Document Detail


Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid.
MedLine Citation:
PMID:  16352954     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Mounting evidence suggests that mild to moderate hypothermia can mitigate neurologic and myocardial injury. The speed of induction appears to be a key factor in determining its efficacy. However, even when the fastest currently available cooling techniques are used, reaching target temperatures takes at least 2 hrs and usually longer. We hypothesized that infusion of refrigerated fluids could be a safe accessory method to increase cooling speed. DESIGN: Prospective intervention study. SETTING: University teaching hospital. PATIENTS: One hundred thirty-four patients with various types of neurologic injury (postanoxic encephalopathy, subarachnoid hemorrhage, or traumatic brain injury). MEASUREMENTS AND MAIN RESULTS: Hypothermia was induced in 134 patients with various types of neurologic injury, by means ice-water cooling blankets and infusion of refrigerated (4 degrees C) saline (110 patients) or saline and colloids (24 patients). An average volume of 2340 +/- 890 mL of refrigerated fluids was infused in 50 mins. Core temperatures decreased from 36.9 +/- 1.9 degrees C to 34.6 +/- 1.5 degrees C at t = 30 mins and to 32.9 +/- 0.9 degrees C at t = 60 mins (target temperature: 32 degrees C-33 degrees C). Monitoring of blood pressure, heart rhythm, central venous pressure, blood gasses, electrolyte and glucose levels, and platelet and white blood cell count revealed no additional adverse effects. Mean arterial pressure increased by 15 mm Hg, with larger increases in blood pressure occurring in hemodynamically unstable patients. No patient developed pulmonary edema. CONCLUSIONS: Induction of hypothermia by means of cold-fluid infusion combined with ice-water cooling blankets is safe, efficacious, and quick. Because the speed of cooling is important to increase its protective effects, we recommend that cold-fluid infusion be used in all patients treated with induced hypothermia. This should be combined with another method to safely and accurately maintain hypothermia once target temperatures have been reached.
Authors:
Kees H Polderman; Emmy R Rijnsburger; Saskia M Peerdeman; Armand R J Girbes
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  33     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-14     Completed Date:  2006-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2744-51     Citation Subset:  AIM; IM    
Affiliation:
Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Blood Pressure / physiology
Body Temperature / physiology
Brain Injuries / physiopathology,  therapy*
Cardiopulmonary Resuscitation
Child
Combined Modality Therapy
Cryotherapy / methods*
Female
Heart Rate / physiology
Humans
Hypothermia, Induced / methods*
Hypoxia, Brain / physiopathology,  therapy*
Intensive Care*
Intracranial Pressure / physiology
Male
Monitoring, Physiologic
Shock, Cardiogenic / physiopathology,  therapy
Sodium Chloride / administration & dosage
Subarachnoid Hemorrhage / physiopathology,  therapy*
Temperature
Treatment Outcome
Chemical
Reg. No./Substance:
7647-14-5/Sodium Chloride
Comments/Corrections
Comment In:
Crit Care Med. 2005 Dec;33(12):2844-5   [PMID:  16352970 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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