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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The records of 163 penetrating trauma patients who required surgery in a 36-month period between 1988 and 1990 were reviewed. Those patients with head trauma were excluded. Thirty patients were identified as having: similar Injury Severity Scores (ISS), received at least 8 L of crystalloid, and received at least 4 units of packed red blood cells during the first 24 hours after admission. There were 22 (73%) survivors and 8 (27%) nonsurvivors. Charts were reviewed for a variety of variables to determine which characteristics distinguished nonsurvivors from survivors. The mean ISS was 30.5 +/- 5.5. As a group, nonsurvivors received more blood transfusions (14.9 +/- 4.9 versus 5.0 +/- 1.14), had longer durations of shock (55.6 +/- 18 minutes versus 19.3 +/- 11.7 minutes), and had lower core body temperatures (92.6 degrees F +/- 2.2 versus 95.1 degrees F +/- 2.4) than survivors. Nonsurvivors also had lower hemoglobin levels (7.84 +/- 1 versus 9.1 +/- 2.3) and platelet counts (134.2 +/- 14.1 versus 188.6 +/- 6.3) than survivors. In addition, nonsurvivors demonstrated greater incidence of three major risk factors than did the survivors: hypothermia (75% versus 41%), acidosis (100% versus 27%), and coagulopathy (62% versus 4.5%). Therapeutic measures to limit these risk factors for increased mortality may maximize the chance of survival in these patients.
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PMID:Evaluation of massive volume replacement in the penetrating trauma patient. 786 71

The management of severe hepatic trauma may represent a challenge in the presence of haemodynamic instability, coagulopathy, hypothermia or metabolic failure. Moreover, the choice of treatment should consider the prevention of complications. The omentum has many advantages including hemostasis, infection preventing, viability and adaptability to reconstruction as a space filler. We report the case of a 19 year-old patient who sustained a gunshot wound, involving the right elbow and forearm and the abdomen with burst of right kidney and a penetrating centro-hepatic injury (stage IV). Surgical treatment was successfully performed in two times, by gauze packing for temporary control of haemostasis and after 24 hours by omental packing to fill the dead space of hepatic lesion. The viable omentum was placed through the hepatic hole and fixed posteriorly to the skin. The postoperative period was uneventful, excluding the development of a biliary fistula which resolved after external drainage. We conclude that omental packing is a valid solution when dealing with penetrating liver injury.
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PMID:[Central liver lesion by a high velocity bullet with massive hemorrhage: what is the solution?]. 796 Sep 14

Hypothermia prolongs clotting times when the tests are performed at hypothermic temperatures, in contrast to standard clinical tests performed at 37 degrees C. The relative impact of hypothermia on plasma clotting factor activity was investigated by determining the specific clotting factor deficiencies required to produce an equivalent effect. Clotting factor concentration curves were constructed for clotting factors II, V, and VII through XII using assayed reference plasma (ARP) diluted with specific factor-deficient plasmas (FDP). Prothrombin times and partial thromboplastin times were measured as appropriate for each factor at test temperatures ranging from 37 degrees to 25 degrees C using a modified fibrometer. The clotting times for each temperature with undiluted ARP were compared with the clotting times at 37 degrees C obtained with FDP dilution. Hypothermia at temperatures below 33 degrees C produces a coagulopathy that is functionally equivalent to significant (< 50% of normal activity) factor-deficiency states under normothermic conditions, despite the presence of normal clotting factor levels.
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PMID:Functional equivalence of hypothermia to specific clotting factor deficiencies. 808 2

In acutely injured patients, recognition of profound shock may be difficult initially. Ensuring adequate oxygenation, restoring intravascular volume, and controlling ongoing blood loss are key principles of treatment in these patients. Additionally, an appreciation for and recognition of the possible adverse consequences of massive transfusion (ie, hypothermia, coagulopathy, hypocalcemia, hyperkalemia, and hemolysis) enable physicians to prevent them or at least lessen their effects.
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PMID:Massive blood loss in trauma patients. The benefits and dangers of transfusion therapy. 812 60

Hypothermia has been shown to cause coagulation abnormalities, primarily related to platelet dysfunction. We reviewed coagulation function and the incidence of delayed traumatic intracerebral hemorrhage in a series of 36 patients with severe head injuries (Glasgow Coma Scale 3-7) enrolled in a prospective, randomized, clinical trial of therapeutic moderate hypothermia. Patients were randomized to a normothermic group (n = 16) or to a group cooled to 32 to 33 degrees C within 6 hours of injury (n = 20). Prothrombin times, partial thromboplastin times, and platelet counts were obtained in the emergency room and then again within 24 hours of randomization. Delayed traumatic intracerebral hemorrhage occurred in 6 of 20 (30%) hypothermic patients and 5 of 16 (31%) normothermic patients. In the hypothermic group, 9 of 17 patients had an increased prothrombin time during hypothermic therapy, as opposed to 11 of 16 in the normothermic group during the corresponding time period. The partial thromboplastin time was prolonged in 2 of 17 hypothermic patients and 2 of 16 normothermic patients. Three patients in the hypothermic group and one in the normothermic group developed thrombocytopenia (a platelet count of less than 100,000). There were no significant differences between the two groups in the incidence of delayed traumatic intracerebral hemorrhage, in measured coagulopathy, or in the mean values of measured coagulation parameters. Although the possibility of a hypothermia-induced coagulopathy has not yet been excluded, the short-term use of hypothermia does not appear to increase the risk for intracranial hemorrhagic complications in head injuries.
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PMID:The effect of hypothermia on the incidence of delayed traumatic intracerebral hemorrhage. 817 85

During the initial operation on victims of multisystem trauma, life-threatening hypothermia, metabolic acidosis and coagulopathy occasionally develop. Without the immediate control of active bleeding and correction of these abnormalities, the intraoperative death rate is high. A patient with severe abdominal trauma was successfully managed with staged laparotomies. The patient's initial surgery was abbreviated to allow the aggressive correction of hypothermia and coagulopathy before definitive reconstruction of bowel injuries. Abbreviated laparotomy for damage control should be a part of the surgical armamentarium in the management of severe abdominal trauma.
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PMID:Abbreviated laparotomy for damage control: a case report. 819 33

A technique is described for cerebral and other vital organ preservation during aortic arch repair using retrograde venous perfusion at 20 degrees C. This technique retains the excellent operating conditions of deep hypothermia and circulatory arrest. Potential benefits include shortening of the cooling and rewarming time, reduction of coagulopathy, prevention of emboli, and extension of the safe period of antegrade circulatory arrest.
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PMID:Retrograde vital organ perfusion during aortic arch repair. 821 84

Forty-six patients with severe nonpenetrating brain injury [Glasgow Coma Scale (GCS) 4-7] were randomized to standard management at 37 degrees C (n = 22) and to standard management with systemic hypothermia to 32 to 33 degrees C (n = 24). The two groups were balanced in terms of age (Wilcoxon's rank sum test, p > 0.95), randomizing GCS (chi-square test, p = 0.54), and primary diagnosis. Cooling was begun within 6 h of injury by use of cooling blankets. Metocurine and morphine were given hourly during induction and maintenance of hypothermia. Rewarming was at a rate of 1 degree C per 4 h beginning 48 h after intravascular temperature had reached 33 degrees C. Muscle relaxants and sedation were continued until core temperature reached 35 degrees C. There were no cardiac or coagulopathy-related complications. Seizure incidence was lower in the hypothermia group (Fisher's exact text, p = 0.019). Sepsis was seen more commonly in the hypothermia group, but difference was not statistically significant (chi-square test). Mean Glasgow Outcome Scale (GOS) score at 3 months after injury showed an absolute increase of 16% (i.e., 36.4-52.2%) in the number of patients in the Good Recovery/Moderate Disability (GR/MD) category as compared with Severe Disability/Vegetative/Dead (SD/V/D) (chi-square test, p > 0.287). Based on evidence of improved neurologic outcome with minimal toxicity, we believe that phase III testing of moderate systemic hypothermia in patients with severe head injury is warranted.
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PMID:A phase II study of moderate hypothermia in severe brain injury. 825 39

Systemic hypothermia is used almost universally in cardiac surgery. Since 1987, 2383 patients underwent normothermic cardiopulmonary bypass (NCPB, "warm body", bladder temperature 36 degrees C) with cold blood cardioplegic arrest ("cold heart", 8-14 degrees C) during myocardial revascularization. No patients were denied this technique regardless of age, condition or severity of surgery. Clinical characteristics in patients: Age range: 31-92 years, mean 66; male/female ratio 3:1; pump time (min): 23-228, mean 80; cross clamp time (min): 18-152, mean 60. One thousand, one hundred and sixty-one patients (49%) had urgent coronary artery bypass grafting (CABG). Ejection fraction was less than 0.4 in 843 patients (30%). Thirty-day operative mortality was 1% (23/2383 patients). Postoperative complications were: perioperative myocardial infarction (35 patients) = 1.5%; postoperative bleeding requiring reexploration (33 patients) = 1.4%; stroke (22 patients) = 0.9%; mediastinal infection (24 patients) = 1%; and renal insufficiency (25 patients) = 1%. During NCPB (warm), systemic vascular resistance was extremely low, cardiac output was high and it was easier to wean patients from the pump. No patient required the intraaortic balloon pump during peri- and post-operative periods. Pulmonary complications and coagulopathy were extremely rare. These results provide reassurance that NCPB (warm) in combination with cold cardioplegic arrest provides excellent myocardial and total body protection during myocardial revascularization and is particularly suitable for high-risk patients.
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PMID:Warm body, cold heart: myocardial revascularization in 2383 consecutive patients. 828 48

Definitive laparotomy (DL) for penetrating abdominal wounding with combined vascular and visceral injury is a difficult surgical challenge. Physiologic derangements such as dilutional coagulopathy, hypothermia, and acidosis often preclude completion of the procedure. "Damage control" (DC), defined as initial control of hemorrhage and contamination followed by intraperitoneal packing and rapid closure, allows for resuscitation to normal physiology in the intensive care unit and subsequent definitive re-exploration. The purpose of the study was to compare the damage control technique with definitive laparotomy. Over a 3 1/2-year period, 46 patients with penetrating abdominal injuries required laparotomy and urgent transfusion of greater than 10 units packed red blood cells for exsanguination. Medical records were retrospectively reviewed for degree and pattern of injury, probability of survival, actual survival, transfusion requirements for the preoperative and postoperative phases, resuscitation and operative times, lowest perioperative temperature, pH, and HCO3. No significant differences were identified between 22 DL and 24 DC patients and actual survival rates were similar (55% DC vs. 58% DL). However, in a subset of 22 patients with major vascular injury and two or more visceral injuries (maximum injury subset), otherwise similar to the overall group, survival was markedly improved in patients treated with damage control (10 of 13, 77%*) vs. DLM (1 of 9, 11%) (Fisher's exact test, * p < 0.02). In preparation for return to the operating room, DC survivors averaged 8.4 units of packed red blood cells transfused and 10.3 units fresh frozen plasma over a mean ICU stay of 31.7 hours. Resolution of coagulopathy (mean prothrombin time/partial thromboplastin time 19.5/70.4 to 13.3/34.9), normalization of acid-base balance (mean pH/HCO3 7.37/20.6 to 7.42/24.2), and core rewarming (mean 33.2 degrees C to 37.7 degrees C) were achieved. All patients had gastrointestinal procedures at reoperation (mean operative time, 4.3 hours). We conclude that damage control is a promising approach for increased survival in exsanguinating patients with major vascular and multiple visceral penetrating abdominal injuries.
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PMID:'Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury. 837 Dec 95


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