A hypothermic, low flow perfusion, using 5% dextrose in water as the priming fluid in the pump-oxygenator, was carried out to observe oxygen consumption, blood pH changes, and CO2 tension during the bypass period. A low oxygen consumption which was approximately one third of the preperfusion value, was observed during the total by-pass period. This is believed to be due to the effect of low flow rates employed, hypothermia and low CO2 tension observed in these animals. The pH of the arterial blood and the partition of the total CO2 remained within a fairly normal range. There was a marked reduction in CO2 tension during the bypass period. Its harmful effect on the oxyhemoglobin dissociation curve and cerebral circulation was discussed. The hemodilution attendant to the use of 5% dextrose in water as the priming fluid is considered insignificant.
Animals ; Dogs ; Glucose/*adverse effects ; *Heart-Lung Machine ; *Hypothermia, Induced ; Plasma Substitutes/*adverse effects

Randomized controlled trials have demonstrated the safety and efficacy of mild hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE), which can reduce mortality or the incidence of severe neurological sequelae. Mild hypothermia has been used in the neonatal intensive care unit (NICU) as a routine treatment method for neonatal HIE in many developed countries, and it is increasingly applied in some NICUs in China. However, 40%-50% of the neonates treated with mild hypothermia die or develop severe neurological disability. Thus, to achieve the best neuroprotective effect, issues such as selection of patients with indications for mild hypothermia, cooling method, optimal time for mild hypothermia, duration of mild hypothermia, optimal target temperature, and the safety and long-term effects of mild hypothermia combined with other therapies, need to be further discussed. This article reviews the latest progress in clinical research on these issues.
Humans ; Hypothermia, Induced ; adverse effects ; methods ; Hypoxia-Ischemia, Brain ; therapy ; Infant, Newborn

OBJECTIVETo investigate the clinical characteristics and significance of thrombocytopenia after therapeutic hypothermia in severe traumatic brain injury (TBI).

METHODSNinety-six inpatients with severe brain injury were randomized into three groups: SBC (selective brain cooling) group (n=24), MSH (mild systemic hypothermia) group (n=30), and control (normothermia) group (n=42). The platelet counts and prognosis were retrospectively analyzed.

RESULTSThrombocytopenia was present in 18 (75%), 23 (77%) and 15 (36%) patients in SBC group, MSH group and control group, respectively (P<0.01). Thrombocytopenia, in which the minimum platelet count was seen 3 days after hypothermia, showed no significant difference between SBC and MSH group (P>0.05). Most platelet counts (37 cases, 90%) in hypothermia group were returned to normal level after 1 to 2 days of natural rewarming. The platelet count in SBC group reduced by 16%, 27% and 29% at day 1, 3 and 5 respectively compared with the baseline value. Good recovery (GOS score 4-5) rate of thrombocytopenia 1 year after injury for hypothermia group (17 cases, 37%) was significantly lower than that of control group (P<0.01).

CONCLUSIONSTherapeutic hypothermia increases the incidence of thrombocytopenia in severe TBI, and patients with thrombocytopenia after therapeutic hypothermia are associated with unfavorable neurological prognosis.

Adult ; Brain Injuries ; therapy ; Female ; Humans ; Hypothermia, Induced ; adverse effects ; Male ; Middle Aged ; Prognosis ; Thrombocytopenia ; etiology

Adult ; Circulatory Arrest, Deep Hypothermia Induced ; adverse effects ; Humans ; Male ; Rhabdomyolysis ; diagnosis ; etiology

Animals ; Female ; Gonads ; physiopathology ; Hypothermia ; chemically induced ; physiopathology ; Male ; Rats ; Rats, Wistar ; Sex Factors ; Soman ; adverse effects ; pharmacology

OBJECTIVETo systematically evaluate the long-term clinical efficacy and safety of mild hypothermia therapy in neonates with hypoxic-ischemic encephalopathy (HIE).

METHODSAll randomized controlled trials (RCTs) of mild hypothermia therapy for neonatal HIE from inception to March 2014 were retrieved from databases including Cochrane Library, PubMed, Embase, CBMdisc, and Wanfang Data. Meta analysis was performed using RevMan 5.1 Software.

RESULTSEight RCTs met the search criteria. The results of Meta analysis showed that, compared with the control group, systemic hypothermia significantly reduced the mortality rate and the incidence of growth delay (RR=0.73, 95% CI: 0.61-0.89; RR=0.70, 95%CI: 0.54-0.93); selective head or systemic hypothermia therapy significantly reduced the incidence of cerebral palsy (RR=0.65, 95%CI: 0.46-0.94; RR=0.67, 95%CI: 0.52-0.86) up to 12-24 months of age. One study reported that hypothermia reduced the mortality rate and the rate of a composite end point of death or severe disability compared with the control group at 6 to 7 years of age. The incidence of adverse events including sinus bradyarrhythmia, thrombocytopenia and hypoglycemia was significantly higher in the hypothermia group than in the control group, whereas the incidence of cardiac arrhythmia, hypotension, thrombosis or bleeding, hypokalemia, sepsis, and liver dysfunction showed no significant differences between the two groups.

CONCLUSIONSMild hypothermia therapy demonstrates a significant efficacy in children with HIE up to 12-24 months of age, but there is still a need for further research on childhood outcomes after mild hypothermia for neonatal HIE. This therapy has few adverse effects and a high clinical tolerability.

Child ; Child, Preschool ; Female ; Humans ; Hypothermia, Induced ; adverse effects ; Hypoxia-Ischemia, Brain ; mortality ; therapy ; Infant ; Infant, Newborn ; Male

Central diabetes insipidus (DI), characterized by unexpected fatal hypernatremia, is a rare complication after successful cardiopulmonary resuscitation with therapeutic hypothermia, but may be potentially fatal if recognition is delayed. We describe here a patient who experienced cardiac arrest due to a pulmonary embolism, followed by successful resuscitation after induction of therapeutic hypothermia. The patient, however, suddenly developed unexpected hypernatremia with increased urine output and was diagnosed with central DI as a complication of cerebral edema, and eventually died. Our findings suggest that central DI should be considered as a possible complication following unexpected hypernatremia with increased urine output during therapeutic hypothermia and that desmopressin acetate should be used to treat central DI.
Adult ; Cardiopulmonary Resuscitation/*adverse effects ; Diabetes Insipidus, Neurogenic/diagnosis/etiology ; Fatal Outcome ; Female ; Heart Arrest/complications/therapy ; Humans ; Hypernatremia/*etiology ; Hypothermia, Induced/*adverse effects ; Pulmonary Embolism/complications

OBJECTIVE: To explore the characteristics of post-operative pain following coblation tonsillectomy and/or adenoidectomy in children with sleep-disordered breathing (SDB) and explore the correlation between the first day post-operative pain scores and age and operating time. METHOD: 1) A total of 113 SDB children scheduled to undergo coblation tonsillectomy and/or adenoidectomy were recruited. 113 children were divided into two groups according to the method of operation, children who underwent coblation tonsillectomy and adenoidectomy were enrolled in study group one and children who underwent coblation adenoidectomy only were in study group two. Be sides, children of study group one with a history of chronic tonsillitis were in chronic tonsillitis group, children without a history of chronic tonsillitis were in non-chronic tonsillitis group. 2) The parents scored pain in their children on a VAS (anchored by "no pain" at 0 and "worst pain" at 10) in the morning, before using any analgesics and having breakfast, over the first 3 and the seventh post-operative days. 3) Post-operative pain scores were compared between both the study group one and two and chronic tonsillitis group and non-chronic tonsillitis group. Futhermore, the correlation between the first day post-operative pain scores and age and operating time were also analysed. RESULT: 1) The difference of post-operative pain scores over the first 3 and the seventh post-operative days were significant between the study group one and group two (P<0.05). 2) Non-chronic tonsillitis group were significantly less painful than chronic tonsillitis group on day 1, day 2 and day 7 (z=-2.004, -2.059, -2.334, P<0.05). But there was no significant difference in pain levels on day 3 (P>0.05). 3) The first day post-operative pain scores was correlated with age (r=0.273, P<0.01) and operating time (r=0.423, P<0.01). CONCLUSION The first day post-operative pain scores was correlated with age and operating time. Children with a history of chronic tonsillitis were more painful than children without the history.
Adenoidectomy ; adverse effects ; methods ; Child ; Child, Preschool ; Female ; Humans ; Hypothermia, Induced ; Male ; Pain Measurement ; Pain, Postoperative ; etiology ; Sleep Apnea Syndromes ; surgery ; Tonsillectomy ; adverse effects ; methods

BACKGROUNDDuring cardiac arrest, the gastrointestinal tract is sensitive to ischemia. Protection of the gastrointestinal tract is a critical factor in determining prognosis following cardiopulmonary resuscitation (CPR). This study seeks to determine the extent of gastrointestinal tract injury and the potential protective effect of inducing hypothermia following a porcine cardiac arrest model and CPR.

METHODSVentricular fibrillation was induced by programmed electrical stimulation in 16 male domestic pigs (n = 8 per group). Four minutes after ventricular fibrillation, CPR was performed. Pigs that successfully restored spontaneous circulation then received intravenous infusions of saline at either 4°C or room temperature to produce hypothermic and control conditions respectively. Serum diamine oxidase and gastrointestinal adenosine triphosphate enzyme activity were determined and histopathology of the gastrointestinal tract was performed by light microscopy and electron microscopy.

RESULTSSignificant injury of the gastrointestinal tract after CPR was found. Na(+)-K(+) and Ca(2+) adenosine triphosphate enzyme activity in the gastric tissue were significantly high in animals receiving hypothermia treatment compared to controls. Hypothermia also significantly reduced serum diamine oxidase after CPR compared to the control group. Moreover, severe injury sustained by the gastrointestinal tissue was significantly ameliorated under hypothermic conditions compared to controls.

CONCLUSIONSGastrointestinal injury and abnormal energy metabolism are strikingly evident following CPR. Hypothermia, which is induced by an infusion of 4°C saline, can rapidly reduce internal body temperature, improve energy metabolism, and ameliorate injury to the gastrointestinal mucosa after CPR.

Animals ; Cardiopulmonary Resuscitation ; adverse effects ; Disease Models, Animal ; Energy Metabolism ; Gastrointestinal Tract ; injuries ; Heart Arrest ; therapy ; Hypothermia, Induced ; methods ; Male ; Swine

Adult ; Chorea ; etiology ; Circulatory Arrest, Deep Hypothermia Induced ; Diffusion Magnetic Resonance Imaging ; Endarterectomy ; adverse effects ; methods ; Humans ; Male ; Pulmonary Embolism ; surgery