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

Two types of acid-base strategies are available for the blood gas management of patients during hypothermia: alpha-stat and pH-stat management. However, the more suitable strategy for therapeutic hypothermia is unclear. We studied the effects of hypothermia (30 degrees C) and acid-base management on reactivity to hypercapnia and hypotension in rat pial arterioles, using a closed cranial window. The baseline diameter during hypothermia decreased in the alpha-stat (PaCO2 was maintained at 35 mm Hg when measured at 37 degrees C, n = 8), but not in the pH-stat (PaCO2 was maintained at 35 mm Hg when corrected to the animal's actual temperature, n = 7). Vasodilation induced by hypotension was significantly reduced in hypothermic groups compared with the normothermic group (n = 7), whereas responses to hypercapnia were preserved. Moreover, hypotensive vasodilation was more attenuated in the pH-stat, than the alpha-stat, management. These findings show that moderate hypothermia and acid-base management alter cerebrovascular autoregulation.
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PMID:Moderate hypothermia reduces hypotensive, but not hypercapnic vasodilation of pial arterioles in rats. 985 Jan 41

We conducted this study to determine whether two of the physiological changes associated with non-sustainable exercise, elevated blood lactate levels and decreased arterial pH, contribute to the behavioral hypothermia exhibited by exhausted lizards. Dipsosaurus dorsalis were placed in a thermal gradient and their body temperatures were recorded from 08:00 to 14:00 h. At 14:00 h, animals were subjected to different experimental regimens. In the exercise (E) regimen, animals at 40 degrees C were forced to exercise maximally for 5 min on a treadmill. In the lactate (L) regimen, animals were infused with 11.5 ml kg-1 of 250-500 mmol l-1 sodium lactate. In the osmolarity control (O) regimen, animals were injected with 11.5 ml kg-1 of 500 mmol l-1 NaCl, and in the injection control (I) regimen, animals were injected with 11.5 ml kg-1 of 150 mmol l-1 NaCl. In the hypercapnia (H) regimen, the thermal gradient was flushed with a gas mixture containing 10 % CO2, 21 % O2 and 69 % N2, a treatment that lowers the arterial pH of D. dorsalis to a value comparable with that imposed by exhaustive exercise. A group of control (C) animals was left undisturbed in the thermal gradient for 24 h. Animals in all experimental groups were returned to the thermal gradient, and their cloacal temperatures were monitored until 08:00 h the following morning. The mean cloacal temperature of E animals underwent a significant decrease of 4-7 degrees C, relative to control animals, which persisted for 7 h. The mean cloacal temperatures of animals subjected to 2 h of regimen H also decreased by 3.5-9 degrees C and remained depressed for 12 h following the beginning of the treatment. L, O and I animals did not undergo a significant change in body temperature following treatment, and their mean body temperatures did not differ from those of C animals at any time during the experiment. The results of this study suggest that the metabolic acidosis, but not the elevated blood lactate level, that follows exhausting exercise might play a role in the behavioral hypothermia that follows exhausting exercise in D. dorsalis.
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PMID:The roles of acidosis and lactate in the behavioral hypothermia of exhausted lizards. 988 44

A brief review about the effects of hypothermia is presented, with regards to the difference between accidental hypothermia and controlled mild hypothermia (Core temperature = 33-35 degrees C). Mild hypothermia does not seem to affect the cardiac performance, while recent experimental reports show potential protective effects on the cardiac muscle during acute infarction. Mild hypothermia improve the outcome of brain function after cardiac arrest and head injury, while experimental reports show a potential protective effect of local spinal cord cooling during ischemic injury. Induced hypothermia of single organ is widely applied in liver resection and in other surgical procedures, further the cardiac ones. In the acute respiratory failure, mild hypothermia may induce a decrease in PaCO2, in sedated and muscle relaxed patients, due to the decrease of metabolic demand. In this setting a mild induced hypothermia potentially may decrease the side effects of therapeutic hypoventilation (permissive hypercapnia) both on haemodynamics and brain circulation. Preliminary data are presented about five ALI/ARDS patients, enclosed in a randomized trial, who were mechanically ventilated and cooled with an air-sheet: three patients died because of underlying disease and two patients survived with complete recovery. Mild controlled hypothermia seems to provide new interesting clinic uses.
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PMID:[Therapeutic applications of hypothermia in intensive care]. 1039 3

We assessed the seasonal variations in the effects of hypercarbia (3 or 5% inspired CO2) on cardiorespiratory responses in the bullfrog Rana catesbeiana at different temperatures (10, 20 and 30 degrees C). We measured breathing frequency, blood gases, acid-base status, hematocrit, heart rate, blood pressure and oxygen consumption. At 20 and 30 degrees C, the rate of oxygen consumption had a tendency to be lowest during winter and highest during summer. Hypercarbia-induced changes in breathing frequency were proportional to body temperature during summer and spring, but not during winter (20 and 30 degrees C). Moreover, during winter, the effects of CO2 on breathing frequency at 30 degrees C were smaller than during summer and spring. These facts indicate a decreased ventilatory sensitivity during winter. PaO2 and pHa showed no significant change during the year, but PaCO2 was almost twice as high during winter than in summer and spring, indicating increased plasma bicarbonate levels. The hematocrit values showed no significant changes induced by temperature, hypercarbia or season, indicating that the oxygen carrying capacity of blood is kept constant throughout the year. Decreased body temperature was accompanied by a reduction in heart rate during all four seasons, and a reduction in blood pressure during summer and spring. Blood pressure was higher during winter than during any other seasons whereas no seasonal change was observed in heart rate. This may indicate that peripheral resistance and/or stroke volume may be elevated during this season. Taken together, these results suggest that the decreased ventilatory sensitivity to hypercarbia during winter occurs while cardiovascular parameters are kept constant.
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PMID:Seasonal changes in the cardiorespiratory responses to hypercarbia and temperature in the bullfrog, Rana catesbeiana. 1062 62

In the immature brain, postischemic metabolism may be influenced beneficially by the effect of inducing hypercarbia or hypothermia. With use of 31P nuclear magnetic resonance spectroscopy, intracellular pH (pHi) and cellular energy metabolites in ex vivo neonatal rat cerebral cortex were measured before, during, and after substrate and oxygen deprivation in in vitro ischemia. Early postischemic hypothermia (fall in temperature -3.2 +/- 1.0 degrees C) delayed the normalization of pHi after ischemia by inducing an acid shift in pHi (P < 0.01). Postischemic hypercarbia (Krebs-Henseleit bicarbonate buffer equilibrated with 10% carbon dioxide in oxygen) and hypothermia induced separate, but potentially additive, reversible decreases in pHi, each of approximately -0.16 pH unit (P < 0.05). When these postischemic perturbations were applied in isolation, there was significant improvement of approximately 20% in the recovery of beta-ATP (P < 0.05). In combination, however, hypercarbia and hypothermia worsened recovery in ATP by approximately 20% (P < 0.05). In control tissue, which had not been exposed to ischemia, ATP content was also significantly reduced by co-administration of the two treatments (P < 0.05), an effect that persisted even after discontinuing the perturbing conditions. Therefore, in this vascular-independent neonatal preparation, early postischemic modulation of metabolism by hypercarbia or hypothermia appears to confer improved bioenergetic recovery, but only if they are not administered together.
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PMID:Hypercarbia and mild hypothermia, only when not combined, improve postischemic bioenergetic recovery in neonatal rat brain slices. 1072 25

This article reviews the relationship between pulmonary ventilation (VE) and metabolic rate (oxygen consumption) during changes in ambient temperature. The main focus is on mammals, although for comparative purposes the VE responses of ectothermic vertebrates are also discussed. First, the effects of temperature on pulmonary mechanics, chemoreceptors, and airway receptors are summarized. Then we review the main VE responses to cold and warm stimuli and their interaction with exercise, hypoxia, or hypercapnia. In these cases, mammals attempt to maintain both oxygenation and body temperature, although conflicts can arise because of the respiratory heat loss associated with the increase in ventilation. Finally, we consider the VE responses of mammals when body temperature changes, as during torpor, fever, sleep, and hypothermia. In ectotherms, during changes in temperature, VE control becomes part of a general strategy to maintain constant relative alkalinity and ensure a constancy of pH-dependent protein functions (alphastat regulation). In mammals on the other hand, VE control is aimed to balance metabolic needs with homeothermy. Therefore, alphastat regulation in mammals seems to have a low priority, and it may be adopted only in exceptional cases.
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PMID:Ventilatory responses to changes in temperature in mammals and other vertebrates. 1084 14

The median annual mortality from snow avalanches registered in Europe and North America 1981-1998 was 146 (range 82-226); trend stable in Alpine countries (r=-0.29; P=0.24), increasing in North America (r=0.68; P=0.002). Swiss data over the same period document 1886 avalanche victims, with an overall mortality rate of 52.4% in completely-buried, versus 4.2% in partially-, or non-buried, persons. Survival probability in completely-buried victims in open areas (n=638) plummets from 91% 18 min after burial to 34% at 35 min, then remains fairly constant until a second drop after 90 min. Likewise, survival probability for completely-buried victims in buildings or on roads (n=97) decreases rapidly following burial initially, but as from 35 min it is significantly higher than that for victims in open areas, with a maximum difference in respective survival probability (31% versus 7%) from 130 to 190 min (P<0.001). Standardised guidelines are introduced for the field management of avalanche victims. Strategy by rescuers confronted with the triad hypoxia, hypercapnia and hypothermia is primarily governed by the length of snow burial and victim's core temperature, in the absence of obviously fatal injuries. With a burial time < or =35 min survival depends on preventing asphyxia by rapid extrication and immediate airway management; cardiopulmonary resuscitation for unconscious victims without spontaneous respiration. With a burial time >35 min combating hypothermia becomes of paramount importance. Thus, gentle extrication, ECG and core temperature monitoring and body insulation are mandatory; unresponsive victims should be intubated and pulseless victims with core temperature <32 degrees C (89.6 degrees F) (prerequisites being an air pocket and free airways) transported with continuous cardiopulmonary resuscitation to a specialist hospital for extracorporeal re-warming.
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PMID:Field management of avalanche victims. 1171 68

The present study examined the effects of severe hypothermia in the absence of anesthesia on breathing pattern, ventilatory control and chemosensitivity in a cold tolerant species capable of seasonal hibernation. Hypothermia was induced in ground squirrels and ventilation and heart rate were recorded in animals breathing air at a body temperature (Tb) of 5 and 10 degrees C. The animals were then exposed to hypercapnic (2, 4 and 6% CO(2)) and hypoxic (12, 10, 8 and 4% O(2)) gas mixtures. We found that severe hypothermia in ground squirrels caused the breathing pattern to change from a continuous pattern to patterns that are commonly observed during hibernation. This suggests that temperature and metabolism alone are important factors in producing these patterns. The relative ventilatory sensitivity to hypercapnia was retained in the ground squirrel during hypothermia while ventilatory sensitivity to hypoxia was totally abolished. This is in contrast to hibernation where a small but significant hypoxic ventilatory response is present along with an enhanced relative response to hypercapnia. This suggests that changes in Tb alone can not account for the changes seen in ventilatory sensitivity during hibernation.
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PMID:Ventilatory pattern and chemosensitivity in unanesthetized, hypothermic ground squirrels (Spermophilus lateralis). 1238 31

A disabled submarine (DISSUB) lacking power and/or environmental control will become cold, and the ambient air may become hypercapnic and hypoxic. This study examined if the combination of hypoxia, hypercapnia, and cold exposure would adversely affect thermoregulatory responses to acute cold exposure in survivors awaiting rescue. Seven male submariners (33 +/- 6 yrs) completed a series of cold-air tests (CAT) that consisted of 20-min at T(air) = 22 degrees C, followed by a linear decline (1 degrees C x min(-1)) in T(air) to 12 degrees C, which was then held constant for an additional 150-min. CAT were performed under normoxic, normocapnic conditions (D0), acute hypoxia (D1, 16.75% O2), after 4 days of chronic hypoxia, hypercapnia and cold (D5, 16.75% O2, 2.5% CO2, 4 degrees C), and hypoxia-only again (D8, 16.75% O2). The deltaTsk during CAT was larger (P < 0.05) on D0 (-5.2 degrees C), vs. D1 (-4.8 degrees C), D5 (-4.5 degrees C), and D8 (-4.4 degrees C). The change (relative to 0-min) in metabolic heat production (deltaM) at 20-min of CAT was lower (P < 0.05) on D1, D5, and D8, vs. D0, with no differences between D1, D5 and D8. DeltaM was not different among trials at any time point after 20-min. The mean body temperature threshold for the onset of shivering was lower on D1 (35.08 degrees C), D5 (34.85 degrees C), and D8 (34.69 degrees C), compared to D0 (36.01 degrees C). Changes in heat storage did not differ among trials and rectal temperature was not different in D0 vs. D1, D5, and D8. Thus, mild hypoxia (16.75% F1O2) impairs vasoconstrictor and initial shivering responses, but the addition of elevated F1CO2 and cold had no further effect. These thermoregulatory effector changes do not increase the risk for hypothermia in DISSUB survivors who are adequately clothed.
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PMID:Physiological responses to cold exposure in men: a disabled submarine study. 1267 Jan 21

Snow avalanche case reports have documented the survival of skiers apparently without permanent hypoxic sequelae, after prolonged complete burial despite there being only a small air pocket on extrication. We investigated the underlying pathophysiological changes in a prospective, randomised 2 x 2 crossover study in 12 volunteers (28 tests) breathing into an artificial air pocket (1- or 2-l volume) in snow. Peripheral SpO(2), ETCO(2), arterialised capillary blood variables, air pocket O(2) and CO(2), snow density, and snow conditions at the inner surface of the air pocket were determined. SpO(2) decreased from a median of 99% (93-100%) to 88% (71-94%; P<0.001) within 4 min of breathing into the air pocket; the reduction was greater at 1 l, than 2 l, volume air pocket (P=0.013, intention to treat P=0.003) and correlated to snow density (r=0.50, P=0.021, partial correlation coefficient). ETCO(2) rose simultaneously from median 5.07 kPa (3.47-6.93 kPa) to 6.8 kPa (5.87-8.27 kPa; P<0.001), with consequent respiratory acidosis. Despite premature interruption due to hypoxia (SpO(2)</=75%) in 17 of 28 tests (61%), a respiratory steady state prevailed in five tests until protocol completion (30 min). We conclude that the degree of hypoxia following avalanche burial is dependent on air pocket volume, snow density and unknown individual personal characteristics, yet long-term survival is possible with only a small air pocket. Hence, the definition of an air pocket, "any space surrounding mouth and nose with the proviso of free air passages" is validated as the main criterion for triage and management of avalanche victims. Our experimental model will facilitate evaluating the interrelation between volume and inner surface area of an air pocket for survival of avalanche victims, whilst the present findings have laid the basis for future investigation of possible interactions between hypoxia, hypercapnia, and hypothermia (triple H syndrome) in snow burial.
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PMID:Hypoxia and hypercapnia during respiration into an artificial air pocket in snow: implications for avalanche survival. 1286 13


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