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1

Diagnosis and treatment of post-traumatic hypothermia in hospitals – a pilot study

100%

Podsiadło P., Kosiński S., Darocha T., Zerebiec K., Wolak P., Kielczewski S., Plewa S., Głuszek S.

Polish Journal of Surgery

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2019

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vol. 91(2)

25-29

EN

Background: An unintentional drop in core body temperature of trauma victims is associated with increased mortality. Thermoregulation is impaired in these patients, especially when treated with opioids or anesthetics. Careful thermal insulation and active warming are necessary to maintain normothermia. The aim of the study was to assess the equipment and procedures for diagnosing and managing post-traumatic hypothermia in Polish hospitals. Methods: Survey forms regarding equipment and procedures on monitoring of core temperature (Tc) and active warming were distributed to every hospital that admits trauma victims in the Holy Cross Province. Questionnaires were addressed to surgery departments, intensive care units (ICUs), and operating rooms (ORs). Results: 92% of surgery departments did not have equipment to measure core body temperature and 85% did not have equipment to rewarm patients. Every ICU had equipment to measure Tc and 83% had active warming devices. In 50% of ICUs, there were no rewarming protocols based on Tc and the initiation of rewarming was left to the physician’s discretion. In 58% of ORs, Tc was not monitored and in 33% the patients were not actively warmed. Conclusions: The majority of surveyed ICUs and ORs are adequately equipped to identify and treat hypothermia, however the criteria for initiating Tc monitoring and rewarming remain unstandardized. Surgery departments are not prepared to manage post-traumatic hypothermia.

2

Is there a hypothermia in Wilson's storm petrel chicks?

86%

Gębczyński A. K., Gębczyński A. K.

Polish Polar Research

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1995

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vol. 16

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issue 3-4

3

Effects of hypothermia on skeletal ischemia reperfusion injury in rats

72%

Ekinci Ş., Kaldırım Ü., Akyıldız F., Bilgiç S., Koca K., Poyrazoğlu Y., Uysal O. S., Turğut H., Türkkan S., Erşen Ö., Topal T., Ozkan H.

Open Medicine

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2014

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vol. 10

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issue 1

EN

Objective: The aim of this study was to investigate the effect of hypothermia (H) on skeletal ischemia-reperfusion (IR) injury in rats by measuring malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), nitric oxide (NO), and interleukin-1 beta (IL-1β) in muscle, and measureing immunohistochemical- inducible nitric oxide synthase (iNOS) staining of skeletal muscle. Materials and Methods: Eighteen Wistar Albino rats were divided randomly into three groups (sham, IR, hypothermia) (n=6). The sham group had all procedures without the IR period. The lower right extremity of rats in the IR and hypothermia groups was subjected to 2 hours of ischemia and 22 hours of reperfusion by applying a clamp on the common iliac artery and a rubber-band at the level of the lesser trochanter under general anesthesia. Rats in the hypothermia group underwent 4 hours of hypothermia during the first four hours of reperfusion in addition to a 2-hour ischemia and 22-hour reperfusion period. All rats were sacrificed at end of the IR period using a high dose of anesthesia. The tibialis anterior muscles were preserved. Immunohistochemical iNOS staining was performed, and MDA, SOD, GSH-Px, NO, and IL-1β were measured in the muscle. Results: The level of MDA, NO, and IL-1β in muscle was increased in the IR group compared with that in the sham group, but these parameters were decreased in the hypothermia group compared with the IR group. The activities of SOD and GSH-Px in muscle were decreased in the IR group; however, these parameters were increased in the hypothermia group. The score and intensity of iNOS staining of skeletal muscle was dens in IR group, mild in hypothermia group, and weak in sham group. Conclusion: The present study has shown that hypothermia reduced IR injury in the skeletal muscle by decreasing the levels of MDA, NO, and IL-1β, and increasing the activities of SOD and GSH-Px. In addition, hypothermia attenuated the score and intensity of iNOS staining.

4

Hemikraniektomia i hipotermia w leczeniu udaru niedokrwiennego mózgu

72%

Rokicka J., Zychowicz-Sielska M., Głąbiński A.

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2011

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vol. 11

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issue 2

111-114

EN

Stroke constitutes the third cause of deaths and the most frequent cause of disability of patients above 40 years old. The malignant middle cerebral artery infarction is associated with high mortality when standard treatment is applied, so the new methods of treatment are searched. Apart from pharmacological treatment the surgical treatment and hypothermia are recommended lately. Hemicraniectomy is a surgical method of treatment where a part of cranium is removed what decreases the intracranial pressure. The analysis of three European randomised clinical trials suggests that hemicraniectomy performed within 48 hours after stroke significantly reduced mortality and improved functional outcome in patients after a surgical decompression. Hypothermia is a condition in which body temperature drops below 35.0°C. It is suggested that only mild hypothermia can give the neuroprotective effect. It means that the temperature of the body should be hold between 34-32°C. Some clinical trials showed that mild hypothermia used during 72 hours after stroke can reduce mortality up to 44%. In the last decade some randomised clinical trials have shown that hemicraniectomyand mild hypothermia are effective in the malignant middle cerebral artery (MCA) territory infarction and significantly reduce mortality and disability in patients with brain oedema. There is however not enough data so far and more randomised controlled clinical trials are needed to confirm the efficacy of those methods of stroke treatment.

PL

Udar mózgu stanowi trzecią co do częstości, po chorobach serca i nowotworach, przyczynę zgonów oraz najczęstszą przyczynę trwałej niesprawności u osób powyżej 40. roku życia. Złośliwy zespół z zakresu unaczynienia tętnicy środkowej mózgu (MCA) cechuje się bardzo złym rokowaniem, w którym śmiertelność sięga 80% przy standardowym sposobie postępowania leczniczego. Leczenie farmakologiczne nie jest zwykle skuteczne w terapii tego zespołu. Niekiedy zaleca się również inne metody, takie jak leczenie neurochirurgiczne lub stosowanie hipotermii. Hemikraniektomia polega na zdjęciu fragmentu pokrywy czaszki w celu umożliwienia swobodnego powiększania się obrzękniętej tkanki mózgowej i obniżenia ciśnienia wewnątrzczaszkowego. Zbiorcza analiza trzech europejskich randomizowanych badań wieloośrodkowych wykazała, że hemikraniektomia w złośliwym udarze mózgu z rejonu unaczynienia MCA może zwiększyć szansę przeżycia i poprawić stan funkcjonalny pacjentów poddanych temu zabiegowi w ciągu 48 godzin od wystąpienia pierwszych objawów. Pojęciem hipotermii określa się ciepłotę ciała poniżej 35°C. W leczeniu może znaleźć zastosowanie jedynie hipotermia łagodna do umiarkowanej, co oznacza, że ciepłota ciała powinna mieścić się w przedziale 34-32°C. Niektóre badania wskazują, iż hipotermia do 33°C stosowana przez 72 godziny pozwala zmniejszyć śmiertelność chorych do 44%. Stosowanie hemikraniektomii i hipotermii może w znaczący sposób wpływać na zmniejszenie śmiertelności i poprawienie stanu funkcjonalnego pacjentów z ciężkim udarem niedokrwiennym mózgu. Należy jednak mieć świadomość, że dotychczasowe wyniki badań są często niewystarczające i istnieje potrzeba przeprowadzenia dalszych dużych badań klinicznych.

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Diagnosis and treatment of post-traumatic hypothermia in hospitals – a pilot study

Is there a hypothermia in Wilson's storm petrel chicks?

Effects of hypothermia on skeletal ischemia reperfusion injury in rats

Hemikraniektomia i hipotermia w leczeniu udaru niedokrwiennego mózgu