Hipotermia terapéutica: estudio descriptivo de una cohorte de 10 años en un hospital público de alta complejidad / Therapeutic hypothermia: A descriptive, cohort study conducted over 10 years at a tertiary care public hospital

Introducción. La hipotermia terapéutica (HT) reduce el riesgo de muerte o discapacidad en niños con encefalopatía hipóxico-isquémica (EHI) moderada-grave. Objetivo. Describir una población de pacientes con EHI que requirió HT y su evolución hasta el alta hospitalaria. Población y métodos. Estudio descriptivo de cohorte retrospectivo. Se analizaron todos los pacientes que ingresaron a HT entre 2013 y 2022. Se evaluaron datos epidemiológicos, clínicos, de monitoreo, tratamiento, estudios complementarios y condición al alta. Se compararon los factores de riesgo entre pacientes fallecidos y sobrevivientes, y de estos, los que requirieron necesidades especiales al alta (NEAS). Resultados. Se incluyeron 247 pacientes. Mortalidad: 11 %. Evento centinela más frecuente: período expulsivo prolongado (39 %). Inicio del tratamiento: mediana 5 horas de vida. Convulsiones: 57 %. Eritropoyetina intravenosa: 66,7 %. Patrón anormal de monitoreo de función cerebral: 52 %. Normalización del monitoreo: mediana 24 horas. Resonancia magnética patológica: 42 %. Variables predictoras de mortalidad: Sarnat y Sarnat grave, y ecografía patológica al ingreso. Conclusión. La mortalidad global fue del 11 %. Las derivaciones aumentaron en forma más evidente a partir del año 2018. El horario de inicio de HT fue más tardío que en reportes anteriores. Los signos neurológicos de gravedad según la escala de Sarnat y Sarnat y la ecografía cerebral basal patológica fueron predictores independientes de mortalidad al alta. Los pacientes con NEAS presentaron normalización del trazado del electroencefalograma de amplitud integrada más tardío. El hallazgo más frecuente en la resonancia fue la afectación de los ganglios basales. No se encontraron diferencias clínicas ni de complicaciones estadísticamente significativas entre los pacientes que recibieron eritropoyetina.

Introduction. Therapeutic hypothermia (TH) reduces the risk of death or disability in children with moderate to severe hypoxic ischemic encephalopathy (HIE). Objective. To describe a population of patients with HIE that required TH and their course until discharge. Population and methods. Retrospective, descriptive, cohort study. All patients admitted to TH between 2013 and 2022 were studied. Epidemiological, clinical, monitoring, and treatment data were assessed, together with supplementary tests and condition at discharge. Risk factors were compared between deceased patients and survivors; and, among the latter, those requiring special healthcare needs (SHCN) at discharge. Results. A total of 247 patients were included. Mortality: 11%. Most common sentinel event: prolonged second stage of labor (39%). Treatment initiation: median of 5 hours of life. Seizures: 57%. Intravenous erythropoietin: 66.7%. Abnormal pattern in brain function monitoring: 52%. Normalization of monitoring: median of 24 hours. Pathological magnetic resonance imaging: 42%. Predictor variables of mortality: severe Sarnat and Sarnat staging and pathological ultrasound upon admission. Conclusion. The overall mortality rate was 11%. Referrals increased more markedly since 2018. The time of TH initiation was later than in previous reports. Severe neurological signs as per the Sarnat and Sarnat staging and a pathological baseline cranial ultrasound were independent predictors of mortality at discharge. Patients with SHCN at discharge showed a normalized tracing in the amplitude-integrated electroencephalography performed later. The most common finding in the magnetic resonance imaging was basal ganglia involvement. No statistically significant differences were observed in terms of clinical characteristics or complications among patients who received erythropoietin.

Impact of therapeutic hypothermia (whole body cooling) on severely asphyxiated term neonates: a prospective non-randomized comparative study in an Indian tertiary care setting

Background: Early application of Therapeutic Hypothermia within 6 hours of birth is neuroprotective. We aimed at examining whether therapeutic hypothermia alongside standard optimal intensive care improves immediate survival outcome and reduces neuro-disability.Methods: This was a prospective non-randomized study involving inborn and out born newborns admitted at NICU, carried out from March 2022 to December 2022. Eligible candidates were enrolled as cases and therapeutic hypothermia was offered while rest were included as a control group and monitored likewise for the overall survival and neurological outcome. These babies were followed up till 1 month and 3 months of age to assess neurological outcome.Results: In this study, a total of 47 patients were enrolled both from extramural and intramural NICU set ups. Of them, 22 patients were offered Therapeutic Hypothermia and 25 patients were given standard post asphyxia care. 7 out of 9 inborn patients and 3 out of 13 out born neonates who were offered therapeutic hypothermia survived whereas 5 out of 11 inborn and 4 out of 14 out born neonates who were offered standard post asphyxia care survived.Conclusions: Therapeutic hypothermia cannot be attributed to significant increase or decrease in mortality when compared with standard care group. No inference could be made about hypothermic neuroprotection in the follow up study. Overall survival outcome was better in inborn patients than that of outborn. Inborn neonates subjected to therapeutic hypothermia, showed a trend towards better survival than those given standard post asphyxia care.

A study on delayed cord clamping and early skin-to-skin contact and its effects on neonatal outcome

Background: Previous study conducted against immediate tying and cutting of the umbilical cord and suggested waiting until the child had taken repeated breaths and the pulsation in the cord had ceased to prevent potential weakness in the child. A comparative study between delayed cord clamping (DCC) and early cord clamping (ECC) was carried out on a select group of primigravida without any high-risk factor and delivering at term. The objective of the study was to identify the effects of delayed cord clamping and early skin to skin contact on new born infant’s physiological parameters (temperature, weight, SpO2= saturation of peripheral oxygen, Apgar score= appearance, pulse, grimace, activity, and respiration, Hb=haemoglobin level).Methods: Study sample consisted of 300 mothers and their new born after gaining mother’s acceptance. They were divided into 2 groups of 150 each. Group A underwent delayed cord clamping and early skin to skin contact and group B early cord clamping. Newborns monitored 24 hours for hypothermia, apnoea, oxygen needs.Results: The findings of the present study were equivalent among both groups regards the mean neonatal haematological parameters were comparable and slightly elevated hemoglobin level and weight status among late cord clamping compared to early cord clamping group with significant difference was observed at 24 hour later.Conclusions: This study was found that DCC does have a beneficial effect on temperature, Apgar score, SpO2, Hb level and weight status of new born. Therefore, it is believed that DCC and early skin to skin contact (ESSC) provides effective thermal control with a reduced risk of hypothermia.

Role of NLRP3 inflammasome in therapeutic mild hypothermia post-treated myocardial ischemia-reperfusion rats / 临床麻醉学杂志

Objective To analyze the role of NOD-like receptor thermal protein domain associated protein 3(NLRP3)inflammasome in a therapeutic mild hypothermia(34℃)treated isolated rat myocardial ischemia-reperfusion model and explore its mechanism.Methods Sixty clean grade adult male SD rats,aged 7-10 weeks,weighing 250-300 g.Using a random number table method,the rats were divid-ed into five groups:blank control group(group S),myocardial ischemia-reperfusion group(group IR),34℃mild hypothermia post-treated myocardial ischemia-reperfusion group(group MH),34℃mild hypother-mia post-treated myocardial ischemia-reperfusion+3-TYP group(group HT),and 34℃mild hypothermia post-treated myocardial ischemia-reperfusion+3-TYP+MCC950 group(group HTM),12 rats in each group.Group S perfused the rat heart at 37℃with a balanced perfusion solution for 180 minutes.Group IR re-ceived balanced perfusion of the rat heart at 37℃for 30 minutes,followed by ischemia for 30 minutes and reperfusion with 37℃perfusion for 120 minutes.Group MH perfused the rat heart at 37℃for 30 minutes,followed by ischemia for 30 minutes and reperfusion with 34℃perfusion solution for 120 minutes.Group HT perfused the hearts of rats at 37℃for 30 minutes,followed by ischemia for 30 minutes,silent mating type information regulation 2 homolog 3(sirt3)inhibitor 3-TYP was added to the perfusate,and then per-fused at 34℃for 120 minutes.Group HTM perfused the hearts of rats at 37℃for 30 minutes,followed by ischemia for 30 minutes,sirt3 inhibitor 3-TYP and NLRP3 inhibitor MCC950 were added to the perfusate,and then perfused at 34℃for 120 minutes.The isolated heart was obtained 120 minutes after reperfusion,and the concentrations of IL-6 and IL-1β in the perfused cardiac fluid was measured using ELISA method,Western blot method for detecting the relative content of NLRP3 and sirt3 proteins in myocardial tissue,1%triphenyl tetrazolium chloride staining for calculating myocardial infarction area,and HE staining for observ-ing myocardial pathological changes.Results Compared with group S,HR were significantly slowed down,LVSP,±dp/dtmax were significantly decreased,and LVEDP were significantly increased 30,60,90,and 120 minutes after reperfusion,the concentrations of IL-6 and IL-1β in cardiac fluid leakage,and the per-centage of myocardial infarction area were significantly increased in groups IR,MH,HT,and HTM(P＜0.05),the content of sirt3 protein in myocardial tissue were significantly reduced,while the content of NLRP3 protein were significantly increased in groups IR,HT,and HTM(P＜0.05),the contents of sirt3 and NLRP3 protein in the myocardial tissue were significantly increased in group MH(P＜0.05).Com-pared with group IR,HR were significantly increased,LVSP,±dp/dtmax were significantly increased,and LVEDP were significantly decreased 30,60,90,and 120 minutes after reperfusion,the concentrations of IL-6 and IL-1β in cardiac fluid leakage and the percentage of myocardial infarction area were significantly decreased in groups MH and HTM(P＜0.05),the content of sirt3 protein in myocardial tissue was signifi-cantly increased,while the content of NLRP3 protein was significantly decreased in group MH(P＜0.05),the content of NLRP3 protein in myocardial tissue was significantly reduced in group HTM(P＜0.05).Compared with group MH,HR were significantly slowed down,LVSP,±dp/dtmax were significantly de-creased,and LVEDP were significantly increased 30,60,90,and 120 minutes after reperfusion,the con-centrations of IL-6 and IL-1β in cardiac fluid leakage,the percentage of myocardial infarction area,and the content of NLRP3 protein in myocardial tissue were significantly increased in group HT(P＜0.05),the content of sirt3 protein in myocardial tissue was significantly reduced in groups HT and HTM(P＜0.05).Compared with group HT,HR were significantly increased,LVSP,±dp/dtmax were significantly increased,and LVEDP were significantly decreased 30,60,90,and 120 minutes after reperfusion,the concentrations of IL-6 and IL-1β in cardiac fluid leakage,the percentage of myocardial infarction area,and the content of NLRP3 protein in myocardial tissue were significantly reduced in group HTM(P＜0.05).Conclusion Therapeutic mild hypothermia(34℃)can improve hemodynamic parameters of isolated hearts and reduce the concentrations of IL-6 and IL-1β,NLRP3 protein content in myocardial tissue,percentage of myocardial infarction area,improve myocardial pathological changes,and reduce myocardial ischemia-reperfusion injury in rats,the mechanism may be related to the mitochondrial mediated sirt3 pathway inhibiting the high expres-sion of inflammatory corpuscle NLRP3.

Long-term mild hypothermia promotes neuroprotection by antagonizing the rebound of intracranial pressure after traumatic brain injury in rats / 天津医药

Objective To explore the optimal duration of long-term mild hypothermia(MHT)for traumatic brain injury(TBI)in rats,and observe its effect on intracranial pressure(ICP)and neurological function.Methods Forty-eight healthy adult male SD rats were divided into the normal temperature treatment(NT)group,the MHT4 h group,the MHT24 h group and the MHT48 h group by random number table method,with twelve rats in each group.The TBI model of rats was prepared by electronic controllable cortical injury device,and ICP monitoring probe was implanted.After modeling,the NT group was treated with normal temperature(37℃),and the other groups were treated with low temperature(33.0±1.0)℃for 4 h,24 h and 48 h,respectively.ICP was monitored and brain water content(BWC)was calculated after MHT treatment in each group.Blood-brain barrier permeability was determined by Evansland(EB)staining.The expression of 5-bromodeoxyuracil nucleoside(BrdU),neuronal nuclear antigen antibody(NeuN)and leukocyte differentiation antigen 86(CD86)positive cells were detected by immunofluorescence staining.The expressions of B-cell lymphoma-2(Bcl-2),Bcl-2 associated X protein(Bax),inducable nitric oxide synthase(iNOS),interleukin(IL)-10 and arginase 1(Arg-1)were detected by Western blot assay.Results Compared with the NT group,levels of BWC,ICP,EB,and CD86 positive cells,Bax and iNOS expression levels were decreased in the MHT4 h group,the MHT24 h group and the MHT48 h group,and the number of BrdU positive cells and BrdU/NeuN double-labeled positive cells were increased in hippocampus.The expression levels of Bcl-2,IL-10 and Arg-1 were increased(P＜0.01).Compared with the MHT24 h group,levels of BWC,ICP and EB,and CD86 positive cells,Bax and iNOS expression were decreased,and the number of BrdU positive cells and BrdU/NeuN double-labeled positive cells were increased in the MHT48 h group,while levels of Bcl-2,IL-10 and Arg-1 expression were increased(P＜0.01).Conclusion Long-term MHT can promote the proliferation and differentiation of neurons,inhibit apoptosis and reduce inflammation by suppressing ICP rebound,further promoting neuroprotection after TBI.

Neurobehavioral effects of long term mild hypothermia combined with compound porcine cerebroside and ganglioside injection after traumatic brain injury in rats / 安徽医科大学学报

Objective @#To investigate the neurobehavioral effects of long term mild hypothermia (MHT) combined with compound porcine cerebroside and ganglioside inj ection (CPCGI) after traumatic brain inj ury (TBI) in rats and its mechanism. @*Methods @#36 healthy adult male SD rats were randomly divided into model group , MHT group , CPCGI group and MHT + CPCGI group . The TBI model was prepared using an electronically controlled cortical in j ury device . The rats in model group received an intraperitoneal inj ection of an equal amount of normal saline (NS , 2 ml/kg) and were treated at room temperature (37 ℃) for 48 hours . The rats in MHT group received an intraper itoneal inj ection of an equal amount of NS and were treated at a slightly low temperature (33.0 ±1 0) ℃ for 48 hours . The rats in CPCGI group received an intraperitoneal inj ection of an equal amount of CPCGI (0.6 ml/kg) and were treated at room temperature for 48 hours . The rats in MHT + CPCGI group received an intraperitoneal injection of an equal amount of CPCGI and were treated at a slightly low temperature for 48 hours. The sensorimotor function of rats was evaluated by modified Neurological Severity Score ( mNSS) . The motor and spatial memory a bilities of rats were detected by Morris water maze test , and the motor function of rats was evaluated by beam walk ing test (BWT) and inclined grid climbing test. The number of neurons in hippocampus was ob served by Nissl stai ning and immunofluorescence was used to detect the expression of doublecortin (DCX) and neuronal nuclear anti gen antibody (NeuN) . Western blot was used to ob serve the protein expression of B cell lymphoma-2 ( Bcl-2) , Bcl 2 associated X protein ( Bax ) and cysteine proteinase-3 ( Caspase-3) . @*Results @#Compared with MHT group and CPCGI group , MHT + CPCGI group had a lower mNNS score, shorter escape latency , higher times across the platform and the percentage of time in the target quadrant , higher BWT score and larger climbing angle , increased numbers of neurons , DCX and NeuN positive cells , increased Bcl-2 expression and decreased expression of Bax and Caspase-3 . (P < 0.05) . @*Conclusion @#Long-term mild hypothermia combined with CPCGI can effectively improve the neurological deficits of TBI rats by promoting nerve regeneration and inhibiting cell apoptosis , and provide potential strategies and basis for the clinical treatment of TBI .

Humanistic Care for the Prevention of Perioperative Hypothermia in the Elderly / 中国医学伦理学

The intervention and prevention of perioperative hypothermia is not only reflected in the technical level, but also reveals the important role of humanistic care in the whole intervention work. If perioperative patients have hypothermia, it is likely to cause a series of complications such as postoperative shivering, which seriously threatens the life safety of patients. Prevention and intervention was based on a comprehensive understanding of the causes and hazards of hypothermia, especially the impact on the lives of the elderly. Effective supervision was implemented in the whole process of operation, such as dynamic monitoring of vital signs including body temperature, followed by room temperature regulation, body temperature protection and preoperative and postoperative psychological nursing. At this time, the sense of responsibility, good humanistic care of medical staff are of positive significance to effectively prevent and reduce the probability of perioperative hypothermia and accelerate the postoperative rehabilitation of patients.

Analysis of hypothermia factors for elderly patients with malnutrition during proximal femoral nail antirota-tion internal fixation under general anesthesia / 局解手术学杂志

Objective To analyze the incidence and risk factors of hypothermia in elderly patients with malnutrition during proximal femoral nail antirotation(PFNA)internal fixation under general anesthesia.Methods A total of 139 elderly patients underwent PFNA internal fixation under general anesthesia were selected,and the nutritional status scores 1 day before surgery ranged from 0 to 11 points.Univariate and multivariate Logistic binary regression analysis was performed to analyze the related factors that may lead to intraoperative hypothermia.Results Among 139 elderly patients with preoperative nutritional scores of 0 to 11 points,79 cases(56.83%)developed intraoperative hypothermia.The results of univariate and multivariate Logistic binary regression analysis suggested that age≥75 years old,mini nutritional assessment short form(MNA-SF)nutritional score 0 to 7 points,BMI<18.5 kg/m2,duration of general anesthesia≥2 hours,intraoperative flushing fluid volume≥1 000 mL and intraoperative fluid volume≥1 000 mL were the risk factors for the occurrence of intraoperative hypothermia in elderly patients(OR>1,P<0.05).The use of warm blanket insulation was the protective factor against the occurrence of intraoperative hypothermia(OR<1,P<0.05).Conclusion The incidence of intraoperative hypothermia during PFNA internal fixation under general anesthesia in elderly patients with mainutrition before operation is high,and patients with poor nutritional status are more likely to develop intraoperative hypothermia.Patients with older age,poor nutritional status,lower BMI,longer duration of general anesthesia,and more intraoperative flushing fluid volume and intraoperative fluid volume are likely to lead to intraoperative hypothermia.The use of warm blanket can reduce the incidence of intraoperative hypothermia.

Construction of a nomogram prediction model for the risk of hypothermia during modified radical mastectomy / 局解手术学杂志

Objective To analyze the risk factors for hypothermia during modified radical mastectomy,and construct a nomogram model for predicting the occurrence of hypothermia during modified radical mastectomy based on the risk factors.Methods A total of 383 patients received modified radical mastectomy admitted to our hospital were selected and divided into the hypothermia group(n=58)and the normal group(n=325)according to whether hypothermia occurred.The clinical data of the patients were collected,and the univariate analysis and Logistic regression analysis were used to screen out the independent risk factors for intraoperative hypothermia,and a risk nomogram model for predicting intraoperative hypothermia was constructed by R software and verified.Results There were statistically significant differences in the hypothyroidism,preoperative basal body temperature,intraoperative room temperature,operation time,anesthesia time,intraoperative blood loss,and intraoperative infusion between the two groups(P<0.05).The hypothyroidism(OR=2.156,95%CI:1.158～4.016,P=0.015),abnormal preoperative basal body temperature(OR=2.451,95%CI:1.309～4.588,P=0.005),intraoperative room temperature<23℃(OR=2.027,95%CI:1.085～3.786,P=0.027),operation time>2 hours(OR=2.316,95%CI:1.239～4.327,P=0.008),anesthesia time>3 hours(OR=2.264,95%CI:1.206～4.252,P=0.011),intraoperative infusion volume>1 500 mL(OR=2.895,95%CI:1.543～5.432,P=0.001)were the independent risk factors for the occurrence of intraoperative hypothermia.The nomogram model showed that the score of intraoperative infusion volume>1 500 mL was 100 points,hypothyroidism was 93 points,anesthesia time>3 hours was 85 points,intraoperative room temperature<23℃was 84 points,operation time>2 hours was 79 points,and abnormal preoperative basal body temperature was 75 points.The nomogram model verification results demonstrated that the C-index was 0.834;the H-L goodness-of-fit test showed χ2=11.854 and P=0.078;the calibration curve was close to the ideal curve;the area under the receiver operating characteristic curve was 0.812;and the net benefit value was high at the threshold probability from 5%to 70%.Conclusion The nomogram model constructed in this study can more accurately and reliably predict the risk of hypothermia occurring during modified radical mastectomy,which meets the clinical need for an integrated model and helps to promote the steady development of individualized medicine.

Mild Hypothemia Inhibits Interferon-α2b-induced AC16 Cardiomyocytes Apoptosis Via Improving Mitochondrial Function / 中国循环杂志

Objectives:To explore the effect and possible mechanisms of mild hypothermia on interferon(IFN)-α2b-induced AC16 cardiomyocytes apoptosis. Methods:Cardiomyocytes were stimulated in ordinary temperature and mild hypothermia by IFN-α2b under different concentrations for different times.Proliferation activity of cardiomyocytes was detected by CCK-8 assay.Apoptosis was detected by flow cytometry technique.The effects of different interventions on mitochondrial morphology were examined using Mito-Tracker Green and laser scanning confocal microscope,respectively.The mitochondrial membrane potentials under different intervention conditions were detected by flow cytometry.The fusion of dynamin-related protein 1(Drp1)and mitochondria,and the effects of different interventions on the mitochondria was examined by Drp1 or mitochondrial fluorescent probes and laser scanning confocal microscope.The effects of different intervention conditions on the protein expression level of Phospho-Drp1(p-Drp1)Ser616,Drp1,cleaved poly ADP-ribose polymerase1(cleaved-PARP1),poly ADP-ribose polymerase1(PARP1)were detected by Western blot. Results:CCK-8 assay and flow cytometry results showed that IFN-α2b inhibited the proliferation and enhanced the apoptosis of AC16 cardiomyocytes in a time and dose-dependent manner,these effects could be attenuated by mild hypothermia.Mito-Tracker Green,laser scanning confocal microscope and flow cytometry results showed that the extent of damage of mitochondria with different interventions were attenuated in the setting of mild hypothermia as compared with ordinary temperature.The morphology of mitochondria remained intact and the mitochondrial membrane potentials were the highest in mild hypothermia group.Injured AC16 cardiomyocytes released Drp1 from cytoplasm to mitochondria and increased mitochondrial fission,these effects were abolished after mild hypothermia.p-Drp1 Ser616/Drp1 ratio and cleaved-PARP1/PARP1 ratio were decreased after mild hypothermia,and above effects could be reversed by mitochondrial division inhibitor-1(Mdivi-1)pretreatment. Conclusions:Mild hypothermia inhibits IFN-α2b-induced AC16 cardiomyocytes apoptosis via improving mitochondrial function.

Pronostic immédiat des nouveaux nés de poids extrêment faible à l'hôpital Saint Camille de Ouagadougou de 2017 à 2021 / Immediate Prognostic of Extremely Low Weight Newborns at Saint Camille Hospital in Ouagadougou From 2017 To 2021

Les prématurés d'extrême faible poids de naissance, constituent un problème de santé publique dans les pays en voie de développement. L'étude avait pour objectif d'évaluer le pronostic immédiat des nouveau-nés de poids de naissance extrêmement faible hospitalisés à l'Hôpital Saint Camille de Ouagadougou (HOSCO). Methode : Il s'est agi d'une étude descriptive et analytique à collecte de données rétrospectives ayant porté sur les nouveau-nés de poids de naissance < 20ans (p=0,013) étaient les facteurs associés à la mortalité. Conclusion : La prise en charge des extrêmes poids de naissance reste difficile à cause des moyens très limités dans nos pays.Des interventions simples comme la mise en place d'un réseau de périnatalité, peuvent améliorer de manière considérable la survie de ces nouveau-nés.

Extremely low birth weight infants are a public health problem in developing countries. The objective of this study was to evaluate the prognosis of extremely low birth weight newborns hospitalized at Saint Camille Hospital in Ouagadougou (HOSCO). Method: This was a descriptive and analytical study with retrospective data collection on newborns with birth weight <1000g in the neonatology department from January 2017 to December 2021. Results: A total of 319 newborns were admitted giving a hospital frequency of 8.62%. Male sex was predominant with a sex ratio of 1.02. The mean age was 0.18 ± 0.71 days. The main signs on admission were hypothermia 88.40% and respiratory distress 92.16%. The evolution was marked by 92.79% of deaths of which 90.20% occurred during the early neonatal period. Hypothermia, birth outside HOSCO and maternal age less than 20 years were the factors associated with mortality. Conclusion: The management of low birth weight remains difficult because of the very limited resources in our countries. Simple and inexpensive interventions can considerably improve the survival of these newborns

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Inadvertent intraoperative hypothermia

Abstract Hemostasis plays a critical role in surgical procedures and is essential for a successful outcome. Advances in hemostatic agents offer new approaches to controlling bleeding thereby making surgeries safer. The appropriate choice of these agents is crucial. Volume replacement, another integral part of Patient Blood Management (PBM), maintains adequate tissue perfusion, preventing cellular damage. Individualization in fluid administration is vital with the choice between crystalloids and colloids depending on each case. Colloids, unlike crystalloids, increase oncotic pressure, contributing to fluid retention in the intravascular space. Understanding these aspects is essential to ensure safe and effective surgery, minimizing complications related to blood loss and maintaining the patient's hemodynamic status.

Type A Aortic Dissection Following Heart Transplantation

ABSTRACT Cannulation strategies in aortic arch surgeries are a matter of immense discussion. Majority of time deep hypothermic circulatory arrest (DHCA) is the way out, but it does come with its set of demerits. Here we demonstrate a case with aortic arch dissection dealt with dual cannulation strategy in axillary and femoral artery without need for DHCA and ensuring complete neuroprotection of brain and spinal cord without hinderance of time factor. Inception of new ideas like this may decrease the need for DHCA and hence its drawbacks, thus decreasing the morbidity and mortality associated.

Bundle para regulação da temperatura corporal de recém-nascidos maiores de 34 semanas: construção e validação / Bundle for regulating the body temperature of newborns over 34 weeks: Construction and validation / Paquete para regular la temperatura corporal de recién nacidos de más de 34 semanas: construcción y validación

Objetivo: Descrever o processo de construção e validação de um bundle para promoção da regulação da temperatura corporal de recém-nascidos maiores de 34 semanas. Métodos: Pesquisa metodológica executada em três etapas: revisão de escopo, construção da primeira versão do bundle e validação de conteúdo realizada por 15 experts, sendo nove enfermeiros e seis médicos, selecionados conforme critérios adaptados de referencial na área. O índice de validade de conteúdo acima de 0,80 foi considerado aceitável para a concordância entre os experts sobre cada cuidado. Foram necessárias duas rodadas de avaliação para a confecção da versão final. Resultados: O bundle foi estruturado em cuidados: na sala de parto, no transporte e no alojamento conjunto, com total de 15 itens, todos com concordância acima de 0,90 após a segunda rodada de avaliação. Conclusão: O bundle elaborado foi considerado válido quanto ao conteúdo e estabelece cuidados baseados em evidências científicas de maneira padronizada e segura para a equipe de assistência ao parto.

Objective: Describe the process of building and validating a bundle to promote body temperature regulation in newborns over 34 weeks of age. Methods: This methodological research was carried out in three stages: a scoping review, construction of the first version of the bundle, and content validation by 15 experts, nine nurses and six physicians, selected according to criteria adapted from references in the field. A content validity index above 0.80 was considered acceptable for the agreement among the experts on each type of care. Two rounds of evaluation were required to produce the final version. Results: The bundle was structured into care in the delivery room, during transportation, and in the rooming- in unit, with a total of 15 items, all with agreement above 0.90 after the second round of evaluation. Conclusion: The bundle developed was considered valid in terms of content and establishes care based on scientific evidence in a standardized and safe way for the childbirth care team.

Objetivo: Describir el proceso de creación y validación de un paquete para promover la regulación de la temperatura corporal en recién nacidos de más de 34 semanas de edad. Métodos: Investigación metodológica realizada en tres etapas: una revisión del alcance, la construcción de la primera versión del paquete y la validación del contenido llevada a cabo por 15 expertos, nueve enfermeras y seis médicos, seleccionados según criterios adaptados a partir de referencias en la materia. Se consideró aceptable un índice de validez de contenido superior a 0,80 para el acuerdo entre los expertos sobre cada tipo de atención. Fueron necesarias dos rondas de evaluación para elaborar la versión final. Resultados: El paquete se estructuró en cuidados: en la sala de partos, durante el transporte y en la unidad de alojamiento, con un total de 15 ítems, todos ellos con una concordancia superior a 0,90 tras la segunda ronda de evaluación. Conclusión: El paquete se consideró válido en cuanto a su contenido y establece una atención basada en pruebas científicas de forma estandarizada y segura para el equipo de atención al parto.

Escenarios para el diagnóstico de encefalopatía hipóxico isquémica e inicio de tratamiento con hipotermia controlada en recién nacidos con asfixia perinatal / Scenarios for the diagnosis of hypoxic-ischemic encephalopathy and initiation of therapeutic hypothermia treatment in newborns with perinatal asphyxia / Cenários para o diagnóstico da encefalopatia hipóxico-isquemia e início de tratamento de hipotermia terapêutica a recém-nascidos com asfixia perinatal

La hipoxia isquemia perinatal y su complicación más temida, la encefalopatía hipóxica isquémica, continúa siendo uno de los principales motivos de ingreso a las unidades de cuidados neonatales. En la actualidad la hipotermia controlada es el tratamiento recomendado para los pacientes con encefalopatía moderada a severa, dado su carácter de neuroprotección ante la injuria cerebral hipóxico isquémica. Si bien los criterios de inclusión en esta terapia han sido bien establecidos, aún hay dificultades tanto en la identificación precoz de aquellos que pueden verse beneficiados, como en la toma de decisiones ante situaciones de controversia entre la evidencia disponible y la que se está gestando en estudios en curso. Este artículo pretende aportar herramientas al clínico para abordar diferentes escenarios que surgen de la práctica diaria.

Perinatal hypoxic ischemia and its most feared complication, hypoxic ischemic encephalopathy, remain one of the main reasons for admission to neonatal care. Controlled hypothermia is currently the recommended treatment for patients with moderate to severe encephalopathy, given its neuroprotective nature against hypoxic-ischemic brain injury. Although the inclusion criteria for this therapy have been well established, there are still difficulties both in the early identification of those who may benefit, and in making decisions regarding situations of controversy between the available evidence and that being developing in ongoing studies. This paper aims at providing tools so that clinicians can address different scenarios that arise during their daily practice.

A hipóxia isquêmica perinatal e sua complicação mais temida, a encefalopatia hipóxico-isquêmica, continuam sendo um dos principais motivos de internação em unidades de cuidados neonatais. A hipotermia controlada é atualmente o tratamento recomendado para pacientes com encefalopatia moderada a grave, dada a sua natureza neuroprotetora contra lesão cerebral hipóxico-isquêmica. Embora os critérios de inclusão dessa terapia estejam bem estabelecidos, ainda há dificuldades tanto na identificação precoce daqueles que podem se beneficiar, quanto na tomada de decisões em situações de controvérsia entre as evidências disponíveis e aquelas que estão se desenvolvendo em estudos em andamento. Este paper tem como objetivo fornecer ferramentas aos clínicos para abordar diferentes cenários que surgem da prática diária.

Influence of maternal and perinatal complications on therapeutic hypothermia in newborns with low Apgar scores

SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of therapeutic hypothermia on maternal and perinatal outcomes in newborns with Apgar score<7 at the 5th min. METHODS: A retrospective cohort study was carried out with 55 newborns who had an Apgar score<7 at the 5th min (35 without and 20 with therapeutic hypothermia) from low-risk pregnancies between 33 and 41 weeks gestation. The Apgar score was calculated through an objective assessment by a neonatologist in the delivery room. Therapeutic hypothermia was indicated by a neonatologist in the delivery room, according to the protocol established by the Brazilian Society of Pediatrics. The maternal and perinatal outcomes of both groups (without and with therapeutic hypothermia) were compared. RESULTS: A rate of Apgar score<7 at the 5th min was 1.02%. No statistical differences were observed between the two groups (without and with therapeutic hypothermia) regarding maternal/perinatal complications. The presence of maternal/perinatal complications did not increase the odds ratio of neonatal therapeutic hypothermia in newborns with Apgar score<7 at the 5th min. CONCLUSION: The rate of Apgar score<7 at the 5th min was low, and it was not associated with any maternal/perinatal complications. There was no significant difference in maternal/perinatal complications between newborns who received therapeutic hypothermia and those who did not.

Is Deep Hypothermic Cardiac Arrest Mandatory in Aortic Arch Surgeries?

ABSTRACT Cannulation strategies in aortic arch surgeries are a matter of immense discussion. Majority of time deep hypothermic circulatory arrest (DHCA) is the way out, but it does come with its set of demerits. Here we demonstrate a case with aortic arch dissection dealt with dual cannulation strategy in axillary and femoral artery without need for DHCA and ensuring complete neuroprotection of brain and spinal cord without hinderance of time factor. Inception of new ideas like this may decrease the need for DHCA and hence its drawbacks, thus decreasing the morbidity and mortality associated.

Estratégias de termorregulação em recém-nascidos prematuros: uma revisão de escopo / Thermoregulation strategies in premature newborns: a scoping review / Estrategias de termorregulación en recién nacidos prematuros: una revisión de alcance

Objetivo: mapear as estratégias para o controle e regulação da temperatura corporal em recém-nascidos prematuros. Método: revisão de escopo sobre termorregulação do prematuro, orientada pelas recomendações do Instituto Joanna Briggs, desenvolvida em oito bases de informações eletrônica. A busca, síntese e análise dos resultados ocorreu em dezembro de 2022. Resultados: compuseram a revisão 15 estudos que foram agrupados em duas categorias: Fontes de calor e Uso de pacotes de medidas/bundle. Como estratégias para a manutenção da temperatura corporal do prematuro, destacam-se: temperatura adequada materna e do ambiente; envoltório plástico; touca dupla; panos aquecidos; aquecimento do ar no suporte respiratório; contato pele a pele; berços aquecidos e incubadoras. Evidenciou-se que os recursos conjugados foram mais efetivos do que quando usados isoladamente. Conclusão: os resultados da revisão de escopo apontaram para estratégias que podem ser utilizadas para mitigar os riscos de hipotermia em recém-nascidos prematuros(AU)

Objective: to map strategies for controlling and regulating body temperature in premature newborns. Method: scope review on premature thermoregulation, guided by the recommendations of the Joanna Briggs Institute, developed in eight electronic databases. The search, synthesis and analysis of the results took place in December 2022. Results: the review was made up of 15 studies, which were grouped into two categories: Heat sources and use of measurement packages/bundle. As strategies for maintaining the body temperature of preterm infants, the following stand out: adequate maternal and environmental temperature; plastic wrap; double bonnet; heated cloths; air heating in respiratory support; skin-to-skin contact; heated cribs and incubators. It was evident that the combined resources were more effective than when used separately. Conclusion: the scoping review results pointed to strategies that can be used to mitigate the risks of hypothermia in premature newborns(AU)

Objetivo: mapear estrategias para el control y regulación de la temperatura corporal en recién nacidos prematuros. Método: revisión de alcance sobre la termorregulación prematura, siguiendo las recomendaciones del Instituto Joanna Briggs, desarrollada en ocho bases de datos electrónicas. La búsqueda, la síntesis y el análisis de los resultados se llevaron a cabo en diciembre de 2022. Resultados: la revisión fue conformada de 15 estudios, agrupados en dos categorías: fuentes de calor y uso de paquetes de medidas/bundle. Como estrategias para mantener la temperatura corporal del prematuro se destacan: temperatura adecuada materna y ambiental; envoltura de plástico; gorro doble; paños tibios; calentamiento del aire en soporte respiratorio; contacto piel a piel; cunas calefaccionadas e incubadoras. Se evidenció que los recursos combinados fueron más efectivos que si usados de forma individual. Conclusión: los resultados de la revisión de alcance señalaron estrategias que pueden usarse para mitigar los riesgos de hipotermia en recién nacidos prematuros(AU)

Neurodevelopmental outcome of babies with moderate to severe birth asphyxia with hypoxic ischemic encephalopathy treated with and without therapeutic hypothermia followed up till 6-24 month of age at tertiary care hospital of Southern Rajasthan

Backgroung: hypoxic ischemic encephalopathy. There are very few studies comparing the neurodevelopmental outcomes in neonates with moderate to severe HIE who received and not received TH. Objective was assessment of neurodevelopmental outcome between TH and non-TH group till last follow-up.Methods: Hospital Based Prospective study. All term neonates with Moderate to severe birth asphyxia with HIE who received TH and not received TH, admitted in NICU of BalChikitsalay, RNTMC, Udaipur, consenting for the study were followed up at age 3-6 month, 6-12 month, 12-18 month and 18-24 month from September 2018 to February 2021 and neurodevelopment outcome was assessed.Results: 70 neonates with birth asphyxia HIE II / III were included in the study, 35 in TH group and 35 in non-TH group. Out of 70 babies enrolled 46 (65.7%) were having normal development and 24 (34.3%) were having development delay. Out of 46 who were having development delay 6 (17.4%) were of TH group and 18 (51.4%) were of non-TH group. Most of the babies of TH group i.e., 30 (85.7%) were neurodevelopmentally normal and 5 (14.3%) were having some neurodevelopmental abnormality. In non-TH group 15 (42.8%) were normal and 20 (57.2%) were having some neurodevelopmental abnormality.Conclusions: Results of the study showed significantly better outcome in infant who received therapeutic hypothermia than those who did not.

The role of warmed intravenous fluid on intraoperative hypothermia and postoperative shivering during prolonged oral and maxillofacial surgery

Background: Under general anaesthesia, the core temperature may drop up to 6°C. Patients undergoing prolonged maxillofacial surgery frequently experience unintentional hypothermia that causes postanaesthetic shivering which is a common complication of anaesthesia that should be prevented. This study aimed to evaluate the role of warmed intravenous fluid in preventing intraoperative hypothermia and postoperative shivering. Methods: Between January 2022 and December 2022, 322 patients with American Society of Anesthesiologists (ASA) physical status I, II and the age group of 18 to 45 years old scheduled for elective major oral and maxillofacial surgery were evaluated under the Department of Anaesthesiology in Dhaka Dental College and Hospital. The patients were grouped into Room Temperature Group and Warmed Fluid Group. Results: 162 patients received warmed fluid, whereas 160 patients received fluid at room temperature. In Room Temperature Group, there were 89 male and 71 female patients, whereas Warmed Fluid group had 88 male and 74 female patients. At the end of the procedure, the basal core temperature was 36.7±0.2°C in the group receiving warmed fluid versus 35.9±0.2°C in the group receiving fluid at room temperature. The incidence of hypothermia (<36 °C) was much lower in Warmed Fluid Group (n=28, 17.28%) than Room Temperature Group (n=86, 53.75%). Shivering was more common in Room Temperature Group (n = 67, 41.86%) than in Warmed Fluid Group (n = 19, 11.73%) in the postanaesthetic care unit (PACU). Conclusions: The results of this study suggested that intraoperative hypothermia and postoperative shivering are less common when warmed fluid is infused.