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

The ability to transfuse blood (a form of tissue transplantation) with relatively few immediate and long-term complications has led to increased survival in victims of injury who require massive amounts of blood. The primary deficit in hypovolemic shock secondary to trauma is in oxygen transport to the hypoperfused tissues; therefore, blood transfusion has an essential role in therapy during resuscitation and definitive treatment. The major immediate complications to be avoided are hypothermia and acidosis, which are the main causes of the coagulopathy associated with massive transfusion. The most worrisome long-term complication is the transmission of disease, of which hepatitis C is the most frequent. With improved screening techniques and heightened donor awareness, the risk of disease transmission is less than 2%. Until synthetic oxygen-carrying solutions are available, the transfusion of red blood cells, when appropriately indicated, will remain an important component in the resuscitation of the trauma patient.
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PMID:The use of blood in resuscitation of the trauma patient. 844 10

Systemic hypothermia is used almost universally in cardiac surgery. Since 1987, 2817 patients have had normothermic cardiopulmonary bypass (NCPB, "warm body", bladder temperature 36 degrees C) with cold blood cardioplegic arrest ("cold heart", 8 degrees-14 degrees C) during open heart surgery. No patients were denied this technique regardless of age, condition or severity of surgery. Clinical Characteristics in Patients: Age range: 16-84 years, mean 66; male/female ratio 3:1; pump time (min) 24-183, mean 91; cross-clamp time (min) 15-148, mean 68; types of surgery: coronary artery bypass (n = 2214), valvular (n = 489) and miscellaneous (aneurysms, tumors, arrhythmias, congenital, etc) (n = 114). One thousand and sixty-nine (1069) patients had urgent coronary artery bypass grafting (CABG). The ejection fraction was less than 0.40 in 843 patients (30%). The thirty-day operative mortality for the entire group was 1.7% (48/2817 patients): CABG = 1% (23/2214 patients), valvular = 3% (15/489 patients) and miscellaneous 9% (10/114 patients). Postoperative complications were: perioperative myocardial infarction (34 patients) = 1.2%, postoperative bleeding requiring reexploration (37 patients) = 1.3%, stroke (27 patients) = 1%, and mediastinal infection (21 patients) = 0.7%. During NCPB (WARM) systemic vascular resistance was extremely low, cardiac output was high and it was easier to wean patients from the pump. No intraaortic balloon pump was used during this period. 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 cardiac surgery and is particularly suitable for high-risk patients.
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PMID:Warm body, cold heart surgery. Clinical experience in 2817 patients. 851 49

Recovery without residual neurological damage after cardiac arrest with global cerebral ischemia is still a rare event. Severe impairment of bodily or cognitive functions is often the result. The individual, emotional, and social aspects of brain damage and rehabilitation are seldom taken into account. Efforts to improve the prevention of brain damage immediately after successful resuscitation of patients are missing. The efficacy of hypothermia in preserving neurologic function when instituted before and during certain no-flow cardiovascular states has been well documented both clinically and experimentally since the 1950s. Most studies have used moderate (28-33 degrees C) to deep (20-28 degrees C) hypothermia to demonstrate these protective effects. Considering the use of hypothermia for preservation and resuscitation, the lack of controlled outcome trials, the long period of time required to reach therapeutic hypothermia, and the incidence of rewarming complications such as infection, arrhythmia, and coagulopathy have made it difficult to apply these methods to emergency situations such as cardiac arrest. Recent experimental evidence in dogs has shown that hypothermia induced after cardiac arrest does indeed mitigate the effects of the postresuscitation syndrome and improves neurologic function and reduces histologic brain damage. More importantly, such benefits can be demonstrated with mild (34-36 degrees C) hypothermia, thus minimizing complications and requiring less time for induction of hypothermia. Ice water nasal lavage, direct carotid infusion of cold fluids, use of a cooling helmet, and peritoneal cooling are promising techniques for clinical cerebral cooling. External auditory canal temperature (e.g., tympanic membrane temperature changes) could provide an approximation to brain temperatures. For accurate temperature monitoring, however, a central pulmonary artery thermistor probe should be inserted. Temperature monitoring is needed to avoid temperature < 30 degrees C. Mild hypothermia may prove to be an important and secure component for cerebral preservation and resuscitation during and after global ischemia; it may also prove to be a useful method of cerebral resuscitation after global ischemic states, thereby promoting the prevention of neuromental diseases.
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PMID:Mild resuscitative hypothermia and outcome after cardiopulmonary resuscitation. 871 99

The treatment of unresectable hepatic metastases has generally been limited to systemic or intra-arterial chemotherapy. Cryosurgery has the advantage of potentially ablating such unresectable tumours. From November 1987 to August 1994, 140 patients underwent 155 procedures using hepatic cryosurgery with and without resection for documented metastatic disease. Intra-operative ultrasound was used for monitoring the freezing zone. The tumours were frozen using liquid nitrogen cooled to -196 degrees C for 15 min. The median number of lesions treated was three. Median hospital stay was 10 days. The operative mortality was 4%. Complications included coagulopathy, hypothermia, myoglobinuria, pleural effusions, ATN and infection. The median survival for all patients was 22 months. Of those patients followed for more than 2 years, the median survival was 25 months. Of the 65 patients that are still alive, the median follow-up is 27 months.
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PMID:Hepatic cryosurgery in the treatment of unresectable metastases. 885 24

Patients at risk for clinically significant bleeding and who require urgent or emergent surgical procedures are encountered. Usually local causes are responsible, but a generalized hematologic defect may be uncovered. Quickly and effectively distinguishing the cause may be critical to rapid treatment and survival. A careful history, appropriate use of laboratory tests (e.g., partial thromboplastin time, prothrombin time, and platelet count), and knowledge of possible causes are key to prompt diagnosis and treatment. Bleeding from multiple sites, spontaneous bleeding, or unexpectedly severe bleeding suggests a systemic process. Immunocompromised or suppressed patients or systemically ill patients with chronic hepatic renal, lymphatic, and hematologic disorders are seen with urgent surgical problems. The key is rapid diagnosis and effective systemic and local therapy to counter the problem. The syndrome of diffuse "medical bleeding" frequently confronts the surgeon treating a patient who has received transfusions of more than 1.5 times blood volume. The coagulation defect is almost always associated with hypothermia and acidosis. Treatment consists in control of large-vessel bleeding by appropriate surgical techniques, blunt packing, and tamponade of diffuse bleeding, rapid rewarming of the patient, and adequate resuscitation for shock. Transfusion of platelets and fresh frozen plasma is empiric initially and subsequently guided by the clinical and laboratory coagulation profiles of the patient.
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PMID:Emergency surgery in hematologic patients. 886 72

Seventy-seven cases of hepatic trauma diagnosed during exploratory laparotomy were retrospectively studied. Blunt trauma comprised the majority of cases. Seventy-five per cent of cases had associated injuries and 58 per cent were in shock on arrival. The mortality rate was 19 per cent. Exsanguination and associated head injuries were the major causes of death. Aggressive resuscitation and immediate exploratory laparotomy are not overemphasized if survival is expected. During operation, suture ligature of the bleeding points or hepatorrhaphy stopped the bleeding in most circumstances. Hepatic artery ligation was seldom performed. Omental packing of the liver wounds was an effective procedure. Anatomical hepatic resections were performed with a relatively high mortality rate. Debridement of devitalized liver tissue should be done routinely to prevent postoperative infection. Perihepatic packing was a useful procedure when termination of the operation was considered necessary in order to prevent the development of hypothermia, acidosis and coagulopathy.
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PMID:Operative management of hepatic injuries. 886 94

Both regional and general anesthesia markedly impair the normal precise regulation of core body temperature. Consequently, inadvertent perioperative hypothermia is common. Hypothermia develops because the typical operating room environment is cold; however it is anesthetic-induced impairment of thermoregulatory responses that contributes most. Internal redistribution of body heat is a surprisingly important factor, contributing more to core hypothermia than net heat loss in most patients. There is now convincing evidence that a typical degree of intraoperative hypothermia, say 2 degrees C, predisposes to numerous complications such as shivering, prolonged duration of action of several drugs, myocardial ischemia, coagulopathy and increased incidence of surgical wound infections, which alter patient outcome. Fortunately, effective methods such as convective warming are available for preventing hypothermia.
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PMID:[Intraoperative hypothermia: pathophysiology and clinical sequelae]. 922 2

Extensive thoracic aortic resections often require a period of profoundly hypothermic circulatory arrest. The extent of surgical dissection, damaging effects of cardiopulmonary bypass, and coagulation disturbances of hypothermia predispose to bleeding. Although impervious vascular grafts and biological glues have made an important contribution to eliminating the vicious cycle of transfusion of stored blood and worsening coagulopathy, hemorrhage remains an important cause of morbidity in these patients. Thrombin generation by activation of the coagulation cascades also leads to excessive fibrinolytic activity with the potential to disrupt the hemostatic process. Pharmacological antifibrinolytic therapy with aprotinin or other agents has been shown to preserve hemostasis, but the efficacy of antifibrinolytic therapy remains unproven in thoracic aortic operations with hypothermic circulatory arrest. This report discusses the interactions of hypothermia with the coagulation system, together with the efficacy of fibrinolytic therapy from existing surgical experience.
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PMID:Coagulation disturbance in profound hypothermia: the influence of anti-fibrinolytic therapy. 926 43

The problem of altered hemostasis remains a major challenge during thoracic aortic surgery. Bleeding is associated with a marked increase in morbidity and mortality. The hemostatic derangements are caused by multiple interrelated factors including interference with the vascular integrity, extensive surgical dissection, transient need for complete inhibition of the normal coagulation process, large blood products and fluid requirements, hemodilution, hypothermia, extensive ischemia and reperfusion, activation of systemic inflammatory responses, interference with fibrinolysis, and the use of extracorporeal circulation systems. Acquired coagulopathy must be specifically diagnosed and treated. Platelet deficiencies, both qualitative and quantitative, are the most predictable and consistent disturbance in the hemostatic function and the most common cause of intraoperative and postoperative bleeding. Precise surgical technique is essential to prevent blood loss. Topical agents should not be used for and cannot correct imperfections in surgical technique. Nonspecific measurements that are useful to decrease intraoperative blood loss include strict control of blood pressure and hemodynamic status, the induction of mild controlled hypotension, and the reversal of hypothermia. Rewarming may produce clear procoagulant effects by improving the efficacy of platelets and clotting factors. Platelet dysfunction can be reduced by several pharmacological interventions including acid aminocaproic, desmopressin and aprotinin; however, efficacy and safety are still being established. The most important factorS regarding safety in thoracic aortic surgery are a secure suture line and the experience of the surgical and anesthesiology teams.
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PMID:Individual strategies of hemostasis for thoracic aortic surgery. 927 49

Damage control procedures are being used with increasing frequency as the physiologic limits of the surgical patient are approached and recognized. These patients are returned to the SICU, where rapid restoration of circulating volume, normothermia, maintenance of oxygen delivery, and correction of transfusion-associated coagulopathy are essential to the success of the technique, which requires expeditious reoperation and completion of definitive surgical management. The potential need for early return to the operating room to control surgical bleeding must be recognized, as well as the difficulty in distinguishing between surgical bleeding and ongoing hemorrhage due to hypothermia and coagulopathy. Because the damage control technique is resource intensive and involves numerous personnel, organization and leadership are important to success.
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PMID:Postoperative care and complications of damage control surgery. 929 92


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