Therapeutic Hypothermia and the Risk of Infection

Geurts, Marjolein; Macleod, Malcolm; Kollmar, Rainer; Kremer, Philip H. C.; Worp, H. Bart van der

doi:10.1097/ccm.0b013e3182a276e8

Cited by 158 publications

(112 citation statements)

References 50 publications

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“…A meta-analysis by Geurts and colleagues demonstrated an increased risk for pneumonia in patients treated with hypothermia (22). This finding was corroborated in our study group: The occurrence of pneumonia was significantly higher in patients receiving TTM (68.5%) compared to non-hypothermic patients (43.1%; P=0.0014) with a relative risk of 1.58 [95% confidence interval (CI), 1.160-1.941].…”

Section: Study Cohortsupporting

confidence: 87%

Therapeutic hypothermia impacts leukocyte kinetics after cardiac arrest

Dufner

André

Stiepak³

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Patients admitted to the hospital after primarily successful cardiopulmonary resuscitation (CPR) are at a very high risk for neurologic deficits and death. Targeted temperature management (TTM) for mild therapeutic hypothermia has been shown to improve survival compared to standard treatment.Acute cardiovascular events, such as myocardial infarction (MI), are a major cause for cardiac arrest (CA) in patients who undergo CPR. Recent findings have demonstrated the importance and impact of the leukocyte response following acute MI.Methods: In this retrospective, single center study we enrolled 169 patients with CA due to non-traumatic causes and primarily successful CPR. A total of 111 subjects (66%) underwent TTM aiming for a target temperature of 32-34 ℃.Results: Analysis of 30 day follow up showed a significantly improved survival of all patients who received TTM compared to patients without hypothermia (P=0.0001). Furthermore TTM was an independent variable of good neurological outcome after 6 months (P=0.0030). Therapeutic hypothermia was found to be beneficial independent of differences in age and sex between both groups. While a higher rate of pneumonia was observed with TTM, this diagnosis had no additional impact on survival or neurological outcome. The beneficial effect on mortality remained significant in patients with the diagnosis of an acute cardiac event (P=0.0145). Next, we evaluated the kinetics of leukocytes in this group over the course of 7 days after CA.At presentation, patients showed a mean level of 16.5±6.7 of leukocytes per microliter. While this level stayed stable in the group of patients without hypothermia, patients who received TTM showed a significant decline of leukocyte levels resulting in significantly lower numbers of leukocytes on days 3 and 5 after CPR. Interestingly, these differences in leukocyte counts remained beyond the time period of TTM while C-reactive protein (CRP) levels were suppressed only during ongoing cooling, but differences between the groups were diminished after TTM was terminated (from day 3 on, P>0.2). Finally, patients who received TTM and showed a leukocyte count of less than 12.7/μL on day 3 had an improved survival (P=0.0214) and neurological outcome (P=0.0049) compared to patients above that level.Conclusions: Our data underline the beneficial effects of TTM and demonstrate an impact of hypothermia on leukocyte counts after CA.

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Section: Study Cohortsupporting

confidence: 87%

Therapeutic hypothermia impacts leukocyte kinetics after cardiac arrest

Dufner

André

Stiepak³

et al. 2016

Cardiovasc. Diagn. Ther.

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“…Pneumonia and sepsis have been found to be increased during hypothermia. (17) Therefore, care must be taken to monitor and treat infections.…”

Section: Infectionsmentioning

confidence: 99%

Therapeutic temperature management (TTM): post-resuscitation care for adult cardiac arrest, with recommendations from the National TTM Workgroup

Leong¹,

Chan²,

Ho³

et al. 2017

smedj

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Therapeutic temperature management (TTM) was strongly recommended by the 2015 International Liaison Committee on Resuscitation as a component of post-resuscitation care. It has been known to be effective in improving the survival rate and neurologic functional outcome of patients after cardiac arrest. In an effort to increase local adoption of TTM as a standard of post-resuscitation care, this paper discusses and makes recommendations on the treatment for local providers.

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“…Randomize kontrollü bir çalışmada, terapötik hipotermi uygulanan hastalarda diğer enfeksiyonların prevalansının değişmediği ancak pnömoni riskinin arttığı gösterilmiştir 113 , başka bir çalışmada ise terapötik hipoterminin lökosit migrasyonunu ve fagositozu inhibe ederek, sonuçları olumsuz etkilemese de, artmış enfeksiyonla ilişkili olduğu saptanmıştır 19 .…”

Section: Enfeksiyonunclassified

İnme ve Terapötik Hipotermi

Kuşçu¹,

Özcengiz²

2016

Arşiv Kaynak Tarama Dergisi

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Stroke is significant cause of morbidity and mortality caused by disruption of blood flow. Neural injury occurs with two stage; while primary neural injury occurs with disruption of blood flow, after days and hours with metabolic processes secondary injury develops in tissues which is non injured in the first stage. Therefore it is important to prevent and treat the secondary injury as much as preventing and treating the primary neural injury. In this article developing pathophysiological changes after stroke, mechanisms of therapeutic hypothermia, application methods, the factors that determine the effectiveness, side effects and complications were reviewed. Key words: Stroke, therapeutic hypothermia, neural injury. ÖZETİnme, beyin kan akımının bozulmasıyla meydana gelen önemli bir morbidite ve mortalite nedenidir. İnmede nöral hasar iki aşamada oluşur; akımın bozulmasıyla primer nöral hasar meydana gelirken, saatler ya da günler sonra gelişen metabolik süreçlerle de ilk aşamada zedelenmeyen dokuda sekonder nöral hasar oluşur. Dolayısıyla primer hasarın önlenmesi ve tedavisi kadar, sekonder nöral hasarın önlenmesi ve tedavisi de önemlidir. Bu derlemede, inme sonrası gelişen patofizyolojik değişiklikler ile terapötik hipoterminin etki mekanizmaları, uygulama yöntemleri, etkinliğini belirleyen faktörler, yan etkileri ve komplikasyonları incelenmiştir. Anahtar kelimeler: İnme, terapötik hipotermi, nöral hasar.

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Therapeutic Hypothermia and the Risk of Infection

Cited by 158 publications

References 50 publications

Therapeutic hypothermia impacts leukocyte kinetics after cardiac arrest

Therapeutic hypothermia impacts leukocyte kinetics after cardiac arrest

Therapeutic temperature management (TTM): post-resuscitation care for adult cardiac arrest, with recommendations from the National TTM Workgroup

İnme ve Terapötik Hipotermi

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