Document Detail


Fever control and application of hypothermia using intravenous cold saline.
MedLine Citation:
PMID:  21037507     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To describe the use and feasibility of cold saline to decrease body temperature in pediatric neurocritical care.
DESIGN: Retrospective chart review.
SETTING: Pediatric tertiary care university hospital.
PATIENTS: Children between 1 wk and 17 yrs of age admitted to the pediatric intensive care unit with acute brain injury and having received intravenous cold saline between June and August 2009.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Eighteen subjects accounted for 20 infusions with mean infusion volume 18 ± 10 mL/kg. Eight subjects had traumatic brain injury, two had intracranial hemorrhage, six had cardiac arrest, and one each had ischemic stroke and status epilepticus. The mean age was 9.5 ± 4.8 yrs. Temperature decreased from 38.7 ± 1.1°C to 37.7 ± 1.2°C and from 37.0 ± 2.0°C to 35.3 ± 1.6°C 1 hr after infusion for fever (n = 14; p < .05) or hypothermia induction (n = 6; p = .05), respectively. Cold saline was not bloused but rather infused over 10-15 mins. Mean arterial blood pressure and oxygenation parameters (PaO2/FIO2 ratio, mean airway pressure) were unchanged, but heart rate decreased in those with hypothermia (121 ± 4 beats per minute vs. 109 ± 12 beats per minute; p < .05). Serum sodium concentration and international normalized ratio were significantly increased after cold saline infusion. There were no differences between preinfusion and postinfusion serum glucose and hematocrit, or between cerebral perfusion pressure and intracranial pressure in traumatic brain injury patients.
CONCLUSIONS: Cold saline was an effective method of reducing temperature in children with acute brain injury. This approach can be considered to treat fever or to induce hypothermia. A prospective study comparing safety and efficacy vs. other cooling measures should be considered.
Authors:
Ericka L Fink; Patrick M Kochanek; Robert S B Clark; Michael J Bell
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  13     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-06     Completed Date:  2012-05-09     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  80-4     Citation Subset:  IM    
Affiliation:
Department of Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. finkel@ccm.upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Brain Injuries / diagnosis,  mortality*,  therapy*
Child
Cohort Studies
Cold Temperature
Critical Care / methods
Critical Illness / mortality,  therapy
Female
Fever / prevention & control,  therapy*
Follow-Up Studies
Hospitals, Pediatric
Hospitals, University
Humans
Hypothermia, Induced / adverse effects,  methods*
Infant
Infant, Newborn
Infusions, Intravenous
Intensive Care Units, Pediatric
Male
Retrospective Studies
Risk Assessment
Sodium Chloride / therapeutic use*
Survival Analysis
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1K23NS065132/NS/NINDS NIH HHS; 5K12HD047349/HD/NICHD NIH HHS; K23 NS065132/NS/NINDS NIH HHS; NS052478/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
7647-14-5/Sodium Chloride
Comments/Corrections

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