Hypothermia In Patients Research Articles

Proarrhythmic changes in human cardiomyocytes during hypothermia by milrinone and isoprenaline, but not levosimendan: an experimental in vitro study

BackgroundAccidental hypothermia, recognized by core temperature below 35 °C, is a lethal condition with a mortality rate up to 25%. Hypothermia-induced cardiac dysfunction causing increased total peripheral resistance and reduced cardiac output contributes to the high mortality rate in this patient group. Recent studies, in vivo and in vitro, have suggested levosimendan, milrinone and isoprenaline as inotropic treatment strategies in this patient group. However, these drugs may pose increased risk of ventricular arrhythmias during hypothermia. Our aim was therefore to describe the effects of levosimendan, milrinone and isoprenaline on the action potential in human cardiomyocytes during hypothermia.MethodsUsing an experimental in vitro-design, levosimendan, milrinone and isoprenaline were incubated with iCell2 hiPSC-derived cardiomyocytes and cellular action potential waveforms and contraction were recorded from monolayers of cultured cells. Experiments were conducted at temperatures from 37 °C down to 26 °C. One-way repeated measures ANOVA was performed to evaluate differences from baseline recordings and one-way ANOVA was performed to evaluate differences between drugs, untreated control and between drug concentrations at the specific temperatures.ResultsMilrinone and isoprenaline both significantly increases action potential triangulation during hypothermia, and thereby the risk of ventricular arrhythmias. Levosimendan, however, does not increase triangulation and the contractile properties also remain preserved during hypothermia down to 26 °C.ConclusionsLevosimendan remains a promising candidate drug for inotropic treatment of hypothermic patients as it possesses ability to treat hypothermia-induced cardiac dysfunction and no increased risk of ventricular arrhythmias is detected. Milrinone and isoprenaline, on the other hand, appears more dangerous in the hypothermic setting.

Hypothermia is Associated with Improved Neurological Outcomes After Mechanical Thrombectomy

Acute ischemic stroke (AIS) is the second leading cause of death globally. Mechanical thrombectomy (MT) has improved patient prognosis but expedient treatment is still necessary to minimize anoxic injury. Lower intraoperative body temperature decreases cerebral oxygen demand, but the role of hypothermia in treatment of AIS with MT is unclear. We retrospectively reviewed patients undergoing MT for AIS from 2014 to 2020 at our institution. Patient demographics, comorbidities, intraoperative parameters, and outcomes were collected. Maximum body temperature was extracted from minute-by-minute anesthesia readings, and patients with maximal temperature below 36°C were considered hypothermic. Risk factors were assessed by χ2 and multivariate ordinal regression. Of 68 patients, 27 (40%) were hypothermic. There was no significant association of hypothermia with patient age, comorbidities, time since last known well, number of passes intraoperatively, favorable revascularization, tissue plasminogen activator use, and immediate postoperative complications. Hypothermic patients exhibited better neurologic outcome at 3-month follow-up (P= 0.02). On multivariate ordinal regression, lower maximum intraoperative body temperature was associated with improved 3-month outcomes (P < 0.001), when adjusting for other factors influencing neurological outcomes. Other significant protective factors included younger age (P= 0.03), better revascularization (P= 0.03), and conscious sedation (P= 0.02). Lower intraoperative body temperature during MT was independently associated with improved neurological outcome in this single center retrospective series. These results may help guide clinicians in employing therapeutic hypothermia during MT to improve long-term neurologic outcomes from AIS, although larger studies are needed.

Hypothermic cardiac arrest patients admitted to hospital who were not rewarmed with extracorporeal life support: A retrospective study

AimsOur goal was to study hypothermic cardiac arrest (CA) patients who were not rewarmed by Extracorporeal Life Support (ECLS) but were admitted to a hospital equipped for it. The focus was on whether the decisions of non-rewarming, meaning termination of resuscitation, were compliant with international guidelines based on serum potassium at hospital admission. MethodsWe retrospectively included all hypothermic CA who were not rewarmed, from three Swiss centers between 1st January 2000 and 2nd May 2021. Data were extracted from medical charts and assembled into two groups for analysis according to serum potassium. We identified the criteria used to terminate resuscitation. We also retrospectively calculated the HOPE score, a multivariable tool predicting the survival probability in hypothermic CA undergoing ECLS rewarming. ResultsThirty-eight victims were included in the study. The decision of non-rewarming was compliant with international guidelines for 12 (33%) patients. Among the 36 patients for whom the serum potassium was measured at hospital admission, 24 (67%) had a value that – alone – would have indicated ECLS. For 13 of these 24 (54%) patients, the HOPE score was <10%, meaning that ECLS was not indicated. The HOPE estimation of the survival probabilities, when used with a 10% threshold, supported 23 (68%) of the non-rewarming decisions made by the clinicians. ConclusionsThis study showed a low adherence to international guidelines for hypothermic CA patients. In contrast, most of these non-rewarming decisions made by clinicians would have been compliant with current guidelines based on the HOPE score.

The Beginning of an ECLS Center: First Successful ECPR in an Emergency Department in Romania-Case-Based Review.

According to the latest international resuscitation guidelines, extracorporeal cardiopulmonary resuscitation (ECPR) involves the utilization of extracorporeal membrane oxygenation (ECMO) in specific patients experiencing cardiac arrest, and it can be considered in situations where standard cardiopulmonary resuscitation efforts fail if they have a potentially reversible underlying cause, among which we can also find hypothermia. In cases of cardiac arrest, both witnessed and unwitnessed, hypothermic patients have higher chances of survival and favorable neurological outcomes compared to normothermic patients. ECPR is a multifaceted procedure that requires a proficient team, specialized equipment, and comprehensive multidisciplinary support within a healthcare system. However, it also carries the risk of severe, life-threatening complications. With the increasing use of ECPR in recent years and the growing number of centers implementing this technique outside the intensive care units, significant uncertainties persist in both prehospital and emergency department (ED) settings. Proper organization is crucial for an ECPR program in emergency settings, especially given the challenges and complexities of these treatments, which were previously not commonly used in ED. Therefore, within a narrative review, we have incorporated the initial case of ECPR in an ED in Romania, featuring a successful resuscitation in the context of severe hypothermia (20 °C) and a favorable neurological outcome (CPC score of 1).

Accuracy of non-invasive sensors measuring core body temperature in cardiac surgery ICU patients – results from a monocentric prospective observational study

PurposeTemperature monitoring in the perioperative setting often represents a compromise between accuracy, invasiveness of probe placement, and patient comfort. Transcutaneous sensors using the Zero-Heat-Flux (ZHF) and Double-Sensor (DS) technology have been developed and evaluated in a variety of clinical settings. The present study is the first to compare the performance of both sensors simultaneously with temperature measured by a Swan-Ganz catheter (PAC) in patients admitted to the intensive care unit (ICU) after cardiac surgery.MethodsIn this monocentric prospective observational study patients were postoperatively transferred to the ICU and both sensors were placed on the patients’ foreheads. Core body temperature measured by intraoperatively placed PAC served as gold standard. Measurements were recorded at 5-minute intervals and up to 40 data sets per patient were recorded. Bland and Altman’s method for repeated measurements was used to analyse agreement. Subgroup analyses for gender, body-mass-index, core temperature, airway status and different time intervals were performed. Lin’s concordance correlation coefficient (LCCC) was calculated, as well as sensitivity and specificity for detecting hyperthermia (≥ 38 °C) and hypothermia (< 36 °C).ResultsOver a period of six month, we collected 1600 sets of DS, ZHF, and PAC measurements, from a total of 40 patients. Bland-Altman analysis revealed a mean bias of -0.82 ± 1.27 °C (average ± 95% Limits-of-Agreement (LoA)) and − 0.54 ± 1.14 °C for DS and ZHF, respectively. The LCCC was 0.5 (DS) and 0.63 (ZHF). Mean bias was significantly higher in hyperthermic and hypothermic patients. Sensitivity and specificity were 0.12 / 0.99 (DS) and 0.35 / 1.0 (ZHF) for hyperthermia and 0.95 / 0.72 (DS) and 1.0 / 0.85 (ZHF) for hypothermia.ConclusionCore temperature was generally underestimated by the non-invasive approaches. In our study, ZHF outperformed DS. In terms of agreement, results for both sensors were outside the range that is considered clinically acceptable. Nevertheless, both sensors might be adequate to detect postoperative hypothermia reliably when more invasive methods are not available or appropriate.Trial RegistrationGerman Register of Clinical Trials (DRKS-ID: DRKS00027003), retrospectively registered 10/28/2021.

Critically buried avalanche victims can develop severe hypothermia in less than 60 min

BackgroundA major challenge in the management of avalanche victims in cardiac arrest is differentiating hypothermic from non-hypothermic cardiac arrest, as management and prognosis differ. Duration of burial with a cutoff of 60 min is currently recommended by the resuscitation guidelines as a parameter to aid in this differentiation However, the fastest cooling rate under the snow reported so far is 9.4 °C per hour, suggesting that it would take 45 min to cool below 30 °C, which is the temperature threshold below which a hypothermic cardiac arrest can occur.Case presentationWe describe a case with a cooling rate of 14 °C per hour, assessed on site with an oesophageal temperature probe. This is by far the most rapid cooling rate after critical avalanche burial reported in the literature and further challenges the recommended 60 min threshold for triage decisions. The patient was transported under continuous mechanical CPR to an ECLS facility and rewarmed with VA-ECMO, although his HOPE score was 3% only. After three days he developed brain death and became an organ donor.ConclusionsWith this case we would like to underline three important aspects: first, whenever possible, core body temperature should be used instead of burial duration to make triage decisions. Second, the HOPE score, which is not well validated for avalanche victims, had a good discriminatory ability in our case. Third, although extracorporeal rewarming was futile for the patient, he donated his organs. Thus, even if the probability of survival of a hypothermic avalanche patient is low based on the HOPE score, ECLS should not be withheld by default and the possibility of organ donation should be considered.

552 Predictions Under Pressure: The Value of Intra-abdominal Hypertension in Forecasting Associated Complications During Fluid Resuscitation

Abstract Introduction The link between burn fluid resuscitation and intra-abdominal hypertension (IAH) is long-standing. Clinicians refer to measures of intra-abdominal pressure (IAP) to guide care of patients requiring resuscitation. In the non-burned critically ill patients mean IAP is 5-7 mmHg, yet more than half of patients with large burns have IAH with a pressure &amp;gt; 12mmHg. The purpose of this study was to determine the predictive value of IAH during resuscitation and to elucidate the prevalence of associated complications. Methods This was a retrospective chart review of patients requiring fluid resuscitation over a five-year period. Patient stratification was based upon IAP, &amp;lt; 12 mmHg (NIAH) vs &amp;gt; 12 mmHg (IAH). Basic descriptive statistics were calculated. Results Charts were reviewed for 138 patients with a total body surface area (TBSA) &amp;gt;20%. There were no significant differences for age, ethnicity, race, gender, nor mechanism of injury. Mean TBSA was greater for those with IAH 44.7% vs NIAH 29.6% (p &amp;lt; 0.0001). Diagnosis of inhalation injury was greater with IAH 37% vs NIAH 10% (p = 0.0009). Admission weight was greater in IAH 90.59 kg vs NIAH 80.34 kg (p=0.0169). Patients who arrive at our burn center sooner (IAH 105, NIAH 160 minutes; p = 0.033), were less likely to receive pre-hospital fluids (IAH 68%, NIAH 84%; p = 0.03850), and time from injury to the start of in-hospital resuscitation was lower (IAH 177 min, NIAH 245 min p = 0.02840). The average resuscitation duration was greater for IAH than for NIAH (34.4 h vs 28.04 h; p = 0.0008), as was total volume given (p &amp;lt; 0.0001), but resuscitation volume per kg/TBSA/hour was not statistically different (IAH 6.72 mL, NIAH 6.15 mL; p = 0.321). Mean urine output per hour between the groups was not significant (p 0.7699). Patients with IAH had more hours in the optimal range for urine output (6.6 h) than NIAH (4.95), (p = 0.041). No significant difference was revealed between the groups for eventual diagnosis of abdominal compartment syndrome (p = 0.06); compartment syndrome (p = 0.8346, ARDS (p = 0.242); laparotomy (p = 0.222), open abdomen (p = 0.060). Administration of vasopressors between the groups was insignificant (IAH 15%, NIAH 7%; p = 0.186), as was the use of CRRT (p = 0.787). Temperatures for hypothermic patients with IAH were significantly lower (34.5 c) than NIAH (35.1 c), (p = 0.0186) and patients with IAH were more likely to have an escharotomy than those in the NIAH group (IAH 43%, NIAH 16%; p = 0.0014). Conclusions Most associated complications of fluid resuscitation were not more likely to occur with IAH as compared to NIAH. However, patients with IAH were more likely to warrant an escharotomy involving an extremity and had a lower temperature when hypothermic than the NIAH group. Applicability of Research to Practice Further research is needed to evaluate the relationship between measures of IAP and associated complications.

Microcirculatory effects of rewarming in experimental hemorrhagic shock.

Rewarming is a recommended therapy during the resuscitation of hypothermic patients with hemorrhagic shock. In experimental models, however, it increases inflammatory response and mortality. Although microcirculation is potential target of inflammation, the microvascular effects of rewarming during the resuscitation of hemorrhagic shock have not been studied. Our goal was to assess the systemic and microcirculatory effects of an increase in core temperature (T°) during the retransfusion of hemorrhagic shock in sheep. Our hypothesis was that rewarming could hamper microcirculation. In anesthetized and mechanically ventilated sheep, we measured systemic, intestinal, and renal hemodynamics and oxygen transport. O2 consumption (VO2) and respiratory quotient were measured by indirect calorimetry. Cortical renal, intestinal villi and sublingual microcirculation were assessed by IDF-videomicroscopy. After basal measurements, hemorrhagic shock was induced and T° was reduced to ~33°C. After 1h of shock and hypothermia, blood was retransfused and Ringer lactate solution was administered to prevent arterial hypotension. In the control group (n=12), T° was not modified, while in the intervention (rewarming) group, it was elevated ~3°C. Measurements were repeated after 1h. During shock, both groups showed similar systemic and microvascular derangements. After retransfusion, VO2 remained decreased compared to baseline in both groups, but was lower in the control compared to the rewarming group. Perfused vascular density has a similar behavior in both groups. Compared to baseline, it remained reduced in peritubular (control vs. rewarming group, 13.8 [8.7-17.5] vs. 15.7 [10.1-17.9] mm/mm2, PNS) and villi capillaries (14.7 [13.6-16.8] vs. 16.3 [14.2-16.9] mm/mm2, PNS), and normalized in sublingual mucosa (19.1 [16.0-20.3] vs. 16.6 [14.7-17.2] mm/mm2, PNS). This is the first experimental study assessing the effect of rewarming on systemic, regional, and microcirculatory perfusion in hypothermic hemorrhagic shock. We found that a 3°C increase in T° neither improved nor impaired the microvascular alterations that persisted after retransfusion. In addition, sublingual mucosa was less susceptible to reperfusion injury than villi and renal microcirculation.

Hypothermia is an independent risk factor for prolonged ICU stay in coronary artery bypass surgery: an observational study

Maintenance of normothermia is a critical perioperative issue. The warming process after hypothermia tends to increase oxygen demand, which may lead to myocardial ischemia. This study explored whether hypothermia was an independent risk factor for increased morbidity and mortality in patients receiving CABG. We conducted a retrospective observational study of CABG surgeries performed from January 2018 to June 2019. The outcomes of interest were mortality, surgical site infection rate, ventilator dependent time, intensive care unit (ICU) stay, and hospitalization duration. Data from 206 patients were analysed. Hypothermic patients were taller (p = 0.012), had lower left ventricular ejection fraction (p = 0.016), and had off-pump CABG more frequently (p = 0.04). Our analysis noted no incidence of mortality within 30 days. Hypothermia was not associated with higher surgical site infection rate or longer intubation time. After adjusting for sex, age, cardiopulmonary bypass duration, left ventricular ejection fraction, and EuroSCORE II, higher EuroSCORE II (p < 0.001; odds ratio 1.2) and hypothermia upon ICU admission (p = 0.04; odds ratio 3.8) were independent risk factors for prolonged ICU stay. In addition to EuroSCORE II, hypothermia upon ICU admission was an independent risk factor for prolonged ICU stay in patients receiving elective CABG.

A Commentary on the Effect of Targeted Temperature Management in Patients Resuscitated from Cardiac Arrest.

The members of the International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force have written a comprehensive summary of trials of the effectiveness of induced hypothermia (IH) or targeted temperature management (TTM) in comatose patients after cardiac arrest (CA). However, in-depth analysis of these studies is incomplete, especially since there was no significant difference in primary outcome between hypothermia versus normothermia in the recently reported TTM2 trial. We critically appraise trials of IH/TTM versus normothermia to characterize reasons for the lack of treatment effect, based on a previously published framework for what to consider when the primary outcome fails. We found a strong biologic rationale and external clinical evidence that IH treatment is beneficial. Recent TTM trials mainly included unselected patients with a high rate of bystander cardiopulmonary resuscitation. The treatment was not applied as intended, which led to a large delay in achievement of target temperature. While receiving intensive care, sedative drugs were likely used that might have led to increased neurologic damage as were antiplatelet drugs that could be associated with increased acute stent thrombosis in hypothermic patients. It is reasonable to still use or evaluate IH treatment in patients who are comatose after CA as there are multiple plausible reasons why IH compared to normothermia did not significantly improve neurologic outcome in the TTM trials.

Abstract 275: The First Series Of Hypothermic Out-of-hospital Cardiac Arrests In A Temperate Urban Area Resuscitated With Prehospital Or Inhospital Extracorporeal Cardiopulmonary Resuscitation: A Fifteen-year Observationnal Study

Introduction: Accidental hypothermia designates an unpredicted drop in body temperature below 35°C. The risk of ventricular fibrillation is major below 28°C and cardiac arrest is almost certain below 24°C. In such cases, conventional cardiopulmonary resuscitation is often inefficient. Hypothesis: Hypothermic out-of-hospital cardiac arrest (OHCA) occurs even in temperate urban areas and extracorporeal cardiopulmonary resuscitation (ECPR) has shown good outcomes with this indication. Methods: We conducted a retrospective observational study of patients admitted to a university hospital in Paris, France. We reviewed patients consecutively admitted between January 1, 2008 and April 31, 2022 and treated with prehospital or inhospital ECPR following refractory hypothermic OHCA. The primary outcome was survival at 28 days with good neurological outcomes, defined as Cerebral Performance Category (CPC) 1 or 2. We compared patients according to their cold air or cold water exposure. Results: A total of 38 patients were analysed. Patient characteristics and outcomes are detailed in Table 1. A total of 15 patients (40%) survived at 28 days, 13 (34%) of whom with good neurological outcomes despite a median low-flow of 85 min. No patient survived with good neurological outcomes in the cold-water group. Conclusion: Survival rates with favourable neurological outcomes at 28 days stood at 34% of all patients with hypothermic OHCA who were resuscitated with ECPR. Prehospital ECPR tended to show better survival results (39% vs 30%) but further data are needed to confirm this as the difference was not statistically significant. We found no survivors in the cold-water group raising the question of ECPR indication for these patients in temperate urban areas. In any case, temperature measurement should be systematic in OHCA and there should be predefined care pathways including ECPR for hypothermic OHCA patients even in urban settings with a temperate climate.

Accidental hypothermia: pathophysiology, investigations and management.

Accidental hypothermia, defined as an unintentional decrease in core body temperature to below 35°C, adversely affects several body systems, including the cardiovascular, central nervous and renal systems. It is classified according to core body temperature from a maximum of 35°C in mild hypothermia to below 24°C in profound hypothermia. Patients with severe hypothermia (28°C-24°C) are at risk of cardiac arrythmias and cardiac arrest. In patients presenting with hypothermia, it is vital to prevent any further heat loss and quickly start rewarming them. Nurses working in the emergency department have a crucial role in supporting the optimal recovery of hypothermic patients. This article explains the pathophysiology of hypothermia, describes the investigations conducted in patients with accidental hypothermia and discusses management and nursing care.

The Value of Myocardium and Kidney Histopathological and Immunohistochemical Findings in Accidental Hypothermia-Related Fatalities.

Background and Objectives: The post-mortem diagnosis of hypothermia is challenging in forensics. The aim of our study was to detect the kidney and heart histopathological changes that occurred in a group of hypothermia-related fatalities. Materials and Methods: The cohort included 107 cases identified in the database of our department between 2007 and 2021, which have been associated with extreme cold stress. Demographic and clinicopathological data were collected from the medico-legal reports. Archived tissue samples were evaluated to identify the histopathological features, in routine haematoxylin-eosin (H&E), Periodic acid-Schiff (PAS), and Masson's trichrome stainings, while cardiac sirtuin1 (SIRT1) and renal ubiquitin (Ub) immunostaining have been performed. Results: The majority of cases exposed to low temperatures were males (76%) from rural regions (68.2%) during the cold season. Paradoxical undressing was documented in 9.3% of cases. The common comorbidities included alcoholism (50.5%), neuropsychiatric diseases (10.3%), diabetes mellitus (3.7%), and lung tuberculosis (4.7%). The microscopic heart exam revealed areas of myocardial degeneration (100%), contraction bands (95.3%), fatty change (13.1%) and focal wavy contractile myocardial cells. Basal vacuolisation of renal tubular epithelial cells (Armanni-Ebstein lesions) (21.5%), focal tubular necrosis (7.5%), tubular renal cysts (7.5%), interstitial haemorrhages (5.6%), diabetic kidney disease (3.7%), background benign nephroangiosclerosis (42.1%), variable thickening of tubules and corpuscles basement membranes, capsular space amorphous material, and intratubular casts were identified in kidney tissue samples. Myocardial cells displayed SIRT1 weak expression, with a loss of immunopositivity correlated with areas with contraction bands, while a variable Ub expression was observed in renal corpuscles capsules, proximal, distal, and collecting renal tubules, Henle's loops, urothelium, and intratubular casts. Conclusions: In the context of the current concept that death associated with hypothermia is still a diagnosis of exclusion, our findings suggest that the microscopic exam provides relevant data that support the diagnosis of hypothermia-related fatalities in appropriate circumstances of death. A deeper insight into the histopathologic findings in hypothermic patients may lead to new therapeutic approaches in these cases.

Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department.

Severe hypothermia (core body temperature < 28°C) is life-threatening and predisposes to cardiac arrest. The comparative effectiveness of different active internal rewarming methods in an urban U.S. population is unknown. We aim to compare outcomes between hypothermic emergency department (ED) patients rewarmed conventionally using an intravascular rewarming catheter or warm fluid lavage versus those rewarmed using extracorporeal membrane oxygenation (ECMO). We performed a retrospective cohort analysis of adults with severe hypothermia due to outdoor exposure presenting to an urban ED in Minnesota, 2007-2021. The primary outcome was hospital survival. We also calculated the rewarming rate in the 4 h after ED arrival and compared these data between patients rewarmed with ECMO (the extracorporeal rewarming group) versus without ECMO (the conventional rewarming group). We repeated these analyses in the subgroup of patients with cardiac arrest. We analyzed 44 hypothermic ED patients: 25 patients in the extracorporeal rewarming group (median temperature 24.1°C, 84% with cardiac arrest) and 19 patients in the conventional rewarming group (median temperature 26.3°C, 37% with cardiac arrest; 89% received an intravascular rewarming catheter). The median rewarming rate was greater in the extracorporeal versus conventional group (2.3°C/h vs. 1.5°C/h, absolute difference 0.8°C/h, 95% confidence interval [CI] 0.3-1.2°C/h) yet hospital survival was similar (68% vs. 74%). Among patients with cardiac arrest, hospital survival was greater in the extracorporeal versus conventional group (71% vs. 29%, absolute difference 42%, 95% CI 4%-82%). Among ED patients with severe hypothermia and cardiac arrest, survival was significantly higher with ECMO versus conventional rewarming. Among all hypothermic patients, ECMO use was associated with faster rewarming than conventional methods.

Hypothermia and cold injuries in children and young people.

Although hypothermia and cold injuries are rare in children and young people in the UK, the risk is persistent and requires urgent medical management when it does occur. This article outlines some considerations for professionals who may be caring for hypothermic patients or those at risk of becoming hypothermic.

EDCB ET AA: A Mnemonic for Resuscitating Hypothermic Patients Under Extreme Conditions

EDCB ET AA: A Mnemonic for Resuscitating Hypothermic Patients Under Extreme Conditions

Adoption of the use of a reflective blanket for passive re-warming of the stable mildly hypothermic patient to reduce unnecessary ICU admissions: A pilot study

Background and objective: In adult inpatients, thermoregulation is important to support vital functions. Occasionally, due to procedures or benign clinical conditions, such as hypoglycemia, autonomic instability, brain injury, paraplegia, autonomic dysreflexia, and septic shock, patients’ body temperature falls below 35°C and thus, requires intervention. Due to the floor nursing constraints of hourly monitoring of forced air re-warming, these active warming techniques often lead to clinically unnecessary admissions to intensive care units and utilization of scarce and costly resources. The purpose of this pilot study was to explore passive re-warming with alternative technologies to avoid unnecessary admissions to the intensive care unit.Methods: A pilot study based on a sample of seventeen patients was conducted to assess the adoption and associated outcome of the use of the reflective blanket. Intervention: Application of a reflective blanket to patients who were mildly hypothermic, yet clinically stable, was explored as an effective mechanism to re-warm these patients in the non-intensive care unit setting. Results: The investigation based on the use of a reflective blanket on a sample of seventeen hypothermic patients had a success rate of 0.7059 (70.59%).Conclusions: We conclude that the use of a reflective blanket is an effective and safe passive rewarming mechanism that leads to avoidance of unnecessary intensive care unit admissions. This leads to both cost reductions to patients and appropriate use of ICU resources.

The effect of hypothermia on the human body

IntroductionHypothermia may appear to be a benign condition, but it is an insidious and life-threatening dysfunction of the thermoregulatory system that occurs in all regions of the world, regardless of season. Hypothermia is caused by cooling when core body temperature decreases below 35°C. The information obtained during a patient interview is also helpful in establishing the causes of hypothermia. The pathophysiology of hypothermia has not been fully elucidated to date. It is rarely diagnosed, in particular in the temperate climate. Hypothermia poses a serious challenge for medical personnel, in particular medical rescue teams who arrive first at the scene.AimThe aim of this study was to present new information concerning hypothermia and the management of this condition.Material and methodsThis article reviews the available literature and statistical data relating to hypothermia, and it discusses various approaches to managing hypothermia, in particular in pre-hospital care.Results and discussionIn homeotherms, significant changes in body temperature affect the functioning of most organs and disrupt homeostasis. According to the European Resuscitation Council, hypothermia is one of the reversible causes of sudden cardiac arrest, which is why hypothermic patients should be adequately managed. Further research is also needed to expand our knowledge about hypothermia.ConclusionsHypothermia is an important cause of death particularly in the elderly, infants, and persons suffering from thermoregulatory disorders or diseases that influence thermogenesis. Therefore, education should be continued in this area and clinical studies should be conducted to deepen our understanding of this problem.

587 Ambient temperatures in the burn operating room: A QI initiative

IntroductionPatients with burn injuries are particularly susceptible to perioperative hypothermia, which is associated with a range of complications, including infection, bleeding and delayed wound healing. Raising the operating room (OR) ambient temperature is an important strategy to prevent hypothermia, but we were uncertain about how strictly we do this. The purpose of this study was to determine the ambient OR temperatures during acute burn surgery as the first step of a quality improvement initiative to ensure we are maintaining a warm OR environment.MethodsBetween 1/3/2020 and 28/2/2021, ambient temperatures during surgery in the burn OR of an ABA-verified burn center were recorded every 15 minutes. Temperatures were measured using a wall-mounted smart sensor, transmitted to a mobile smartphone application via Bluetooth. All patients undergoing acute burn excision and closure procedures lasting > 2 hours were included in the study. Hypothermia was defined as a core temperature < 36°C.ResultsOf the 119 patients, the majority were male (n=86; 72.3%), the mean age was 49.8 years (range 18-89) and the mean total body surface area (TBSA) was 15.8% (range 1-62%). They underwent 261 operations (mean 2.2 cases per patient; range 1-15) with a mean duration of 211.1 minutes (range 120-468 minutes). Sixty-two patients underwent 1 surgery, and 31 had 2 surgeries. Eight patients (6.7%) died. Thirty-three patients (27.7%) were hypothermic at the end of 43 cases (16.5%).The mean ambient temperature was 24.8oC (range 18.7oC to 29.6oC). Hypothermic patients (n= 33 patients, 43 cases), did not differ significantly in age or operative duration from non- hypothermic patients (n= 86 patients, 218 cases) but did have significantly larger %TBSA burns [32.3 vs 24.8 (p= 0.02)]. Hypothermic cases experienced significantly lower ambient temperatures at the start of surgery (p=0.007), and mean temperature during surgery (p=0.009), and tended to experience a lower ambient temperature at the end of surgery (24.5 C vs 25.1 °C , p= 0.06). [Table]ConclusionsWe have identified that the ambient temperature in our burn OR is lower than desirable and that this is directly related to development of hypothermia. These results now indicate that a QI intervention (stricter attention and manoeuvers to ensuring a warm operating room at the start and during surgery) is required.

Prediction of Ventricular Arrhythmias by QRS/QTc - Ratio in Citalopram or Escitalopram Intoxication

BackgroundThe U.S. Food and Drug Administration (FDA) has stated that citalopram and escitalopram should not be used at daily doses above 40 mg/20 mg due to risk for development of fatal ventricular arrhythmias like torsade de pointes (TdP). Yet, supratherapeutic serum concentrations of citalopram are common and predicting patients at risk for TdP is of high clinical value. Accordingly, we investigated whether QRS/QTc; developed for predicting TdP in hypothermic patients could be used in citalopram intoxication.MethodsA total of 16 publications describing patients suffering from complications due to citalopram or escitalopram treatment, or intoxication with the same substances, were included after a systematic search. The main criterion for inclusion was admission ECG, either with given QRS and QTc values or with attached ECG-files that enabled calculation.ResultsQRS/QTc rather that QTc alone emerged as a marker of ventricular arrhythmia in the 16 included case reports, with highly significant (p < 0.0005) lower values in patients displaying ventricular arrhythmias.ConclusionCitalopram and escitalopram are extensively used in treatment of depressive disorders, and a large proportion of patients have supratherapeutic serum concentrations. Calculation of QRS/QTc in available case reports show that this novel ECG-marker has potential to predict patients at risk for developing ventricular arrhythmias.