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

Unanesthetized and unrestrained rats, chronically cannulated in the carotid artery, were exposed to normal air (NA) and Helox (21% O2, 79% He) at ambient temperatures (Ta) of 22 and -10 degrees C. In Helox at Ta = 22 degrees C, the Vo2 was 1.39 ml O2/g-h and the Vco2 0.98 ml CO2/g-h, 145 and 126%, respectively, of the values in NA at Ta = 22 degrees C. The arterial Pao2, Paco2, and pH were comparable in Helox and NA at Ta = 22 degrees C. In Helox at Ta = -10 degrees C, rats invariably became hypothermic after exposure of 0.75 to 1.5 h. During the induction of hypothermia the decrease of Vo2 and Vco2 was oscillatory, Pao2 and pH increased, and Paco2 decreased significatnly (P less than 0.05). Minimum Vo2 and Vco2 during hypothermia averaged 0.71 ml O2/g-h and 0.50 ml CO2/g-h, 23 and 22%, respectively, of the values in normothermic animals at Ta = -10 degrees C. Minimum body temperature during hypothermia was clamped at 21.7 +/- 0.3 degrees C (X +/- SE) by increasing Ta to 19 degrees C. When Helox was replaced by NA, hypothermic rats rewarmed spontaneously, returning to normothermia within 4 h. The data suggest that hypothermia induced by Helox plus cold does not seem to be due to respiratory failure, as systemic hypoxia or hypercapnia were not observed. The controlled hypothermia cycle reported here provides a model for dynamic studies of thermogenic mechanisms both at the normothermic and hypothermic states without the interference of drugs and other nonphysiological treatments.
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PMID:Metabolic and respiratory responses during Helox-induced hypothermia in the white rat. 24 22

A total of 74 patients under 24 months of age with large ventricular septal defects (VSD) and pulmonary hypertension were subjected to surgical treatment from 1969 through 1975. Emergency pulmonary artery (PA) banding was performed in 13 patients during the first year of life with 1 death from postoperative respiratory failure. Primary closure of the VSD was performed in 61 patients using simple hypothermia and short-term coronary perfusion, with an operative mortality of 1.6%. There were no late deaths or neurological disturbances. Normal hemodynamic data were obtained in all 7 patients who underwent postoperative cardiac catheterization from one month to five years after the primary correction. It is concluded that primary closure of a VSD in infancy is reasonable and that PA banding is indicated only for those patients less than 6 months old with a complicated defect or in an emergency situation.
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PMID:Surgical treatment of large ventricular septal defect with pulmonary hypertension in the first 24 months of life. 96 6

Injection of ibotenic acid (IA), a glutamate agonist, into the ventral medullary raphe (VMR; especially the nucleus raphe magnus) of the rat produced respiratory failure and death following a predictable course of events. The response to the IA injection was characterized initially by increased respiratory frequency and was followed by pulmonary arterial hypertension, systemic arterial hypoxemia, acidosis, and hypothermia. Within 90 min apnea occurred as a terminal event in all animals. Gravimetric, bronchoalveolar lavage protein, and histological analyses revealed no evidence of pulmonary edema. Intracerebral (VMR) pretreatment with PPP, a sigma receptor agonist, or scopolamine, a muscarinic cholinergic antagonist, prevented pulmonary failure and death even though postmortem histological analysis showed VMR cell loss and gliosis consequent to the cytotoxic IA injection. Based on the results of the study, it is suggested that the VMR has a role in regulation of pulmonary blood flow. Preliminary pharmacological studies suggested that a disruption of glutamatergic and cholinergic mechanisms mediates the lethal pulmonary phenomenon.
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PMID:Respiratory failure without pulmonary edema following injection of a glutamate agonist into the ventral medullary raphe of the rat. 137 23

Surgical resection of the descending thoracic and thoracoabdominal aorta is associated with the risk of spinal cord ischemic injury, particularly in patients with aortic dissection. Hypothermic total cardiopulmonary bypass with periods of circulatory arrest has been advocated for spinal cord protection with encouraging early results. However, techniques for this procedure are relatively complex. An alternative cannulation technique with venous return from the right atrium through the internal jugular vein and arterial return to the aortic arch is described. This has been used in 6 patients for replacement of the descending thoracic or thoracoabdominal aorta. Despite profound hypothermia and preservation of the principal spinal radicular artery, 1 patient suffered early paraparesis with some recovery but eventually died of multisystem failure. A second elderly patient with severe obstructive airways disease died of respiratory failure 11 days postoperatively. Four patients made a good recovery including 1 with a ruptured thoracoabdominal aneurysm who subsequently required gut resection for ischemic necrosis present preoperatively. This cannulation technique together with profound hypothermia has greatly improved the operating conditions for extensive aneurysms of the thoracoabdominal aorta. Paraparesis occurring despite hypothermic protection and attempted preservation of the spinal cord arterial supply suggests that unfavorable vascular anatomy still predominates in the risk factors for ischemic injury.
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PMID:Hypothermic thoracic and thoracoabdominal aneurysm operation: a central cannulation technique. 834 39

The measurement of the plasma amino acid was made in 15 patients with chronic respiratory failure and 15 persons of control. The results showed: (1) The plasma acid model changed. Lysine increases and arginine decreases, due to hypothermia. Hypercapnia imbalance of acid and alkali and changes of hepatic dysfunction etc. (2) The prognosis of respiratory failure as well as its severity was judged according to the decreasing extent of arginine and BCAA. The more worse the condition of the disease, the more lowering of the level of arginine and BCAA. (3) The changes of blood gas analysis and hepatic dysfunction may effect on the metabolism of plasma amino acid in some degree. (4) Hypoxemia in infected patients with respiratory failure may cause peripheral deficit of energy. We suggested that patients should be given BCAA and arginine for more energy as anti-infection and oxygen therapy were used.
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PMID:[The determination and evaluation of the plasma amino acid in respiratory failure]. 191 67

Postanesthetic hypothermia is a common, significant, and costly problem in the PACU. The scope of the problem ranges from an adverse outcome for the patient to undue financial burden to the institution providing the care. All of these problems can be minimized or prevented with active warming therapy. From the quality assurance perspective, patient temperatures in the PACU should be measured and documented at appropriate intervals. When hypothermia is detected, even in a mild state, it ought to be assertively treated, particularly in the elderly or patients compromised by systemic disease. When hypothermia is encountered in a moderate to severe form, however, it should be recognized as a grave threat to the patient. Hypothermia has been associated with the most serious postanesthetic complications, including MI, congestive heart failure, respiratory failure, recurarization (reparalyzation), renarcotization, stroke, and bleeding. Inability to control variables makes it exceedingly difficult to identify the contribution of hypothermia to these forms of anesthesia-related morbidity and mortality, but it is undoubtedly significant. For this reason, failure to treat postanesthetic hypothermia is beginning to be recognized as a potential cause of action for a malpractice suit in the presence of an adverse anesthetic outcome. This article evaluates and compares the existing warming therapies with respect to effectiveness, safety, and cost. Fluid warmers, warmed cotton blankets, and infra-red warming devices show no effectiveness in treating hypothermia in the PACU. Only active warming, as characterized by the Bair Hugger warming system, succeeds. With respect to budgetary concerns, Convective Warming Therapy is less expensive to use than warmed cotton blanket treatment. Perioperative temperature management is an emerging science in nursing and medicine. The problem is as ancient as surgery and anesthesia, but the implications are only beginning to be appreciated. Analysis of the problem of hypothermia in terms of clinical and financial outcome are proceeding, with new studies appearing in the literature monthly. More investigation is indicated in the area of patient temperature regulation, which is likely to identify additional situations when active warming therapy is indicated, as a mechanism to protect patients during emergence from anesthesia and to insure cost-effective use of PACU time.
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PMID:Hypothermia in the PACU. 204 23

An important goal in managing patients with respiratory failure using mechanical ventilatory support and positive end-expiratory pressure (PEEP) is to optimize tissue oxygen delivery relative to oxygen consumption. To this end, systemic hypothermia has been reported to reduce oxygen consumption. Cooling, however, may antagonize hypoxic pulmonary vasoconstriction and depress cardiac output. To determine whether these potentially adverse effects of cooling on tissue oxygen delivery would outweigh any potential benefits, we studied the effects of systemic hypothermia and end-expiratory pressure on venous admixture, intrapulmonary blood distribution, and oxygenation variables in 40 dogs with oleic acid-induced pulmonary edema of the right lung. The dogs were randomly assigned to four treatment groups of 10 dogs each: normothermia and zero end-expiratory pressure (ZEEP); normothermia and 10 cm H2O PEEP; hypothermia and ZEEP; hypothermia and PEEP. Hypothermia to 31.9 +/- 0.1 degree C (mean +/- SEM) caused no adverse effects on intrapulmonary blood flow distribution (measured by radioactive microspheres) or on venous admixture. Tissue oxygen delivery and arterial oxygenation did not improve with hypothermia, the latter being 109 +/- 13 mm Hg and 70 +/- 8 mm Hg with PEEP and ZEEP, respectively. However, hypothermia significantly reduced oxygen consumption, so that the coefficient of oxygen delivery (i.e., the ratio of oxygen supply to consumption) increased from 2.5 +/- 0.1 to 3.2 +/- 0.2 (p less than 0.01) with ZEEP and from 2.0 +/- 0.1 to 2.6 +/- 0.3 with PEEP (p = 0.016). Thus, although systemic hypothermia failed to improve arterial oxygenation and tissue oxygen delivery, it decreased systemic oxygen demands, thereby improving the oxygen supply-demand balance.
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PMID:Hypothermia with and without end-expiratory pressure in canine oleic acid pulmonary edema. 266 83

We studied 385 episodes of nosocomial bloodstream infections occurring over 45 months to ascertain if the etiologic organisms were independent predictors of death and morbidity. Independent predictors of death included respiratory failure, oliguria, metabolic acidosis, hypotension, increased age, antibiotic therapy in cases where susceptibility data were unknown, and infection with Pseudomonas aeruginosa. If parameters associated with septic shock were excluded, increased age, severity of disease, and infection with Candida spp. or P. aeruginosa predicted death. Infection with P. aeruginosa, Enterococcus, and Klebsiella pneumoniae predicted hypotension; severity of disease, polymicrobial infection, and infection with Candida spp., Enterococcus, Enterobacter, or Serratia marcescens predicted oliguria; infection with Candida spp. or P. aeruginosa, increased age, severity of disease, and inability to meet hospital financial obligations without assistance predicted respiratory failure. Inability to meet hospital financial obligations without assistance and severity of disease predicted hypothermia; infection with Candida spp. or P. aeruginosa and sex (male) predicted metabolic acidosis.
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PMID:Etiologic organisms as independent predictors of death and morbidity associated with bloodstream infections. 361 32

Perinatal factors associated with death or disability at 2 years were identified in an inborn cohort of 196 live births with a birth weight of 500-999 g. Antepartum haemorrhage, multiple pregnancy, breech presentation, perinatal asphyxia, hypothermia on admission, hyaline membrane disease, persistent pulmonary hypertension, severe respiratory failure, and intraventricular haemorrhage were associated with increased mortality. Factors associated with increased survival included maternal hypertension, caesarean birth, increasing maturity or size at birth, female sex, and fetal growth retardation. Stepwise multiple discriminant function analysis showed that six factors correctly classified the outcome in 83% of infants: intraventricular haemorrhage was the most important factor followed by the presence of acidosis and hypoxia in the early neonatal period, birth weight, pre-eclamptic toxaemia, and caesarean birth. This study also showed that intraventricular haemorrhage, seizures, antepartum haemorrhage and delay in regaining birth weight were associated with increased disability among survivors.
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PMID:Perinatal factors and adverse outcome in extremely low birthweight infants. 372 24

Sudden unexplained death may be seen with treatment of craniovertebral anomalies and surgery of the upper cervical spine. Death is due to sleep-induced apnea, premonitored by periods of confusion, lethargy, and asthenia. There may be associated hypotension, bradycardia, hyponatremia, hypothermia, inappropriate antidiuretic hormone secretion, and difficulty in micturition. The potential for respiratory failure may be predicted if a CO2 response test demonstrates an attenuated or abnormal response. Apnea during sleep may be reversed by arousal or may require ventilatory support for a period of time. The condition is self-limiting, but remains the major life-threatening complication. Both apnea and autonomic dysfunction are treatable and curable with appropriate diagnosis and management.
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PMID:Occult respiratory and autonomic dysfunction in craniovertebral anomalies and upper cervical spinal disease. 375 66


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