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.

The cold truth about postcardiac arrest targeted temperature management: 33°C vs. 36°C.

This article provides nurses with up-to-date evidence to empower them in contributing to the 33°C versus 36°C discussion in postcardiac arrest targeted temperature management (TTM). Presented in debate format, this article addresses the pros and cons of various target temperatures, examines the evidence around TTM, and applies it to clinical scenarios.

[Increasing the Rate of Completion of the Therapeutic Hypothermia Procedure in the NICU].

BACKGROUND & PROBLEMS: The most effective treatment currently available for perinatal asphyxia-induced hypoxic-ischemic encephalopathy is therapeutic hypothermia, which reduces the mortality rate and neurological disorders in newborns. The earlier this therapy is performed, the better the protective effects on the nerves of the patient. In our neonatal intensive care unit (NICU), we discovered that nurses lack experience caring for patients undergoing hypothermia therapy due to the limited number of cases. In addition, outdated guidelines, the disorganized placement of equipment, and the paucity of hands-on simulations exacerbate the unfamiliarity of the nurses with this therapy. PURPOSE: To expand the knowledge of nurses regarding therapeutic hypothermia in the NICU and to increase the rate of completion of the therapeutic hypothermia procedure. RESOLUTIONS: 1. Regular care training programs and scenario-based simulations were conducted to help nurses obtain related knowledge and become more familiar with therapeutic hypothermia. 2. In order to reduce the preparation time, a specific preparation kit and an instruction folder for therapeutic hypothermia was developed that included a material placement checklist. 3. The procedure guidance booklet for therapeutic hypothermia was revised and a monitoring system was established. RESULTS: The accuracy of nurses' knowledge regarding therapeutic hypothermia in the NICU improved from 82.0% to 94.5%. The completion rate for the therapeutic hypothermia procedure rose from 75.6% to 100.0%. CONCLUSIONS: This project successfully enhanced the accuracy of nurses' knowledge regarding therapeutic hypothermia and increased the rate of completion for this care procedure, resulting in a safer and more-standardized procedure for neonates undergoing therapeutic hypothermia.

Using Esophageal Temperature Management to Treat Severe Heat Stroke: A Case Report.

BACKGROUND: Exertional heat stroke (EHS) is defined by a core body temperature that exceeds 40°C with associated central nervous system dysfunction, skeletal muscle injury, and multiple organ damage. The most important initial focus of treatment involves reduction of patient temperature. First approaches to achieve temperature reduction often include ice packs, water blankets, and cold intravenous fluid administration. When these measures fail, more advanced temperature management methods may be deployed but often require surgical expertise. Esophageal temperature management (ETM) has recently emerged as a new temperature management modality in which an esophageal heat transfer device replaces the standard orogastric tube routinely placed after endotracheal intubation and adds a temperature modulation capability. The objective of this case study is to report the first known use of ETM driven by bedside nursing staff in the treatment of EHS. METHOD: An ETM device was placed after endotracheal intubation in a 28-year-old man experiencing EHS over a 5-day course of treatment. RESULTS: Because the ETM device was left in place, when the patient experienced episodes of increasing temperature as high as 39.1°C, which required active cooling, nursing staff were able to immediately adjust the external heat exchange unit settings to achieve aggressive cooling at bedside. CONCLUSION: This nurse-driven technology offers a new means to rapidly deploy cooling to critically ill patients without needing to implement advanced surgical approaches or obstruct access to the patient, freeing the provider to continue optimal care in high-morbidity conditions.

An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature.

BACKGROUND: The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia and guide the management of hypothermic patients. The proposed temperature range for clinical stage 1 is < 35-32 °C, for stage 2 is < 32-28 °C, for stage 3 is < 28-24 °C, and for stage 4 is below 24 °C. Our previous study using 183 case reports from the literature showed that the measured temperature only corresponded to the clinical stage in the Swiss staging model in approximately 50% of cases. This study, however, included few patients with moderate hypothermia. We aimed to expand this database by adding cases of hypothermic patients admitted to hospital to perform a more comprehensive evaluation of the staging model. METHODS: We retrospectively included patients aged ≥18 y admitted to hospital between 1.1.1994 and 15.7.2016 with a core temperature below 35 °C. We added the cases identified through our previously published literature review to estimate the percentage of those patients who were correctly classified and compare the theoretical with the observed temperature ranges for each clinical stage. RESULTS: We included 305 cases (122 patients from the hospital sampling and the 183 previously published). Using the theoretically derived temperature ranges for clinical stages resulted in 185/305 (61%) patients being assigned to the correct temperature range. Temperature was overestimated using the clinical stage in 55/305 cases (18%) and underestimated in 65/305 cases (21%); important overlaps in temperature existed among the four stage groups. The optimal temperature thresholds for discriminating between the four stages (32.1 °C, 27.5 °C, and 24.1 °C) were close to those proposed historically (32 °C, 28 °C, and 24 °C). CONCLUSIONS: Our results provide further evidence of the relationship between the clinical state of patients and their temperature. The historical proposed temperature thresholds were almost optimal for discriminating between the different stages. Adding overlapping temperature ranges for each clinical stage might help clinicians to make appropriate decisions when using clinical signs to infer temperature. An update of the Swiss staging model for hypothermia including our methodology and findings could positively impact clinical care and future research.

Cuidados de Enfermería en el tratamiento con hipotermia en la encefalopatía hipóxico-isquémica del recién nacido / Nursing care in hypothermia treatment for newborns with hypoxic-ischemic encephalopathy

Objetivo: analizar la evidencia científica disponible sobre el tratamiento con hipotermia y los cuidados de Enfermería en la encefalopatía hipóxico-isquémica del recién nacido. Método: revisión narrativa de la literatura. Se realizó una búsqueda bibliográfica en diferentes bases de datos, plataformas, bibliotecas y repositorios, que incluían entre otras PubMed, Cochrane, Lilacs, Enfispo, Cuiden, Scielo, etc. Se usaron los términos combinados "hipoxia- isquemia encefálica", "hipotermia inducida", "recién nacido" y "atención de Enfermería". La búsqueda se limitó a artículos científicos de neonatología y pediatría, publicados entre 2006 y 2017, en castellano o inglés. Resultados: se identificaron 29 estudios que hacían referencia al tratamiento con hipotermia en la encefalopatía hipóxico-isquémica (EHI) del recién nacido, así como de los cuidados de Enfermería. Diversos estudios han demostrado que la hipotermia aplicada antes de las seis horas de vida y mantenida durante 72 horas, reduce la mortalidad y lesiones cerebrales. Existe controversia en su aplicación en la encefalopatía hipóxico-isquémica severa o moderada, pero en las dos se obtienen resultados favorables. No hay ninguna terapia que combinada con la hipotermia mejore su eficacia. El éxito de este tratamiento requiere del esfuerzo de un equipo multidisciplinar. La profesión enfermera tiene un papel fundamental en su aplicación y ha de incluir también la atención a los padres durante todo el proceso. Conclusiones: la evidencia disponible apoya que la hipotermia inducida reduce la mortalidad y las secuelas neurológicas en recién nacidos afectados. Queda pendiente un mayor control a lo largo de los años de estos neonatos. Son necesarias otras estrategias que combinadas con la hipotermia inducida reduzcan el impacto de la encefalopatía hipóxico-isquémica

Objective: to analyze the scientific evidence available about hypothermia treatment and Nursing care for newborns with hypoxic-ischemic encephalopathy. Method: a narrative review of literature. A bibliographic search was conducted in different databases, platforms, libraries and repositories, including PubMed, Cochrane, Lilacs, Enfispo, Cuiden, Scielo, etc. The following combined terms were used: "hipoxia- isquemia encefálica" (hypoxic-ischemic encephalopathy), "hipotermia inducida" (induced hypothermia), "recién nacido" (newborn) and "atención de Enfermería" (Nursing care). The search was limited to scientific articles on Neonatology and Paediatrics published between 2006 and 2017, in Spanish and English. Results: twenty-nine (29) studies were identified regarding hypothermia treatment for newborns with hypoxic-ischemic encephalopathy (HIE) as well as Nursing care. Different studies have demonstrated that applying hypothermia before the first 6 hours of life, and maintaining it for 72 hours, will reduce mortality and brain damage. There is some controversy regarding its application in severe or moderate hypoxic-ischemic encephalopathy, but favourable results are obtained in both. No therapy will improve the efficacy of hypothermia when used in combination. The success of this treatment requires the effort of a multidisciplinary team. Nurses as professionals will play an essential role in its application, with must also include care for parents during the entire process. Conclusions: the evidence available supports that induced hypothermia will reduce mortality and neurological consequences in newborns. Further follow-up over the years should be conducted in these newborns. Other strategies are required, to be used in combination with induced hypothermia, for a reduction in the impact of hypoxic-ischemic encephalopathy

Therapeutic Hypothermia in the ICU: The Nursing Aspect.

Clinical studies and experimental research have described therapeutic hypothermia for patients suffering from traumatic brain injury (TBI), cardiac arrest, and neonatal hypoxic ischemic encephalopathy. This procedure is implemented by intensive care unit (ICU)-trained nurses. The aim of the present study was to compare cold compresses/ ice packs, cooling blankets, and heat-exchange systems via intravascular catheters used in the ICU for therapeutic hypothermia from a nursing perspective with respect to ease of application, additional workload, ease of temperature monitoring, and effectiveness. A questionnaire was completed by ICU nurses to evaluate these techniques for therapeutic hypothermia. The results were calculated and a score of 1 to 5 was obtained, where 1 = very bad, 2 = bad, 3 = moderate, 4 = good, and 5 = very good. Overall, heat exchange via intravascular catheters had the best score for implementation of therapeutic hypothermia. Regarding ease of the application, cold compresses/ice packs had the best score. Regarding additional workload, cold compresses/ice packs had the worst score, whereas the heat-exchange system via intravascular catheters scored the best. Regarding ease of temperature monitoring, the heat-exchange system via intravascular catheters had the best score and, regarding effectiveness, cold compresses/ice packs scored the best.

Induced Hypothermia in Neurocritical Care: A Review.

Induced hypothermia (IH) continues to become a more prevalent treatment modality in neurocritical care. Reducing core temperature has been shown to protect brain tissue during injury and disease. IH has been particularly beneficial in the medical management of refractory intracranial hypertension and malignant cerebral edema. These pathologies are often the result of diffuse cerebral edema after traumatic brain injury, malignant ischemic stroke, or intracerebral hemorrhage. Although there are many benefits to IH, it is not without complications. Chief among these is shivering, which decreases oxygen delivery to brain tissue, increases metabolic demands, and consequently reduces nutrient delivery. This article will review indications for IH administration, methods of providing IH, nursing responsibilities, and identifying and/or managing complications.

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.

Nurses' Attitudes Toward Clinical Research: Experience of the Therapeutic Hypothermia After Pediatric Cardiac Arrest Trials.

OBJECTIVES: To understand factors affecting nurses' attitudes toward the Therapeutic Hypothermia After Pediatric Cardiac Arrest trials and association with approach/consent rates. DESIGN: Cross-sectional survey of pediatric/cardiac intensive care nurses' perceptions of the trials. SETTING: Study was conducted at 16 of 38 self-selected study sites. SUBJECTS: Pediatric and cardiac intensive care nurses. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the proportion of nurses with positive perceptions, as defined by agree or strongly agree with the statement "I am happy to take care of a Therapeutic Hypothermia after Pediatric Cardiac Arrest patient". Associations between perceptions and study approach/consent rates were also explored. Of 2,241 nurses invited, 1,387 (62%) completed the survey and 77% reported positive perceptions of the trials. Nurses, who felt positively about the scientific question, the study team, and training received, were more likely to have positive perceptions of the trials (p < 0.001). Nurses who had previously cared for a research patient had significantly more positive perceptions of Therapeutic Hypothermia After Pediatric Cardiac Arrest compared with those who had not (79% vs 54%; p < 0.001). Of the 754 nurses who cared for a Therapeutic Hypothermia After Pediatric Cardiac Arrest patient, 82% had positive perceptions, despite 86% reporting it required more work. Sixty-nine percent believed that hypothermia reduces brain injury and mortality; sites had lower consent rates when their nurses believed that hypothermia was beneficial. Institution-specific approach rates were positively correlated with nurses' perceptions of institutional support for the trial (r = 0.54; p = 0.04), ICU support (r = 0.61; p = 0.02), and the importance of conducting the trial in children (r = 0.61; p = 0.01). CONCLUSIONS: The majority of nurses had positive perceptions of the Therapeutic Hypothermia After Pediatric Cardiac Arrest trials. Institutional, colleague, and study team support and training were contributing factors. Despite increased work, nurses remained enthusiastic demonstrating that studies with intensive bedside nursing procedures are feasible. Institutions whose nurses believed hypothermia was beneficial had lower consent rates, suggesting that educating nurses on study rationale and equipoise may enhance study participation.

Caring for Patients Treated With Therapeutic Hypothermia.

Numerous studies have indicated that therapeutic hypothermia can improve neurological outcomes after cardiac arrest. This treatment has redefined care after resuscitation and offers an aggressive intervention that may mitigate postresuscitation syndrome. Caregivers at Lehigh Valley Health Network, Allentown, Pennsylvania, an academic, community Magnet hospital, treated more than 200 patients with therapeutic hypothermia during an 8-year period. An interprofessional team within the hospital developed, implemented, and refined a clinical practice guideline for therapeutic hypothermia. In their experience, beyond a protocol, 5 critical elements of success (interprofessional stakeholders, coordination of care delivery, education, interprofessional case analysis, and participation in a global database) enhanced translation into clinical practice.

A Systematic Review of the Effects of Body Temperature on Outcome After Adult Traumatic Brain Injury.

OBJECTIVE: This systematic review describes effects of body temperature alterations defined as fever, controlled normothermia, and spontaneous or induced hypothermia on outcome after traumatic brain injury (TBI) in adults. DATA SOURCES: A search was conducted using PubMed, Cochrane Library database, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and ISI Web of Science in July 2013 with no back date restriction except for induced hypothermia (2009). STUDY SELECTION: Of 1366 titles identified, 712 were reviewed. Sixteen articles met inclusion criteria: randomized controlled trials in hypothermia since 2009 (last Cochrane review) or cohort studies of temperature in TBI, measure core and/or brain temperature, neurologic outcome reporting, primarily adult patients, and English language publications. Exclusion criteria were as follows: most patients with non-TBI diagnosis, primarily pediatric patients, case reports, or laboratory/animal studies. DATA SYNTHESIS: Most studies found that fever avoidance resulted in positive outcomes including decreased length of stay in the intensive care unit; mortality; and incidence of hypertension, elevated intracranial pressure, and tachycardia. Hypothermia on admission correlated with poor outcomes. Controlled normothermia improved surrogate outcomes. Prophylactic induced hypothermia is not supported by the available evidence from randomized controlled trial. CONCLUSION: Setting a goal of normothermia, avoiding fever, and aggressively treating fever may be most important after TBI. Further research is needed to characterize the magnitude and duration of temperature alteration after TBI, determine if temperature alteration influences or predicts neurologic outcome, determine if rate of temperature change influences or predicts neurologic outcome, and compare controlled normothermia versus standard practice or hypothermia.

Use of a nursing checklist to facilitate implementation of therapeutic hypothermia after cardiac arrest.

Therapeutic hypothermia has become a widely accepted intervention that is improving neurological outcomes following return of spontaneous circulation after cardiac arrest. This intervention is highly complex but infrequently used, and prompt implementation of the many steps involved, especially achieving the target body temperature, can be difficult. A checklist was introduced to guide nurses in implementing the therapeutic hypothermia protocol during the different phases of the intervention (initiation, maintenance, rewarming, and normothermia) in an intensive care unit. An interprofessional committee began by developing the protocol, a template for an order set, and a shivering algorithm. At first, implementation of the protocol was inconsistent, and a lack of clarity and urgency in managing patients during the different phases of the protocol was apparent. The nursing checklist has provided all of the intensive care nurses with an easy-to-follow reference to facilitate compliance with the required steps in the protocol for therapeutic hypothermia. Observations of practice and feedback from nursing staff in all units confirm the utility of the checklist. Use of the checklist has helped reduce the time from admission to the unit to reaching the target temperature and the time from admission to continuous electroencephalographic monitoring in the cardiac intensive care unit. Evaluation of patients' outcomes as related to compliance with the protocol interventions is ongoing.

Therapeutic hypothermia after cardiac arrest and return of spontaneous circulation: it's complicated.

Providing evidence-based care to patients with return of spontaneous circulation after a cardiac arrest is a recent complex innovation. Once resuscitated patients must be assessed for appropriateness for therapeutic hypothermia, be cooled in a timely manner, maintained while hypothermic, rewarmed within a specified time frame, and then assessed for whether hypothermia was successful for the patient through neuroprognostication. Nurses caring for therapeutic hypothermia patients must be knowledgeable and prepared to provide care to the patient and family. This article provides an overview of the complexity of therapeutic hypothermia for patients with return of spontaneous circulation in the form of a case study.

Valoración de la carga de trabajo de Enfermería en pacientes sometidos a hipotermia terapéutica / Evaluation of nurse workload in patients undergoing therapeutic hypothermia

OBJETIVO: La hipotermia terapéutica (HT) se recomienda para minimizar el daño neurológico de pacientes que sobreviven a una parada cardiorrespiratoria (PCR). Existen pocos datos que evalúen la carga de trabajo de Enfermería en estos pacientes. El objetivo del estudio es evaluar la carga de trabajo del personal de Enfermería en pacientes sometidos a HT tras una PCR. MÉTODO: Se diseñó un estudio prospectivo-retrospectivo comparativo de cohortes durante 43 meses donde se incluyeron todos los pacientes ingresados en unidades de cuidados intensivos con PCR recuperada. Se compararon características basales, manejo médico, mortalidad intrahospitalaria, y carga de trabajo de Enfermería en las primeras 96 horas mediante las escalas validadas Therapeutic Intervention Scoring System-28 (TISS-28); Nursing Activities Score (NAS); y Nine Equivalents of Nursing Manpower Use Score (NEMS) entre aquellos pacientes tratados y no tratados mediante HT. RESULTADOS: Se incluyeron 46 pacientes: 26 en el grupo HT y 20 en el grupo no HT. El grupo HT presentó mayor prevalencia de tabaquismo (69 vs. 25%, p = 0,012), PCR extrahospitalaria (96 vs. 55%, p < 0,001) y realización de coronariografías (96 vs. 65%, p = 0,014). No hubo diferencias en la carga de trabajo evaluada por las escalas TISS 28, NAS o NEMS ni tampoco en el pronóstico intrahospitalario. CONCLUSIONES: En este estudio la realización de HT en pacientes que sobreviven a una PCR no se asocia con un aumento de la carga de trabajo de Enfermería. La instauración de programas de HT no requeriría la implementación de más recursos en Enfermería en términos de carga de trabajo

OBJECTIVE: Therapeutic hypothermia (TH) is recommended to minimize neurological damage in patients surviving sudden cardiac arrest (SCA). There is scarcity of data evaluating the nursing workload in these patients. The objective of the study is to assess the workload of nurses whilst treating patients undergoing TH after SCA. METHOD: A 43-month prospective-retrospective comparative cohort study was designed. Patients admitted to intensive care unit, for recovered SCA and persistent coma, were included. A comparison was made using the baseline characteristics, medical management, in-hospital mortality, and nursing workload during the first 96 hours using the Therapeutic Intervention Scoring System-28 (TISS-28); Nursing Activities Score (NAS); and Nine Equivalents of Nursing Manpower Use Score (NEMS) scales among patients who received TH and those who did not. RESULTS: A total 46 patients were included: 26 in the TH group and 20 in the Non-TH group. Regarding baseline characteristics and management, the TH group presented higher prevalence of smoking habit (69 vs. 25%, p = 0 .012), out-of-hospital SCA (96 vs. 55%, p < 0 .001), and the performance of coronary angiography (96 vs. 65%, p = 0 .014) compared with the non-TH group. No differences were observed in the nursing workload, assessed by TISS 28, NAS or NEMS scales, or in-hospital mortality. CONCLUSIONS: In this study performance of TH in SCA survivors is not associated with an increase in nursing workload. The installation of a TH program does not require the use of more nursing resources in terms of workload

Hipotermia inducida posparada cardiorrespiratoria / Induced hypothermia aftere cardiac arrest

Introducción. La muerte súbita cardiaca en el adulto es uno de los retos de la medicina cardiovascular. La parada cardiorrespiratoria (PCR) frecuentemente asocia daños neurológicos derivados de la hipoxia cerebral, y desencadena una serie de alteraciones celulo-tisulares que conducen a la lesión cerebral. La hipotermia terapéutica disminuye las demandas de oxígeno y actúa como protector. Objetivos. Describir la casuística de la hipotermia inducida (HI) pos PCR del Hospital Universitari de Bellvitge (HUB) desde 2009 hasta 2012. Elaborar una hoja de seguimiento del proceso de la hipotermia inducida. Reflejar la experiencia profesional de la HI pos PCR a través del seguimiento de un caso. Metodología. Estudio descriptivo retrospectivo de 54 casos, 45 hombres y 9 mujeres, con una edad media de 57 años (intervalo de 15 a 80) sometidos a HI pos PCR del HUB. Análisis de variables sociodemográficas, variables específicas y descripción de los criterios de inclusión de la HI. Diseño de registro de enfermería para plasmar los cuidados estandarizados que llevar a cabo durante el proceso de la HI y prueba piloto. Seguimiento de un paciente de 60 años que sufre PCR y a quien se somete a HI. Resultados. Principal causa de PCR: síndrome coronario agudo (SCA) (63 %). Ritmo inicial más representativo, taquicardia ventricular sin pulso/fibrilación ventricular (TVSP/FV) (68.5 %). Se objetiva mayor supervivencia en pacientes cuyas maniobras de RCP son inferiores a 30 minutos. La temperatura objetivo de los pacientes ha sido de 33 ºC durante 24 horas, a excepción de 5 casos, que se detuvieron por inestabilidad hemodinámica. Al alta hospitalaria 54 % son éxitus, 4 % presenta encefalopatía severa, 11 % encefalopatía leve y 31 % sin secuelas neurológicas. Se comprueba la aplicabilidad del registro de enfermería creado para el proceso de la HI, que permitió una visión global y rápida del procedimiento. Se describe la situación clínica del caso al ingreso, durante la HI, a las 48 horas, al alta de la Unidad Coronaria (UCC) y al alta hospitalaria. Discusión. Los datos recogidos en el centro de 2009 a 2012 de los pacientes con PCR candidatos a HI presentaron una favorable recuperación neurológica de los pacientes supervivientes. Asimismo, tienen mejor pronóstico los pacientes con PCR no prolongado, lo que coincide con estudios anteriores. Conclusiones. La HI es una terapia viable en el caso de pacientes que han sufrido PCR. Es importante realizar una valoración específica de cada uno de estos pacientes para posteriormente poder realizar la evaluación de los mismos (AU)

Introduction. Sudden cardiac death in adults remains a challenge in cardiovascular medicine. Cardiac arrest often drives neurological damage resulting from cerebral hypoxia, causing a series of cellulose tissue alterations that lead to brain injury. Therapeutic hypothermia decreases oxygen demand acting as protection to the brain. Objectives. To describe the casuistry of hypothermia after retourn of spontaneous circulation (ROSC) at Bellvitge University Hospital (BUH) from 2009 to 2012. Develop a tracking sheet of the induced hypothermia process. Reflect professional experience of induced hypothermia after cardiac arrest through a case. Methodology. Retrospective descriptive study of the 54 cases, 45 men and 9 women, aged between ages 57 (15 to 80) years old treated with hypothermia after ROSC at BUH. Analysis of soiodemographic variables, specific variables and description of the inclusion criteria for hypothermia. Design of nursing record to express standardized care to undertake during the HI and its pilot trial. Monitoring a 60 years old patient who suffers cardiopulmonary arrest and is subjected to hypothermia. Results. Leading cause of cardiopulmonary arrest is acute coronary syndrome (ACS) (63%). Most representative initial rhythm is pulseless ventricular tachycardia / ventricular fibrillation (PVT / VF) (68.5%). There is longer survival in patients whose CPR is less than 30 minutes. The target temperature of the patients was 33 °C for 24 hours, except for 5 patients who were stopped because of hemodynamic instability. At discharge, 54 % were exitus, 4 % had severe encephalopathy, 11 % mild encephalopathy and 31 % without neurological sequel. The applicability of the nursing record that was created for the HI process was checked, which allowed a fast overview of the procedure. It describes the clinical status of the case on admission, during the HI, at 48 hours, at discharge from the coronary care unit (CCU) and at discharge. Discussion. The data collected between 2009 and 2012 of patients with cardiopulmonary arrest candidates to hypothermia showed a favorable neurological recovery within the surviving patients. Additionally, patients with cardiopulmonary arrest not prolonged have a better prognosis agreeing with ROSC previous studies. Conclusions. Hypothermia is a viable therapy for patients who have undergone cardiopulmonary arrest. It is important to make a specific assessment of each case as well as agree the track record of care applied to these patients to subsequently allow their assessment (AU)

Study shows ongoing benefits of cooling therapy for neonates.

OXYGEN DEPRIVATION at birth - perinatal asphyxia - is a well-known risk to children's health and development, resulting in permanent neurological damage that can include cerebral palsy and/or learning disability.