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Mild Hypothermia (mild + hypothermia)
Selected AbstractsSurface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines EfficacyACADEMIC EMERGENCY MEDICINE, Issue 4 2010Thomas Uray MD Abstract Objectives:, Recently, a novel cooling pad was developed for rapid induction of mild hypothermia after cardiac arrest. The aim of this study was to evaluate the cooling efficacy of three different pad designs for in-hospital cooling. Methods:, Included in this prospective interventional study were patients with esophageal temperature (Tes) > 34°C on admission. The cooling pad consists of multiple cooling units, filled with a combination of graphite and water, which is precooled to ,18°C (design A) or to ,9°C (designs B and C) before use. The designs of the cooling pad differed in number, shape, and thickness of the cooling units, with weights of 9.7 kg (design A), 5.3 kg (design B), and 6.2 kg (design C). All three designs were tested in sequential order and were changed according to the results found in the previous trial. Cooling was started after admission until Tes = 34°C, when the cooling pad was removed. The target temperature of Tes = 32,34°C was maintained for 24 hours. Data are presented as medians and interquartile ranges (IQRs = 25%,75%) or proportions. Results:, Cooling rates were 3.4°C/hour (IQR = 2.5,3.7) with design A (n = 12), 2.8°C/hour (IQR = 1.6,3.3) with design B (n = 7), and 2.9°C/hour (IQR = 1.9,3.6) with design C (n = 10; p = 0.5). To reach 34°C, the cooling pad had to be exchanged with a new one due to melting and therefore depleting cooling capacity in three patients with design A, in five patients with design B, and in no patient with design C (p = 0.004). Conclusions:, With adequate design and storage temperature, the cooling pad proved to be efficient for rapid in-hospital cooling of patients resuscitated from cardiac arrest. ACADEMIC EMERGENCY MEDICINE 2010; 17:360,367 © 2010 by the Society for Academic Emergency Medicine [source] Correlation and agreement between the bispectral index vs. state entropy during hypothermic cardio-pulmonary bypassACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010P. MEYBOHM Background: The bispectral index (BIS) and spectral entropy enable monitoring the depth of anaesthesia. Mild hypothermia has been shown to affect the ability of electroencephalography monitors to reflect the anaesthetic drug effect. The purpose of this study was to investigate the effect of hypothermia during a cardio-pulmonary bypass on the correlation and agreement between the BIS and entropy variables compared with normothermic conditions. Methods: This prospective clinical study included coronary artery bypass grafting patients (n=25) evaluating correlation and agreement (Bland,Altman analysis) between the BIS and both spectral and response entropy during a hypothermic cardio-pulmonary bypass (31,34 °C) compared with nomothermic conditions (34,37.5 °C). Anaesthesia was maintained with propofol and sufentanil and adjusted clinically, while the anaesthetist was blinded to the monitors. Results: The BIS and entropy values decreased during cooling (P<0.05), but the decrease was more pronounced for entropy variables compared with BIS (P<0.05). The correlation coefficients (bias±SD; percentage error) between the BIS vs. spectral state entropy and response entropy were r2=0.56 (1±11; 42%) and r2=0.58 (,2±11; 43%) under normothermic conditions, and r2=0.17 (10±12; 77%) and r2=0.18 (9±11; 68%) under hypothermic conditions, respectively. Bias was significantly increased under hypothermic conditions (P<0.001 vs. normothermia). Conclusion: Acceptable agreement was observed between the BIS and entropy variables under normothermic but not under hypothermic conditions. The BIS and entropy variables may therefore not be interchangeable during a hypothermic cardio-pulmonary bypass. [source] Mild hypothermia inhibits IL-10 production in peripheral blood mononuclear cellsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2004T. Matsui Background:, Hypothermia is often associated with compromised host defenses and infections. Deterioration of immune functions related to hypothermia have been investigated, but the involvement of cytokines in host defense mechanisms and in infection remains unclear. Therefore, we determined whether mild hypothermia affects the production of several types of cytokines in peripheral blood mononuclear cells (PBMCs), and the balance between pro-inflammatory and anti-inflammatory states. Methods:, PBMCs obtained from 12 healthy humans were cultured with phytohemagglutinin (PHA) in normothermic (37°C: control) or hypothermic (33°C) conditions for 24 h. The production levels of tumor necrosis factor (TNF)-,, the interleukins (ILs) IL-6, IL-8 and IL-10, and interferon (IFN)-, in the culture supernatants were measured by means of enzyme-linked immunosorbent assay (ELISA). Results:, Under hypothermic conditions (33°C), PHA-induced production of IL-10 and IFN-, in PBMCs was significantly lower, by 34% and 84%, respectively, when compared with controls, while production of TNF-,, IL-6 and IL-8 did not change. The magnitude of reduction of IL-10 in hypothermic conditions resulted in IL-10/pro-inflammatory cytokine ratios decreasing to approximately 30,45% of those of controls. Conclusions:, The present study clearly demonstrates that mild hypothermia (33°C) inhibits IL-10 and IFN-, production in cultured PBMCs. The profound inhibition of IL-10 and the pro-inflammatory reaction-dominated state induced suggests that the host defense mechanism against secondary infection may be maintained rather than inhibited in hypothermia. Thus, the reduction of IL-10 could be an important characteristic of immune responses in mild hypothermia. [source] Hypothetical pathophysiology of acute encephalopathy and encephalitis related to influenza virus infection and hypothermia therapyPEDIATRICS INTERNATIONAL, Issue 2 2000Shumpei Yokota AbstractBackground: To establish a treatment strategy for acute encephalopathy and encephalitis associated with influenza virus infection, the pathophysiology of the disease was investigated through manifestations and laboratory findings of patients. Patients and Methods: A child with central nervous system (CNS) complications during the course of influenza virus infection was analyzed in view of immunologic abnormalities. In addition, four children with acute encephalopathy and encephalitis were enrolled in the hypothermia treatment for the purpose of stabilizing the cytokine storm in the CNS. Results: The CNS symptoms preceded the systemic progression to the failure of multiple organs (MOF) and disseminated intravascular coagulopathy (DIC). The mild hypothermia suppressed the brain edema on computed tomography (CT) scanning and protected the brain from the subsequent irreversible neural cell damage. Conclusion: The replicated viruses at the nasopharyngeal epithelium may disrupt the olfactory mucosa and gain access to the brain via the olfactory nerve system. The direct virus,glial cell interaction or viral stimulation of the glial cells induces the production and accumulation of the pro-inflammatory cytokines, especially tumor necrosis factor (TNF)-,, in the CNS. The cytokine storm results in neural cell damage as well as the apoptosis of astrocytes, due to the TNF-,,induced mitochondrial respiratory failure. The disruption of the blood,brain barrier progresses to the systemic cytokine storm, resulting in DIC and MOF. Mild hypothermia appears promising in stabilizing the immune activation and the brain edema to protect the brain from ongoing functional, apoptotic neural and glial damage and the systemic expansion of the cytokine storm. [source] Cardiac function during mild hypothermia in pigs: increased inotropy at the expense of diastolic dysfunctionACTA PHYSIOLOGICA, Issue 1 2010H. Post Abstract Aim:, The induction of mild hypothermia (MH; 33 °C) has become the guideline therapy to attenuate hypoxic brain injury after out-of-hospital cardiopulmonary resuscitation. While MH exerts a positive inotropic effect in vitro, MH reduces cardiac output in vivo and is thus discussed critically when severe cardiac dysfunction is present in patients. We thus assessed the effect of MH on the function of the normal heart in an in vivo model closely mimicking the clinical setting. Methods:, Ten anaesthetized, female human-sized pigs were acutely catheterized for measurement of pressure,volume loops (conductance catheter), cardiac output (Swan-Ganz catheter) and for vena cava inferior occlusion. Controlled MH (from 37 to 33 °C) was induced by a vena cava inferior cooling catheter. Results:, With MH, heart rate (HR) and whole body oxygen consumption decreased, while lactate levels remained normal. Cardiac output, left ventricular (LV) volumes, peak systolic and end-diastolic pressure and dP/dtmax did not change significantly. Changes in dP/dtmin and the time constant of isovolumetric relaxation demonstrated impaired active relaxation. In addition, MH prolonged the systolic and shortened the diastolic time interval. Pressure,volume analysis revealed increased end-systolic and end-diastolic stiffness, indicating positive inotropy and reduced end-diastolic distensibility. Positive inotropy was preserved during pacing, while LV end-diastolic pressure increased and diastolic filling was substantially impaired due to delayed LV relaxation. Conclusion:, MH negatively affects diastolic function, which, however, is compensated for by decreased spontaneous HR. Positive inotropy and a decrease in whole body oxygen consumption warrant further studies addressing the potential benefit of MH on the acutely failing heart. [source] Biochemical insights into the mechanisms central to the response of mammalian cells to cold stress and subsequent rewarmingFEBS JOURNAL, Issue 1 2009Anne Roobol Mammalian cells cultured in vitro are able to recover from cold stress. However, the mechanisms activated during cold stress and recovery are still being determined. We here report the effects of hypothermia on cellular architecture, cell cycle progression, mRNA stability, protein synthesis and degradation in three mammalian cell lines. The cellular structures examined were, in general, well maintained during mild hypothermia (27,32 °C) but became increasingly disrupted at low temperatures (4,10 °C). The degradation rates of all mRNAs and proteins examined were much reduced at 27 °C, and overall protein synthesis rates were gradually reduced with temperature down to 20 °C. Proteins involved in a range of cellular activities were either upregulated or downregulated at 32 and 27 °C during cold stress and recovery. Many of these proteins were molecular chaperones, but they did not include the inducible heat shock protein Hsp72. Further detailed investigation of specific proteins revealed that the responses to cold stress and recovery are at least partially controlled by modulation of p53, Grp75 and eIF3i levels. Furthermore, under conditions of severe cold stress (4 °C), lipid-containing structures were observed that appeared to be in the process of being secreted from the cell that were not observed at less severe cold stress temperatures. Our findings shed light on the mechanisms involved and activated in mammalian cells upon cold stress and recovery. [source] On the Future of Reanimatology,ACADEMIC EMERGENCY MEDICINE, Issue 1 2000Peter Safar MD Abstract: This article is adapted from a presentation given at the 1999 SAEM annual meeting by Dr. Peter Safar. Dr. Safar has been involved in resuscitation research for 44 years, and is a distinguished professor and past initiating chairman of the Department of Anesthesiology and Critical Care Medicine at the University of Pittsburgh. He is the founder and director of the Safar Center for Resuscitation Research at the University of Pittsburgh, and has been the research mentor of many critical care and emergency medicine research fellows. Here he presents a brief history of past accomplishments, recent findings, and future potentials for resuscitation research. Additional advances in resuscitation, from acute terminal states and clinical death, will build upon the lessons learned from the history of reanimatology, including optimal delivery by emergency medical services of already documented cardiopulmonary cerebral resuscitation, basic-advanced,prolonged life support, and future scientific breakthroughs. Current controversies, such as how to best educate the public in life-supporting first aid, how to restore normotensive spontaneous circulation after cardiac arrest, how to rapidly induce mild hypothermia for cerebral protection, and how to minimize secondary insult after cerebral ischemia, are discussed, and must be resolved if advances are to be made. Dr. Safar also summarizes future technologies already under preliminary investigation, such as ultra-advanced life support for reversing prolonged cardiac arrest, extending the "golden hour" of shock tolerance, and suspended animation for delayed resuscitation. [source] Surface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines EfficacyACADEMIC EMERGENCY MEDICINE, Issue 4 2010Thomas Uray MD Abstract Objectives:, Recently, a novel cooling pad was developed for rapid induction of mild hypothermia after cardiac arrest. The aim of this study was to evaluate the cooling efficacy of three different pad designs for in-hospital cooling. Methods:, Included in this prospective interventional study were patients with esophageal temperature (Tes) > 34°C on admission. The cooling pad consists of multiple cooling units, filled with a combination of graphite and water, which is precooled to ,18°C (design A) or to ,9°C (designs B and C) before use. The designs of the cooling pad differed in number, shape, and thickness of the cooling units, with weights of 9.7 kg (design A), 5.3 kg (design B), and 6.2 kg (design C). All three designs were tested in sequential order and were changed according to the results found in the previous trial. Cooling was started after admission until Tes = 34°C, when the cooling pad was removed. The target temperature of Tes = 32,34°C was maintained for 24 hours. Data are presented as medians and interquartile ranges (IQRs = 25%,75%) or proportions. Results:, Cooling rates were 3.4°C/hour (IQR = 2.5,3.7) with design A (n = 12), 2.8°C/hour (IQR = 1.6,3.3) with design B (n = 7), and 2.9°C/hour (IQR = 1.9,3.6) with design C (n = 10; p = 0.5). To reach 34°C, the cooling pad had to be exchanged with a new one due to melting and therefore depleting cooling capacity in three patients with design A, in five patients with design B, and in no patient with design C (p = 0.004). Conclusions:, With adequate design and storage temperature, the cooling pad proved to be efficient for rapid in-hospital cooling of patients resuscitated from cardiac arrest. ACADEMIC EMERGENCY MEDICINE 2010; 17:360,367 © 2010 by the Society for Academic Emergency Medicine [source] Pre-hospital cardiac arrest and induction of mild hypothermia: studies on epidemiology and feasibilityACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010A. Kämäräinen No abstract is available for this article. [source] Noninvasive Control of Adequate Cerebral Oxygenation During Low-Flow Antegrade Selective Cerebral Perfusion on Adults and Infants in the Aortic Arch SurgeryJOURNAL OF CARDIAC SURGERY, Issue 5 2008Álvaro Rubio M.D. Background: Aortic arch repair techniques using low-flow antegrade selective cerebral perfusion have been standardized to a certain degree. However, some of the often-stated beneficial effects have never been proven. Especially, the existence of an adequate continuous flow in both cerebral hemispheres during the surgical procedure still remains unclear as the monitoring of an effective perfusion remains a nonstandardized technique. Methods: Seventeen patients underwent surgical reconstruction of the aortic arch due to aortic aneurysm surgery (adult group n = 8 patients) or of the hypoplastic aortic arch due to hypoplastic left heart syndrome (HLHS) or aortic coarctation (infant group n = 9 patients) under general anesthesia and mild hypothermia (adult group 28 °C; infant group 25 °C). Mean weights were 92.75 ± 14.00 kg and 4.29 ± 1.32 kg, and mean ages were 58.25 ± 10.19 years and 55.67 ± 51.11 days in the adult group and the infant group, respectively. The cerebral O2 saturation measurement was performed by continuous plotting of the somatic reflectance oximetry of the frontal regional tissue on both cerebral hemispheres (rSO2, INVOS®; Somanetics Corporation, Troy, MI, USA). Results: During low-flow antegrade perfusion via innominate artery, continuous plots with similar values of O2 saturation (rSO2) in both cerebral hemispheres were observed, whereas a decrease in the rSO2 values below the desaturation threshold correlated with a displacement or an incorrect positioning of the arterial cannula in the right subclavian artery. Conclusions: Continuous monitorization of the cerebral O2 saturation during aortic arch surgery in adults and infants is a feasible technique to control an adequate cannula positioning and to optimize clinical outcomes avoiding neurological complications related to cerebral malperfusion. [source] Intracerebral monitoring in comatose patients treated with hypothermia after a cardiac arrestACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009J. NORDMARK Background: Induced mild hypothermia (32,34 °C) has proven to reduce ischemic brain injury and improve outcome after a cardiac arrest (CA). The aim of this investigation was to study the occurrence of increased intracranial pressure (ICP) and neurochemical metabolic changes indicating cerebral ischemia, after CA and cardiopulmonary resuscitation (CPR), when induced hypothermia was applied. Methods: ICP, brain chemistry and brain temperature were monitored during induced hypothermia and re-warming in four adult unconscious patients with restoration of spontaneous circulation after CA and CPR. Results: ICP was occasionally above 20 mmHg. Neurochemical changes indicating cerebral ischemia (increased lactate/pyruvate ratio) and excitoxicity (increased glutamate) were found after CA, and signs of ischemia were also observed during the re-warming phase. A biphasic increase in glycerol was seen, which may have been a result of both membrane degradation and overspill from the general circulation. Conclusions: Intracerebral microdialysis and ICP monitoring may be used in selected patients not requiring anticoagulants and PCI to obtain information regarding the common disturbances of intracranial dynamics after CA. The results of this study underline the importance of inducing hypothermia quickly after CA and emphasize the need for developing tools for guidance of the re-warming. [source] Mechanism of the protective effect of hypothermia on ammonia toxicity in astrocytesJOURNAL OF NEUROCHEMISTRY, Issue 2002C. Zwingmann Ammonia is a key factor in the pathogenesis of hepatic encephalopathy (HE). Acute ammonia treatment causes energy failure of astrocytes, which are able to compensate partly by increased anaerobic metabolism as a means of making up for the energetic shortfall. As hypothermia offers protection from severe encephalopathy and lactate accumulation in liver failure, we investigated the mechanism by which hypothermia protects against ammonia toxicity by multinuclear NMR spectroscopy. 12 h exposure to 5 mm NH4CL decreased the phosphocreatine (PCr)/creatine (Cr) and ATP/ADP ratios to 65 and 76% of control, increased synthesis and release of glutamine to 200,250% and led to a significant stimulation of glycolytic activity reflected by increased uptake and consumption of glucose and accumulation of de novo synthesized intra- and extracellular lactate to 161 and 230% of control. The protective effect of mild hypothermia was evident from inhibiton of lactate accumulation and restoration of ammonia-induced depletion of PCr/Cr. Moderate hypothermia led to an increase of PCr/Cr ratio and inhibited lactate synthesis to 14% of normothermic control, but did not prevent the ATP decrease. While hypothermia inhibited glycolytic flux, intracellular glutamine remained elevated. The results suggest that hypothermia-induced protection against ammonia toxicity results from reduction of cellular energy demand leading to inhibition of anaerobic glucose metabolism and a compensatory stimulation of mitochondrial energy production. Acknowledgements:, Funded by CIHR Canada. [source] Neuroprotective effect of hypothermia at defined intraischemic time courses in cortical culturesJOURNAL OF NEUROSCIENCE RESEARCH, Issue 6 2001Sriranganathan Varathan Abstract Many experimental and clinical studies have shown that hypothermia confers cerebroprotective benefits against ischemic insults. Because of the many conflicting reports on hypothermic neuroprotection, we undertook this cellular study to identify the optimal temperature or a range of temperatures for maximal neuroprotection at different times (6,24 hr) during ischemic insults. Cultured Wistar rat cortical neurons were exposed to oxygen deprivation at defined times and temperatures (37°C normothermia, 32°C mild hypothermia, 27°C moderate hypothermia, 22°C deep hypothermia, and 17°C profound hypothermia). The survival rate of neurons was evaluated by assessing viable neurons on photomicrographs. The normothermic group demonstrated a significantly lower survival rate of cultured neurons (6 hr, 80.3% ± 2.7%; 12 hr, 56.1% ± 2.1%; 18 hr, 34.2% ± 1%; 24 hr, 18.1% ± 2.2%) compared to hypothermic groups (P < 0.001). The survival rate for the profound hypothermic group was significantly reduced (P < 0.01) compared to other hypothermic groups (at 17°C: 12 hr, 85.9% ± 2.5%, 18 hr, 74.7% ± 3.7%, 24 hr, 58.7% ± 2.7%). Almost equal survival rates were observed among mild, moderate, and deep hypothermic groups following <18 hr exposure to hypoxia, but the deep hypothermic group showed a significantly higher survival rate (84.1% ± 1.6%; P < 0.001) when subjected to hypoxia for 24 hr. In conclusion, hypothermia offers marked neuroprotection against hypoxia, but attenuation of neuronal cell death was less with profound hypothermia compared to mild, moderate, and deep hypothermia. Deep hypothermia affords maximal protection of neurons compared to mild and moderate hypothermia during long-lasting hypoxia (>18 hr). J. Neurosci. Res. 65:583,590, 2001. © 2001 Wiley-Liss, Inc. [source] Maintenance of integrity and function of isolated hepatocytes during extended suspension culture at 25°CLIVER INTERNATIONAL, Issue 3 2003Alan J. Wigg Abstract: Isolated hepatocytes in suspension provide a number of advantages for use in bioartificial liver device, however, poor stability of this cell preparation at physiological temperatures is an apparent barrier preventing their use. We therefore investigated the integrity and differentiated function of isolated rat hepatocytes under conditions of mild hypothermia. Isolated hepatocytes were suspended in a bicarbonate buffered saline medium, supplemented with glucose and bovine serum albumin (BSA), and maintained for 48 h at 25 °C on a rotary shaker under an atmosphere of 95% O2 and 5% CO2. Under these conditions there was no significant decline in cell viability and good preservation of cellular morphology on transmission electron microscopy for at least 24 h. Isolated hepatocytes in suspension at 25 °C were also able to maintain normal Na + and K + ion gradients. The cellular energy status ([ATP], ATP/ADP ratio, cytoplasmic and mitochondrial redox potentials), metabolic function (urea synthesis and ammonia removal), albumin synthesis and phase I and phase II drug detoxification activity of these cells were also maintained for at least 24 h post isolation. These observations demonstrate the robust nature of mildly hypothermic isolated hepatocytes in suspension and encourage further studies re-examining the feasibility of using this cell preparation in bioartificial livers. [source] Mild hypothermia inhibits IL-10 production in peripheral blood mononuclear cellsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2004T. Matsui Background:, Hypothermia is often associated with compromised host defenses and infections. Deterioration of immune functions related to hypothermia have been investigated, but the involvement of cytokines in host defense mechanisms and in infection remains unclear. Therefore, we determined whether mild hypothermia affects the production of several types of cytokines in peripheral blood mononuclear cells (PBMCs), and the balance between pro-inflammatory and anti-inflammatory states. Methods:, PBMCs obtained from 12 healthy humans were cultured with phytohemagglutinin (PHA) in normothermic (37°C: control) or hypothermic (33°C) conditions for 24 h. The production levels of tumor necrosis factor (TNF)-,, the interleukins (ILs) IL-6, IL-8 and IL-10, and interferon (IFN)-, in the culture supernatants were measured by means of enzyme-linked immunosorbent assay (ELISA). Results:, Under hypothermic conditions (33°C), PHA-induced production of IL-10 and IFN-, in PBMCs was significantly lower, by 34% and 84%, respectively, when compared with controls, while production of TNF-,, IL-6 and IL-8 did not change. The magnitude of reduction of IL-10 in hypothermic conditions resulted in IL-10/pro-inflammatory cytokine ratios decreasing to approximately 30,45% of those of controls. Conclusions:, The present study clearly demonstrates that mild hypothermia (33°C) inhibits IL-10 and IFN-, production in cultured PBMCs. The profound inhibition of IL-10 and the pro-inflammatory reaction-dominated state induced suggests that the host defense mechanism against secondary infection may be maintained rather than inhibited in hypothermia. Thus, the reduction of IL-10 could be an important characteristic of immune responses in mild hypothermia. [source] The anaesthetic management of patients with congenital insensitivity to pain with anhidrosisPEDIATRIC ANESTHESIA, Issue 4 2004V. Rozentsveig MD Summary Background :,Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, related to a mutation in the TrkA gene, characterized by inability to sweat, insensitivity to pain and recurrent episodes of hyperpyrexia. There are two Bedouin tribes in Israel with different mutations of the TrkA gene: one in the southern region and the other in the northern region. The Soroka University Medical Center is the referral centre for the entire southern region of Israel. One in 4500 anaesthesia cases involves a patient with CIPA. Methods :,We reviewed 40 anaesthesia records of 20 patients with CIPA for anaesthetic technique and incidence of side-effects. Results :,Sixteen patients developed complications in the immediate perioperative period: mild hypothermia in one patient and cardiovascular events in 15 others with one case of cardiac arrest. These complications were unrelated to the anaesthetic drug administered. There were no events of hyperthermia or postoperative nausea. Conclusions :,Cardiovascular complications following anaesthesia are common in patients with the southern Israel variant of CIPA. Hyperthermia, previously recognized as a major concern in patients with congenital insensitivity to pain with anhydrous, was not seen in our patients. We conclude that cardiovascular involvement is frequently encountered in CIPA patients following anaesthesia and is the major concern in their anaesthetic management. [source] Passive induction of hypothermia during transport of asphyxiated infants: a risk of excessive coolingACTA PAEDIATRICA, Issue 6 2009Boubou Hallberg Abstract Background: Induced mild hypothermia is an emerging therapy that has been shown to reduce the combined outcome of death or severe neurodevelopmental disabilities in asphyxiated full-term infants if started within 6 h after birth. Aim: To study the feasibility and safety of inducing hypothermia in asphyxiated infants already at the referring hospital by stopping active warming. Methods: Temperatures during passive induction of hypothermia were prospectively collected from transported asphyxiated infants. Results: Between December 2006 and April 2008, 37 infants of the total birth cohort of 40 350 fulfilled the criteria for hypothermia treatment. Eighteen of 34 infants treated with induced hypothermia were outborn. The rectal temperatures of the infants were 33.0,36.4°C before transport and 31.0,36.5°C on arrival. Six of the infants had a sub-therapeutic (<33.0°C) rectal temperature on arrival. Conclusion: Passive induction of hypothermia by turning off active warming devices is possible, making an earlier start of hypothermia achievable. However, there is a substantial risk of unintended excessive cooling; therefore, continuous monitoring of the central temperature is mandatory when such a strategy is used. 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