Therapeutic hypothermia and temperature management最新文献

This study aimed to explore the antipyretic and anti-inflammatory effects of rectal administration of Reduning injection in feverish rats induced by lipopolysaccharide (LPS), and observe the temperature changes and inflammatory indexes. The selected rats were randomly divided into 6 groups, with 10 rats in each group, named as normal empty group, model group, intravenous group (2 mL/kg), low-dose enema group (1 mL/kg), middle-dose enema group (2 mL/kg), and high-dose enema group (4 mL/kg). The hourly temperature variations in rats injected with LPS in the abdomen were recorded. Five hours later, blood samples from the abdominal aorta were collected to monitor immunoglobulin M (IgM), immunoglobulin A (IgA), interleukin (IL)-6, and tumor necrosis factor (TNF)-α. At 5 hours, the fever peak induced by LPS appeared, and obvious antipyretic effects were observed; the effect was optimal in the medium dose enema group at 4 hours (p < 0.05); the IgM value in the enema groups, the intravenous group, and normal empty group was significantly lower than that in the model group; the IgA value in each group was higher than that in the model group, but there was no statistical significance (p > 0.05); values of IL-6 and TNF-α in each group were lower than those in the model group, and the difference was statistically significant except for the high-dose enema group (p > 0.05). Low-dose and medium-dose rectal administration of Reduning injection have inhibitory effects on IL-6, TNF-α, and IgM in feverish rats induced by LPS, but there is no obvious difference compared to intravenous administration and it could achieve an anti-inflammatory effect. There is a possibility of enhancing IgA immunity with rectal administration, but there is no obvious difference compared to intravenous administration, and rectal administration has no significant effect on mucosal immunity.

To assess the effectiveness and molecular mechanisms of mild hypothermia and remote ischemic postconditioning (RIPC) in patients with acute ischemic stroke (AIS) who have undergone thrombolysis therapy. A total of 58 AIS patients who received recombinant tissue plasmin activator (rt-PA) intravenous thrombolysis were included in this prospective study. Participants were randomly allocated to the experimental group (rt-PA intravenous thrombolysis plus mild hypothermic ice cap plus remote ischemic brain protection, n = 30) and the control group (rt-PA intravenous thrombolysis plus 0.9% saline, n = 28). The RIPC was performed for 14 consecutive days on both upper limb arteries spaced 2 minutes apart. Five cycles of ischemia-reperfusion were performed sequentially (2-2, 3-3, 4-4, 5-5, 5-0 minutes, respectively). The outcome measures of the National Institute of Health stroke scale (NIHSS) score, volume of cerebral infarction, serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-1β, tumor necrosis factor α, nuclear factors kappa B (NF-κB), and NOD-1ike receptor pyrin 3 (NLRP3) were evaluated at different time points after treatment. Similarly, the 90-day modified Rankin Scale (mRS) scores were compared between the two groups. After treatment, the NIHSS score, MDA, NF-κB, and NLRP3 levels in the experimental group were significantly lower than those in the control group (p < 0.05). While the SOD in the experimental group was significantly higher than in the control group (p < 0.05), the NIHSS scores decreased within groups (all p < 0.05) in both experimental and control groups. The 90-day mRS score (0-2 points) in the experimental group was significantly higher than that in the control group (73.33% vs. 53.57%, p < 0.05) and no significant differences were observed in the safety indices between the two groups (all p > 0.05). Our study shows that combining mild hypothermia and RIPC has a positive effect on brain protection and can significantly reduce the oxidative stress and associated outburst of inflammatory response. The Clinical Trial Registration number is ChiCTR2300073136.

Current guidelines strongly recommend providing targeted temperature management (TTM) after cardiac arrest, but hypothalamic dysregulation may confound TTM's impact on a patient's ultimate outcome. Although time to reach target temperature has largely been viewed as a process measure for TTM protocols, the difference between initial presenting temperature and target temperature (Δ-temperature) may be a potential surrogate marker of hypothalamic dysregulation. We performed a retrospective observational study to explore whether Δ-temperature was associated with neurologic outcomes and mortality. We included 86 patients (53 with out-of-hospital cardiac arrest [OHCA] and 33 with in-hospital cardiac arrest [IHCA]) in our analysis; more than half of the patients were cooled to 33°C (56.9% in OHCA and 57.6% in IHCA). In univariate logistic regression analysis, Δ-temperature alone did not appear to be statistically associated with mortality or neurologic outcomes regardless of target temperature. In exploratory analysis, longer time from TTM initiation-to-target was associated with worse neurological outcomes in the 33°C target (odds ratio = 0.996, 95% confidence interval = 0.992-1.000). Further research investigating the impact of hypothalamic dysregulation and Δ-temperature as well as the rate of cooling may be warranted to elucidate additional factors contributing to outcomes after cardiac arrest. In addition, our study population was noted to have a higher proportion of Asians and Native Hawaiians/Pacific Islanders, with a potential disparity in outcomes. Future studies may be warranted to ensure generalizability of TTM protocols and findings across populations.

There is a paucity of evidence regarding the utility of targeted temperature management (TTM) in COVID-19 patients who suffer cardiac arrest. This systematic review and meta-analysis aimed to use the available data of how temperature predicts outcomes in COVID-19 patients and the association between active cooling and outcomes in non-COVID-19 cardiac arrest patients to give recommendations for the utility of TTM in COVID-19 survivors of cardiac arrest. The PubMed, Embase, and Web of Science databases were queried in August 2022 for two separate searches: (1) temperature as a predictor of clinical outcomes in COVID-19 and (2) active cooling after return of spontaneous circulation (ROSC) in non-COVID-19. Forest plots were generated to summarize the results. Of the 4209 abstracts screened, none assessed the target population of TTM in COVID-19 victims of cardiac arrest. One retrospective cohort study evaluated hyperthermia in critically ill COVID-19 patients, two retrospective cohort studies evaluated hypothermia in septic COVID-19 patients, and 20 randomized controlled trials evaluated active cooling in non-COVID-19 patients after ROSC. Risk of death was higher in COVID-19 patients who presented with hyperthermia (risk ratio [RR] = 1.87) or hypothermia (RR = 1.77; p < 0.001). In non-COVID-19 victims of cardiac arrest, there was no significant difference in mortality (RR = 0.94; p = 0.098) or favorable neurological outcome (RR = 1.05; p = 0.41) with active cooling after ROSC. Further studies are needed to evaluate TTM in COVID-19 victims of cardiac arrest. However, given the available evidence that hyperthermia or hypothermia in COVID-19 patients is associated with increased mortality as well as our findings suggesting limited utility for active cooling in non-COVID-19 cardiac arrest patients, we posit that TTM to normothermia (core body temperature ∼37°C) would most likely be optimal for the best outcomes in COVID-19 survivors of cardiac arrest.

Therapeutic hypothermia (TH) is the only currently approved treatment for neonatal hypoxic-ischemic encephalopathy (HIE) and must be started within 6 hours to optimize effectiveness. This narrow therapeutic window often requires initiation of TH before or during transport. The goal of this study was to assess the effects of servo-controlled TH versus passive hypothermia during transport on short-term outcomes in newborns with HIE. This was a single-center retrospective case-control study of neonates with HIE treated with active or passive TH during transport. Primary outcomes included brain injury on magnetic resonance imaging (MRI) and presence of seizures. Seventy-six neonates were included-13 active and 63 passive. The active TH group was more likely to arrive within goal temperature. No difference was noted between groups in seizures or TH complications. Active TH was associated with increased injury on MRI. Active TH resulted in tighter temperature control, but no improvement in short-term outcomes in our cohort. The MRI findings may be due to differences in overall disease severity, which could not be adjusted for, given the modest sample size.

Decades of animal research show therapeutic hypothermia (TH) to be potently neuroprotective after cerebral ischemic injuries. While there have been some translational successes, clinical efficacy after ischemic stroke is unclear. One potential reason for translational failures could be insufficient optimization of dosing parameters. In this study, we conducted a systematic review of the PubMed database to identify all preclinical controlled studies that compared multiple TH durations following focal ischemia, with treatment beginning at least 1 hour after ischemic onset. Six studies met our inclusion criteria. In these six studies, six of seven experiments demonstrated an increase in cerebroprotection at the longest duration tested. The average effect size (mean Cohen's d ± 95% confidence interval) at the shortest and longest durations was 0.4 ± 0.3 and 1.9 ± 1.1, respectively. At the longest durations, this corresponded to percent infarct volume reductions between 31.2% and 83.9%. Our analysis counters previous meta-analytic findings that there is no relationship, or an inverse relationship between TH duration and effect size. However, underreporting often led to high or unclear risks of bias for each study as gauged by the SYRCLE Risk of Bias tool. We also found a lack of investigations of the interactions between duration and other treatment considerations (e.g., method, delay, and ischemic severity). With consideration of methodological limitations, an understanding of the relationships between treatment parameters is necessary to determine proper "dosage" of TH, and should be further studied, considering clinical failures that contrast with strong cerebroprotective results in most animal studies.

This study aimed to explore the relationship between preoperative baseline perfusion index (PI) and intraoperative hypothermia during general anesthesia. PI reflects the peripheral perfusion status, which may be associated with the decrease of core temperature during general anesthesia, as the redistribution of temperature from the core compartment to the peripheral compartment depends on the peripheral perfusion status. A total of 68 patients underwent radical surgery for urological malignancies in this study. The baseline PI value was measured upon entering the operating room. Core temperature was continuously monitored using a nasal pharyngeal probe from anesthesia induction to the end of surgery, with temperature data recorded every 15 minutes. Univariate and multivariate logistic regression analyses were used to identify risk factors for intraoperative hypothermia. Intraoperative hypothermia occurred in 26 patients, whose baseline PI (2.70 ± 0.73) was significantly lower than that of the normothermic group (3.65 ± 1.05), with P<0.05. The baseline PI was independently associated with intraoperative hypothermia (PI: [OR] 0.375, 95% confidence interval [CI]: 1.584-6.876, p = 0.001). This study suggests that low baseline PI is an independent factor associated with intraoperative hypothermia. In future studies, PI value could be considered as a predictor for the treatment of intraoperative hypothermia.

Infants with perinatal asphyxia and moderate-to-severe hypoxic ischemic encephalopathy (HIE) are currently treated with therapeutic hypothermia (TH) as part of a brain protective strategy. However, perinatal asphyxia is a risk factor for development of persistent pulmonary hypertension (PPHN). As such, the aim of this study was to quantify the risk of PPHN in infants undergoing TH and assess short-term outcomes in infants developing PPHN. All N = 59 infants undergoing TH for moderate-to-severe HIE over a period of 3 years (January 2020-December 2022) at a single center were included. PPHN was diagnosed in N = 10 (17%), with this deemed to have been exacerbated by TH in n = 6 (10%). Only 50% (5/10) with PPHN required inhaled nitric oxide, and none of the infants received extracorporeal membrane oxygenation. PPHN was not found to be significantly associated with short-term outcomes, including the extent of HIE on brain magnetic resonance imagings, in-hospital mortality or requirement for nasogastric feeding at discharge. In conclusion, TH appears to be a safe and effective treatment for moderate-to-severe HIE with or without PPHN.

The study aimed to explore the effect of the temperature chain management scheme on preventing hypothermia in patients undergoing robot-assisted radical prostatectomy (RARP). The patients were randomized to receive either intraoperative warming only (control group, Group C) or the temperature chain management (experimental group, Group T). We compared the core temperature, inadvertent perioperative hypothermia (IPH) rates, the incidence of shivering, and thermal comfort between the two groups. The perioperative core temperature of the Group T was higher than that of the Group C, and the incidence of IPH, the incidence of shivering in the postanesthesia care unit (PACU), and the length of stay in PACU were lower than those of the control group. The thermal comfort of Group T scored higher than that of Group C when leaving the PACU, all above have a statistically significant difference (p < 0.05). The temperature chain management scheme could decrease the IPH rates and reduce postoperative complications in RARP patients. The Clinical Trials Registration number is 2023IIT034.

Therapeutic hypothermia (TH) is the only treatment method that is known to reduce mortality and neurological sequela rates in newborns with moderate and severe hypoxic-ischemic encephalopathy (HIE). We aimed to evaluate the relationship between rectal temperatures measured upon arrival to our unit and short-term outcomes in newborns with HIE/TH. This was a retrospective study conducted between January 2022 and January 2023. The neonates were divided into three groups according to their rectal temperatures measured upon arrival at our unit as follows: Group 1) <33°C, Group 2) 33-34°C (group arriving at target temperature), and Group 3) >34°C. Short-term outcomes and mortality were compared between the groups. Group 1 consisted of 17 (19.8%) neonates, Group 2 consisted of 34 (39.5%) neonates, and Group 3 consisted of 35 (40.7%) neonates who had HIE and an indication for TH. Rectal temperature on arrival to the unit was not related to the rate of clinical convulsions, rates of abnormal attenuated electroencephalography and magnetic resonance imaging findings, rate of pulmonary hypertension, duration of mechanical ventilation and length of hospital stay. Although the mortality rate was 29% in Group 1, it was 3% and 6% in Groups 2 and 3, respectively (p = 0.016). No relationship was found between the rectal temperature upon arrival to the NICU and the short-term outcomes in HIE/TH neonates. However, the mortality rate in those who were overcooled was significantly higher compared with the other groups.