Pharmacodynamics in hypothermia

Tveita, Torkjel

doi:10.1186/cc11264

Cited by 5 publications

(3 citation statements)

References 42 publications

(53 reference statements)

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“…In our study, we defined the time point T2 as the moment of reaching the core temperature of 30 °C, as it is considered the potential threshold of cardiovascular stabilization and the point for unaltered catecholamines action. According to the resuscitation guidelines, a core temperature of 30 is the moment of pharmacotherapy initiation, increasing the chances of successful defibrillation and return of spontaneous circulation [ 26 , 27 , 28 ]. These assumptions allowed us to standardize the study population in our study regarding the core temperature and the stage of resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?

Hymczak

Podsiadło

Kosiński

et al. 2021

IJERPH

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Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. Methods: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. Results: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased −2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors’ group (p = 0.024), it increased 1.44 ± 6.41 mmol/L. Conclusions: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?

Hymczak

Podsiadło

Kosiński

et al. 2021

IJERPH

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“…We chose this value as the initial because it is close to the temperature at which cardiac arrest usually occurs in accidental hypothermia 9 . We measured the time of warming the central compartment to 30°C, as it is considered to be the limit of cardiovascular stability and catecholamines effectiveness, therefore, recommended in the resuscitation guidelines as the pharmacotherapy threshold 9‐11 …”

Section: Methodsmentioning

confidence: 99%

“…9 We measured the time of warming the central compartment to 30°C, as it is considered to be the limit of cardiovascular stability and catecholamines effectiveness, therefore, recommended in the resuscitation guidelines as the pharmacotherapy threshold. [9][10][11] (1)…”

Section: Methodsmentioning

confidence: 99%

The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia––An experimental study

et al. 2021

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Severe accidental hypothermia carries high mortality and morbidity and is often treated with invasive extracorporeal methods. Continuous veno‐venous hemodiafiltration (CVVHDF) is widely available in intensive care units. We sought to provide theoretical basis for CVVHDF use in rewarming of hypothermic patients. CVVHDF system was used in the laboratory setting. Heat balance and transferred heat units were evaluated for the system without using blood. We used 5L of crystalloid solution at the temperature of approximately 25°C, placed in a thermally insulated tank (representing the “central compartment” of a hypothermic patient). Time of warming the central compartment from 24.9 to 30.0°C was assessed with different flow combinations: “blood” (central compartment fluid) 50 or 100 or 150 mL/min, dialysate solution 100 or 1500 mL/h, and substitution fluid 0 or 500 mL/h. The total circulation time was 1535 minutes. There were no differences between heat gain values on the filter depending on blood flow (P = .53) or dialysate flow (P = .2). The mean heating time for “blood” flow rates 50, 100, and 150 mL/min was 113.7 minutes (95% CI, 104.9‐122.6 minutes), 83.3 minutes (95% CI, 76.2‐90.3 minutes), and 74.7 minutes (95% CI, 62.6‐86.9 minutes), respectively (P < .01). The respective median rewarming rate for different “blood” flows was 3.6°C/h (IQR, 3.0‐4.2°C/h), 4.8 (IQR, 4.2‐5.4°C/h), and 5.4 (IQR, 4.8‐6.0°C/h), respectively (P < .01). The dialysate flow did not affect the warming rate. Based on our experimental model, CVVHDF may be used for extracorporeal rewarming, with the rewarming rates increasing achieved with higher blood flow rates.

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Steintreppe auf dem Bauernhof

Roessler

2023

Mehr Fallbeispiele Notfallmedizin

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Pharmacodynamics in hypothermia

Cited by 5 publications

References 42 publications

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?

The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia––An experimental study

Steintreppe auf dem Bauernhof

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