Hipotermia terapêutica na encefalopatia hipóxico-isquêmica neonatal: revisão integrativa / Therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: integrative review / Hipotermia terapéutica em la encefalopatía hipóxico-isquémica neonatal: revisión integrativa

Objetivo: identificar evidências acerca do uso seguro da hipotermia terapêutica em recém-nascidos. Método: revisão integrativa realizada entre junho e julho de 2018, em fontes eletrônicas da Biblioteca Virtual de Saúde e PubMed, por meio da pergunta:"Que evidências podem subsidiar o cuidado de enfermagem voltado para a redução de sequelas em recém-nascidos submetidos à hipotermia terapêutica?".Foram eleitos nove artigos para análise, sendo oito internacionais e um nacional. Resultados:o resfriamento deve acontecer por 72 horas, com hipotermia leve. As indicações para inclusão no protocolo foram: primeiras seis horas de vida, idade gestacional maior que 35 semanas e acidose na primeira hora de vida.São cuidados essenciais: monitoração hemodinâmica, observação da pele, controle térmico retal, vigilância do Eletroencefalograma de Amplitude Integrada. Conclusão: a terapêutica apresenta benefícios, porém sua aplicação depende de protocolo institucional e treinamento das equipes com foco nas potenciais complicações.

Objective: to identify the evidence on safe use of therapeutic hypothermia in newborns. Method: integrative review of the literature, conducted between June and July of 2018, in electronic sources from the Virtual Health Library and PubMed, through the question: "What evidence can support nursing care aimed at reducing sequelae in newborns undergoing therapeutic hypothermia?". Analysis was conducted for nine selected article, being eight from international literature and one from Brazilian national literature. Results: cooling should occur for 72 hours with mild hypothermia. Indications for inclusion in the protocol were: first six hours of life, gestational age greater than 35 weeks and acidosis in the first hour of life. Essential care includes hemodynamic monitoring, skin observation, rectal thermal control, Integrated Amplitude Electroencephalogram surveillance. Conclusion: the therapy has benefits, but its application depends on institutional protocol and team training focusing on potential complications.

Objetivo: identificar la evidencia sobre el uso seguro de la hipotermia terapéutica en recién nacidos. Método: revisión integradora de la literatura, realizada entre junio y julio de 2018, en fuentes electrónicas de la Biblioteca Virtual de Salud y PubMed, a través de la pregunta: "¿Qué evidencia puede apoyar la atención de enfermería dirigida a reducir las secuelas en los recién nacidos que sufren hipotermia terapéutica?". Se realizaron análisis para nueve artículos seleccionados, ocho de literatura internacional y uno de literatura nacional brasileña. Resultados: el enfriamiento debe ocurrir durante 72 horas con hipotermia leve. Las indicaciones para la inclusión en el protocolo fueron: primeras seis horas de vida, edad gestacional mayor de 35 semanas y acidosis en la primera hora de vida. El cuidado esencial incluye monitoreo hemodinámico, observación de la piel, control térmico rectal, vigilancia integrada de electroencefalograma de amplitud. Conclusión: la terapia tiene beneficios, pero su aplicación depende del protocolo institucional y del entrenamiento del equipo, enfocándose en posibles complicaciones.

Effects of Cold Therapy on Pain and Breathing Exercises Among Median Sternotomy Patients.

The most painful activities during the days following cardiac surgery are coughing and deep breathing exercises. Cold therapy is an effective nonpharmacological method that decreases the pain during coughing and mobilization. In this study, the effects of cold therapy on pain and breathing exercises among patients with median sternotomy following cardiac surgery were investigated in a randomized crossover clinical trial. Data were collected from patients with median sternotomy (N = 34) in the first two postoperative days. Because of the crossover design of the study, each patient was taken as a simultaneous control. Gel pack application was used as the cold therapy. Patients underwent four episodes of deep breathing and coughing exercises using an incentive spirometer (volumetric). Patients were evaluated according to the visual analogue scale for pain intensity before and after deep breathing and coughing exercise sessions. The pain score was 3.44 ± 2.45 at baseline for deep breathing and coughing exercises on the first day. The reported postoperative pain in the gel-pack group was not significantly different before and after the deep breathing and coughing exercises, but it significantly increased in the no-gel-pack group (p < .001). Although the interaction between the treatment and time was significant (partial eta-squared: .09), the gel-pack group had a lower change in average pain levels. This interaction was not significant in terms of spirometric values. In conclusion, cold therapy had a positive effect on pain management in the early period of post-cardiac surgery but was not effective for the pain associated with breathing exercises.

Experiences of parents whose newborns undergo hypothermia treatment following perinatal asphyxia.

OBJECTIVE: To describe and interpret experiences of parents whose newborns are treated with induced hypothermia following perinatal asphyxia. DESIGN: A qualitative exploratory study. SETTING: Data collection in parental home environments (n = 8) and in a study room in a university library (n = 2). PARTICIPANTS: A total of 10 parents, seven mothers and three fathers, participated in the study. Their newborns were treated with induced hypothermia 4 to 12 months prior to the interviews. METHODS: Recorded open-ended interviews with the participants lasted from 60 to 90 minutes. Field notes were made after each interview. The interviews were transcribed verbatim and inductive content analysis was used in the analyzing process. RESULTS: Four main themes emerged from the data: emotional landscapes, adaptation to a new situation (with subthemes creating control, external and internal support in a difficult situation, normalizing the abnormal and reconciling oneself to uncertainty), moments of rebirth, and change in attitude toward life and existence. CONCLUSION: Term newborns are treated with induced hypothermia treatment due to perinatal asphyxia. During the hospitalization of newborns in neonatal intensive care units (NICUs), parents experience high levels of stress. Parents use several strategies for adapting to this situation, and nurses play a pivotal role in providing individual support and acting as advocates for parents in the NICU. After the infants are rewarmed, parents experience a moment of rebirth that might help them attach to their infants. Further research is warranted in this area to provide holistic care and support to families whose neonates undergo this treatment.

Hipotermia. La modificación de la temperatura corporal como terapéutica clínica / Modification of body temperature as clinical therapeutics. Hypothermia

La aplicación del frío como terapéutica se denomina termoterapia. Se pueden diferenciar dos grandes modalidades: local y general. A nivel local es muy utilizada en el campo de la rehabilitación física, reumatología, y en diversas especialidades quirúrgicas. No obstante, la evidencia existente sobre aspectos relacionados con sus posibles beneficios, razón fisiológica que fundamenta su acción, o forma de aplicación no está suficientemente respaldada. Respecto a las técnicas de aplicación de frío, las mayores expectativas se centran en la hipotermia inducida o terapéutica, por sus importantes efectos neuroprotectores tras isquemia secundaria a parada cardiorrespiratoria. El interés por la hipotermia comienza en el tercer decenio del siglo xx; el primer informe científico sobre la hipotermia inducida fue publicado en 1945 y describía su aplicación en pacientes con TCE. En las siguientes décadas aparecieron decisivas investigaciones sobre su aplicación, pero también grandes sombras sobre sus beneficios. El desarrollo de protocolos y los grandes avances en los cuidados prestados en las UCI, han aumento la capacidad de prevenir y controlar los efectos secundarios de la aplicación de esta terapéutica. Basándonos en la revisión de la bibliografía, se describirán los principales usos de la hipotermia terapéutica, las principales indicaciones de estás técnicas así como la evidencia existente sobre sus beneficios y las complicaciones que se derivan de su manejo(AU)

The application of cold therapy is called thermotherapy. Can distinguish two major forms: local and general. At the local level is widely used in the field of physical rehabilitation, rheumatology, and various surgical specialties. However, the evidence on issues relating to its potential benefits, physiological reason underlying its action, or application form is not sufficiently supported. Regarding the application of cold techniques, higher expectations are focused on hypothermia induced or therapeutic, for its significant neuroprotective effects after ischemia secondary to cardiac arrest. Interest in hypothermia begins in the third decade of the twentieth century, the first scientific report on induced hypothermia was published in 1945 and described its application in patients with TBI. In the following decades appeared critical research on their application, but also great shadows of its benefits. The development of protocols and the great advances in the care provided in ICUs, have increased the capacity to prevent and control the side effects of the application of this therapy. Based on the literature review, describing the main uses of therapeutic hypothermia, the major indications of these techniques and the evidence of its benefits and complications arising from their use(AU)