of this failure. These failures included the failure to start the therapy at the selected trigger point, the interruption of therapy, inadequate pad sizing, and the failure to select the correct protocol. Surface cooling pitfalls are not commonly discussed in the literature, and therefore there remains a risk that units may overlook them, either when transitioning between protocols or when continuing with an ongoing surface cooling device. With evidence suggesting that pyrexia contributes to poorer outcomes, it is of vital importance that staff are aware of any potential pitfalls of surface cooling devices to mitigate unnecessary fever burden.

Although critically ill patients with bloodstream infections (BSIs) who present with hypothermia are at the highest risk for death, it is not known how rewarming rates may influence the outcomes. The objective of this study was to identify the occurrence and determinants of hypothermia among patients admitted to intensive care units (ICUs) with BSI and assess how the rate of temperature correction may influence 90-day all-cause case-fatality. A cohort of 3951 ICU admissions associated with BSI was assembled. The lowest temperature measured within the first 24 hours of admission was identified, and among those who were hypothermic (<36°C), the rewarming rate [(time difference between lowest and subsequent first temperature ≥36°C) divided by hypothermia severity (difference between lowest measured and 36°C)] was determined. Within the first 24 hours of admission to the ICU, 329 (8.4%) and 897 (22.7%) subjects had the lowest temperature measurements ranging <34.9°C and 35-35.9°C, respectively. Patients with lower temperatures were more likely to be admitted to tertiary care ICUs, have more comorbid illnesses, have greater severity of illness, and have a higher need for organ-supportive therapies. The 90-day all-cause case-fatality rate was 22.9% overall and was 45.3%, 24.8%, and 19.6% for those with the lowest 24 hours temperatures of <35°C, 35-35.9°C, and ≥36°C, respectively (p < 0.001). Among 1133 hypothermic patients with documented temperatures corrected to the normal range while admitted to the ICU, the median rate of temperature increase was 0.24 (interquartile range, 0.13-0.45)^oC/hour. After controlling for the severity of illness and comorbidity, a faster rewarming rate was associated with significantly lower 90-day case-fatality. Hypothermia is a significant risk factor associated with death among critically ill patients with BSI that faster rates of rewarming may modify.

Many patients experience unintended hypothermia in intraoperative processes. This randomized clinical trial aims to investigate the impact of surgical drapes on hypothermia during the intraoperative period. A randomized clinical trial was conducted from April 2019 to November 2020 in the Department of Anesthesiology and Reanimation/Operating Rooms at an education and research hospital. Out of 205 patients assessed for eligibility, 74 underwent elective abdominal surgery and were randomized into two groups: nonwoven surgical drapes and woven surgical drapes. The study had two stages: preoperative and intraoperative. Preoperative data were collected using information and evaluation forms, while intraoperative assessment involved forms for wetness and weight. Tympanic and esophageal temperatures were recorded every 15 minutes, and surgical drapes were weighed with a precision scale before and after surgery. There was no significant difference between the two groups in terms of body mass index, irrigation amount, surgery duration, gender, and preoperative shivering (p > 0.05). A statistically significant difference was found in preoperative body temperature (36°C), type of surgery, and intraoperative hypothermia (p < 0.05). Both types of surgical drapes were wet, but this difference was not statistically significant between the nonwoven group (mean ± SD [1368 ± 607]) and the woven group (mean ± SD [1335 ± 636], p = 0.824). This study demonstrated that neither woven nor nonwoven surgical drapes, nor the wetness of the surgical drapes, had a significant effect on intraoperative hypothermia. However, there is a need for randomized controlled trials involving uniform types of surgery related to the topic.

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.

The incidence of intraoperative hypothermia (IPH) exceeds 70% during spinal surgery, which can lead to many adverse outcomes, including increased intraoperative blood loss/transfusion and delayed recovery. We aimed to evaluate the comprehensive efficiency of a kind of enhanced warming measure on patients undergoing spinal surgery. A retrospective analysis was conducted on the clinical data, surgical procedures, and outcomes of consecutive patients admitted to the department of orthopedics of a hospital from December 2019 to May 2023 and undergoing spinal surgery (scoliosis correction and internal fixation surgery). The impact of the perioperative warming measures on surgical temperature variation and postoperative recovery was analyzed. The surgical patients who received normal active warming measures (quilt, blood transfusion and infusion warming, flushing fluid warming) were the control group (Normal Warming Group [NWG], n = 199), and the enhanced active warming measures (NWG and forced air warming) were the experimental group (Enhanced Warming Group [EWG], n = 201). Incidence of IPH was the primary endpoint of this study. EWG exhibited a significantly reduced incidence of IPH and average frequency of hypothermia per patient compared with NWG (respectively, p < 0.01) and demonstrated notable reductions in intraoperative blood loss, urine output, anesthesia recovery time, and duration of arousal (respectively, p < 0.05, p < 0.01, and p < 0.001). Postoperatively, EWG showed a significantly reduced incidence of shivering (p < 0.001) and had lower costs for postoperative antibiotic use and albumin administration (respectively, p < 0.05 and p < 0.01). So we infer that the occurrence of hypothermia during spinal surgery may seem unavoidable, but EWG can effectively lower the occurrence of IPH and its adverse outcomes, and then somewhat alleviate the postoperative treatment burden. However, given that this study is a retrospective cohort study, it is not yet possible to definitively prove the above conclusions, so we will design relevant prospective clinical studies to prove that the optimization of temperature management may be crucial to ensure optimal overall recovery outcomes.

This investigation seeks to assess the impact of various temperature management approaches on the rates of death and organ failure among adult patients suffering from sepsis. A comprehensive search of PubMed, Embase, and CENTRAL was performed to identify randomized controlled trials (RCTs) published up to September 2024. These trials examined the impact of temperature management strategies on sepsis patients. Two independent investigators conducted literature screening, quality assessment, and data extraction. A meta-analysis was conducted using a fixed-effect model to evaluate outcome measures, including mortality and organ dysfunction. This study is registered with PROSPERO, CRD42024627677. The analysis incorporated eight RCTs, involving 1843 patients. The findings demonstrated that the management of hyperthermia markedly diminished the mortality risk among individuals suffering from sepsis (risk ratio = 0.47, 95% confidence interval [CI]: 0.37-0.59, p < 0.001), exhibiting low heterogeneity (I² = 39%). However, the effects of hyperthermia on organ dysfunction remained unclear (Mean Difference [MD] = -0.92, 95% CI: -1.91 to 0.07, p = 0.07), exhibiting low heterogeneity (I² = 0%). However, these effects on organ dysfunction were based on only two studies and 215 patients, which made them prone to a type II error. Hyperthermia management strategies are effective in reducing mortality among adults with sepsis. However, their impact on organ dysfunction requires further investigation through high-quality RCTs. Despite the limitations of this study, hyperthermia strategies offer a promising approach to multidimensional intervention in sepsis. Further studies should strengthen structured subgroup analyses and mechanistic studies based on RCTs to optimize treatment strategies under various clinical scenarios.

Hypoxic-ischemic encephalopathy (HIE) affects 1-2 per 1000 term live births, often resulting in severe long-term disabilities. Therapeutic hypothermia (TH) is the standard care in developed countries, but high costs of modern cooling devices necessitate low-cost alternatives. This study compares passive cooling with active machine cooling regarding short-term renal outcomes, specifically acute kidney injury (AKI), in neonates with HIE. This retrospective study was conducted at Dr. Soliman Fakeeh Hospital's neonatal intensive care unit from 2019 to 2023. The study analyzed patient demographics, clinical outcomes, and laboratory data (sodium, potassium, urea, and creatinine) to assess AKI. Treatment involved whole-body cooling at 33.5-34.5°C for 72 hours, followed by gradual rewarming. A total of 39 neonates were included in the study. Both cooling methods showed similar short-term renal outcomes, with no statistically significant differences in creatinine levels between the groups at baseline, 24 hours, 72 hours, or discharge. A trend of higher creatinine levels in the passive cooling group was observed, but it did not reach statistical significance. The median length of hospital stay was longer in the passive cooling group, though this difference was marginally nonsignificant. Long-term follow-up revealed no significant differences in chronic kidney disease incidence or neurodevelopmental outcomes between the groups. This study found no significant differences in both short-term renal outcomes and long-term effects between passive and active cooling methods in neonates with HIE. However, the trend of higher creatinine levels in the passive cooling group suggests the need for further investigation with larger sample sizes and extended follow-up to clarify the long-term effects of cooling methods on renal and neurodevelopmental outcomes in neonates with HIE.

This study aimed to explore the effect of the temperature chain management scheme on inadvertent perioperative hypothermia (IPH) during gynecological laparoscopic surgery. A total of 48 female adult patients who underwent elective gynecological laparoscopic surgery under general anesthesia from November 2023 to April 2024 in a teaching hospital were enrolled and randomized to receive either intraoperative prewarming fluid alone (Group C) or temperature chain management (Group T). Comparing the perioperative core and peripheral temperatures, IPH rates, shivering in postanesthesia care unit (PACU), and thermal comfort in two groups, perioperative core temperature of Group T was higher than that of Group C (p < 0.05); IPH rates and the incidence of shivering in PACU of Group T were lower than that of Group C (p < 0.05); Group T scored higher in thermal comfort than Group C when entering PACU (p < 0.05). This study reports that the use of intraoperative prewarming fluid alone does not sufficiently warm the patients. The optimal temperature management is achieved when using temperature chain management during gynecological laparoscopic surgery.