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Prehospital cooling by cold infusion: searching for the optimal infusion regimen.
MedLine Citation:
PMID:  20736186     Owner:  NLM     Status:  In-Data-Review    
Background The cooling efficacy of intravenous administration of cold crystalloids can be enhanced by optimisation of the procedure. This study assessed the temperature stability of different application regimens of cold normal saline (NS) in simulated prehospital conditions. Methods Twelve different application regimens of 4°C cold NS (volumes of 250, 500 and 1000&emsp14;ml applied at infusion rates of 1000, 2000, 4000 and 6000&emsp14;ml/h) were investigated for infusion temperature changes during administration to an artificial detention reservoir in simulated prehospital conditions. Results An increase in infusion temperature was observed in all regimens, with an average of 8.1±3.3°C (p<0.001). This was most intense during application of the residual 20% of the initial volume. The lowest rewarming was exhibited in regimens with 250 and 500&emsp14;ml bags applied at an infusion rate of 6000&emsp14;ml/h and 250&emsp14;ml applied at 4000&emsp14;ml/h. More intense, but clinically acceptable, rewarming presented in regimens with 500 and 1000&emsp14;ml bags administered at 4000&emsp14;ml/h, 1000&emsp14;ml at 6000&emsp14;ml/h and 250&emsp14;ml applied at 2000&emsp14;ml/h. Other regimens were burdened by excessive rewarming. Conclusion Rewarming of cold NS during application in prehospital conditions is a typical occurrence. Considering that the use of 250&emsp14;ml bags means the infusion must be exchanged too frequently during cooling, the use of 500 or 1000&emsp14;ml NS bags applied at an infusion rate of ≥4000&emsp14;ml/h and termination of the infusion when 80% of the infusion volume has been administered is regarded as optimal.
Roman Skulec; Anatolij Truhlár; Pavel Dostál; Jana Seblová; Jirí Knor; Gabriela Dostálová; Stefan Skulec; Vladimír Cerny
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Publication Detail:
Type:  Journal Article     Date:  2010-08-23
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  28     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  695-9     Citation Subset:  IM    
Emergency Medical Service of the Central Bohemian Region, Professor Veseleho 461, Beroun 266 01, Czech Republic;
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