Implications of Admission Hypothermia in Trauma Patients

Steinemann, Susan; Shackford, Steven R.; Davis, James W.

doi:10.1097/00005373-199002000-00011

Cited by 173 publications

(57 citation statements)

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“…While hypothermia on admission is common in trauma patients with more severe injuries and poor prognoses (Little and Stoner, 1981;Little, 1985;Steinemann et al, 1990;Jeremitsky et al, 2003), it is currently unclear if hypothermia contributes to poor outcome or is simply correlative (Steinemann et al, 1990). We did not observe significant differences in any physiologic or neurologic outcome measures between the brain-injured animals that were hypothermic for 12 to 24 hours after injury and those that developed PTH.…”

Section: Discussionmentioning

confidence: 51%

Development of Posttraumatic Hyperthermia after Traumatic Brain Injury in Rats is Associated with Increased Periventricular Inflammation

Thompson

Hoover

Tkacs

et al. 2005

J Cereb Blood Flow Metab

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Posttraumatic hyperthermia (PTH) is a noninfectious elevation in body temperature that negatively influences outcome after traumatic brain injury (TBI). We sought to (1) characterize a clinically relevant model and (2) investigate potential cellular mechanisms of PTH. In study I, body temperature patterns were analyzed for 1 week in male rats after severe lateral fluid percussion (FP) brain injury (n ¼ 75) or sham injury (n ¼ 17). After injury, 27% of surviving animals experienced PTH, while 69% experienced acute hypothermia with a slow return to baseline. A profound blunting or loss of circadian rhythmicity (CR) that persisted up to 5 days after injury was experienced by 75% of brain-injured animals. At 2 and 7 days after injury, patterns of cell loss and inflammation were assessed in selected brain thermoregulatory and circadian centers. Significant cell loss was not observed, but PTH was associated with inflammatory changes in the hypothalamic paraventricular nucleus (PVN) by one week after injury. In brain-injured animals with altered CR, reactive astrocytes were bilaterally localized in the suprachiasmatic nucleus (SCN) and the PVN. Occasional IL-1b þ / ED-1 þ macrophages/microglia were observed in the PVN and SCN exclusively in brain-injured animals developing PTH. In animals with PTH there was a significant positive correlation (r ¼ 0.788, Po0.01) between the degree of postinjury hyperthermia and the total number of cells positive for inflammatory markers within selected thermoregulatory and circadian nuclei. In study II, a separate group of animals underwent the same injury and temperature monitoring paradigm as in study I, but had additional physiologic data obtained, including vital signs, arterial blood gases, white blood cell counts, and C-reactive protein levels. All parameters remained within normal ranges after injury. These data suggest that PTH and the alteration in CR of temperature may be due, in part, to acute reactive astrocytosis and inflammation in hypothalamic centers responsible for both thermoregulation and CR.

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Section: Discussionmentioning

confidence: 51%

Development of Posttraumatic Hyperthermia after Traumatic Brain Injury in Rats is Associated with Increased Periventricular Inflammation

Thompson

Hoover

Tkacs

et al. 2005

J Cereb Blood Flow Metab

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“…[1][2][3] In northern climates and during winter, hypothermia is a common concern, but its significance remains controversial. [4][5][6][7][8][9] Shock, hypotension and hypovolemia impair thermoregulation. Critically ill patients are typically disrobed, most receive cold crystalloid infusions and many undergo neuromuscular blockade, which inhibits heat generation.…”

Section: Introductionmentioning

confidence: 99%

Can body temperature be maintained during aeromedical transport?

Sookram

Barker

Kelly

et al. 2002

CJEM

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Background: Aeromedical transport in northern areas may be associated with hypothermia. The objective of this study was to determine whether significant hypothermia (core temperature <35ºC) occurs in severely injured or ill intubated patients during transport by rotary wing aircraft. Methods: In this prospective cohort study, all intubated patients over 16 years of age who were transported by rotary wing aircraft from rural hospitals or trauma scenes in northern Alberta to regional hospitals in Edmonton were eligible for study. Esophageal thermometers were used to measure core temperature at 10-minute intervals during transport. Results: Of 133 potentially eligible patients, 116 were enrolled; 69 (59%) had esophageal thermometers inserted, and 47 (41%) had other temperature measurements. Severe hypothermia occurred in only 1% to 2% of cases, but 28% to 39% of patients met criteria for mild hypothermia prior to transport. Core temperatures did not fall during transport, despite the fact that warming techniques were documented in only 38% of cases. Conclusions: During brief (<225 km) rotary wing aeromedical transport of severely injured or ill patients, significant hypothermia is uncommon and body temperature is generally well maintained with the use of simple passive measures. These findings do not justify recommendations for more aggressive core temperature monitoring during this type of aeromedical transport. RÉSUMÉ Contexte :Le transport aéromédical dans les régions nordiques peut être associé à l'hypothermie. La présente étude avait comme objectif de déterminer si une hypothermie importante (tempéra-ture centrale <35ºC) se manifeste chez des patients intubés gravement blessés ou malades lors du transport par aéronef à voilure tournante. Méthodes : Dans cette étude de cohorte prospective, tous les patients intubés âgés de plus de 16 ans qui avaient été transportés par aéronef à voilure tournante à partir d'hôpitaux ruraux ou de scènes de trauma dans la région du nord de l'Alberta vers des hôpitaux régionaux à Edmonton étaient admissibles à l'étude. On eut recours à des thermomètres oesophagiens pour prendre la température centrale à des intervalles de 10 minutes pendant le transport. Résultats : Parmi 133 patients potentiellement admissibles, 116 furent inclus dans l'étude; on inséra un thermomètre oesophagien chez 69 de ces patients (59 %) et on eut recours à d'autres

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“…Según diversos estudios realizados con vícti-mas traumáticas, la mortalidad de las víctimas hipotérmicas comparada con las normotérmicas, aumenta hasta 50% 12 . Son especialmente propensas aquellas víctimas que presentan quemaduras, traumatismos craneoencefálicos o lesión medular alta con implicación de la cadena simpática.…”

Section: Consecuencias De La Hipotermia En Las Víctimas Traumáticasunclassified

Manejo de la hipotermia accidental severa

Avellanas¹,

Ricart²,

Botella³

et al. 2012

Medicina Intensiva

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Resumen La hipotermia accidental es una patología ambiental con unos principios básicos de clasificación y reanimación que sirven tanto para el medio montañoso, marítimo o urbano. Esta patología ha formado parte, junto a la acidosis y la coagulopatía, de la famosa «tríada letal» de las víctimas traumáticas en situación crítica. En su manejo y asistencia está implicada toda una cadena asistencial que se extiende desde la medicina de urgencia prehospitalaria hasta la medicina intensiva, llegando incluso hasta la cirugía cardiaca y/o a los programas de circulación extracorpórea.Una buena clasificación prehospitalaria del grado de hipotermia facilitará su manejo inicial y evitará traslados interhospitalarios o secundarios innecesarios. Lo fundamental es trasladar, con la mayor urgencia posible, a las víctimas hipotérmicas en asistolia o fibrilación ventricular hasta aquellos hospitales que tengan la capacidad tecnológica adecuada para el tratamiento de estas especiales situaciones clínicas.Este artículo, trata de sentar las bases que faciliten un manejo adecuado de la hipotermia accidental desde la primera asistencia prehospitalaria hasta tratamiento final hospitalario, incluyendo la reanimación y el recalentamiento con circulación extracorpórea. © 2011 Elsevier España, S.L. y SEMICYUC. Todos los derechos reservados. KEYWORDSAccidental hypothermia; Classification of hypothermia; Cardiac arrest; Management of severe accidental hypothermiaAbstract Accidental hypothermia is an environmental condition with basic principles of classification and resuscitation that apply to mountain, sea or urban scenarios. Along with coagulopathy and acidosis, hypothermia belongs to the lethal triad of trauma victims requiring critical care. A customized healthcare chain is involved in its management, extending * Autor para correspondencia. Correo electrónico: mlavellanas@ono.com (M.L. Avellanas). 0210-5691/$ -see front matter

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Implications of Admission Hypothermia in Trauma Patients

Cited by 173 publications

References 0 publications

Development of Posttraumatic Hyperthermia after Traumatic Brain Injury in Rats is Associated with Increased Periventricular Inflammation

Development of Posttraumatic Hyperthermia after Traumatic Brain Injury in Rats is Associated with Increased Periventricular Inflammation

Can body temperature be maintained during aeromedical transport?

Manejo de la hipotermia accidental severa

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