1/11. Fatal severe vasospasm due to rewarming following hypothermia--case report.A 37-year-old female died of cerebral vasospasm as a complication of rewarming following hypothermia therapy for severe head injury. She presented with severe consciousness disturbance and anisocoria after falling down a flight of stairs. Computed tomography (CT) revealed a right acute subdural hematoma and temporal contusion. Following surgery, mild hypothermia was started and rewarming was completed by the 11th day. Neurological examination showed no abnormalities, but intracranial pressure (ICP) suddenly increased and she manifested anisocoria on the 13th day. Repeat CT revealed a low density area in the right middle cerebral artery region and cerebral angiography showed diffuse narrowing of the main arterial trunks. A cerebrospinal fluid (CSF) sample was collected using an intraventricular ICP monitoring catheter. The CSF level of 8-hydroxy-2'-deoxyguanosine was elevated during the rewarming period, indicating substantial deoxyribonucleic acid (DNA) oxidation. She died on the 15th day due to uncontrollable ICP. Histological examination at autopsy of the narrowed artery found the waving phenomenon in the internal elastic lamina and invasion of inflammatory cells into the adventitia. These findings constitute the possible evidence that free-radical-mediated oxidative dna damage may be important in the genesis of severe vasospasm due to rewarming following hypothermia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/11. Post-herpes encephalitic anterior pituitary insufficiency with hypothermia and hypotension.A 49-year-old man with herpes simplex encephalitis at age 22 was admitted with hypotension (90/60 mm Hg) and hypothermia (33.7 degrees C). His blood pressure was 80-90/50-60 mm Hg, with temperatures averaging 35 degrees C, for at least 3 years before admission. Evaluation of his hypothermia and hypotension revealed a low free triiodothyronine, low normal thyrotropin, luteinizing hormone < 2 mIU/L, follicle stimulating hormone <3 mIU/L, and low testosterone of 1.39 ng/dL. A baseline cortisol of 13.9 microg/dL was stimulated to 41.8 microg/dL with corticotropin, indicating he had partial anterior hypopituitarism with an intact pituitary-adrenal axis. Posterior pituitary function was normal. MRI revealed a "bright" posterior pituitary on a T1-weighted image, further indicating a normal posterior pituitary. Extensive decreased T1-weighting on MRI in the right and left temporal lobes was consistent with encephalomalacia. With thyroid hormone replacement, his blood pressure increased to 110/70 mm Hg with a temperature of 37 degrees C.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/11. Effects of warming therapy on pressure ulcers--a randomized trial.Postoperative pressure ulcers are a common and expensive problem. Intraoperative hypothermia also is a common problem and may have a connection with impaired tissue viability. Researchers in this study hypothesized that intraoperative control of hypothermia may reduce the incidence of postoperative pressure ulcers. A randomized clinical trial (n = 338) was used to test the effects of using forced air warming therapy versus standard care. Results indicated an absolute risk reduction in pressure ulcers of 4.8% (i.e., 10.4% to 5.6%) with a relative risk reduction of 46% in patients who received warming therapy. Although not reaching statistical significance, the clinical significance of almost halving the pressure ulcer rate is important. A correlation between body temperature and postoperative pressure ulcers was established.- - - - - - - - - - ranking = 9keywords = pressure (Clic here for more details about this article) |
4/11. Episodic hypothermia with hyperhidrosis in a pregnant woman.BACKGROUND: Episodic hypothermia with hyperhidrosis is a disorder of thermoregulation, believed to be secondary to a hypothalamic dysfunction, which affects the body's thermoregulatory centers. During this rare condition, the body may sweat profusely in an attempt to maintain a lowered body temperature set point. The exact cause of episodic hypothermia with hyperhidrosis is not known.CASE: A multigravida at 35 weeks' gestation presented with symptoms consistent with hypothermia, although she was diaphoretic. Her basal body temperature was 91.2F, with a lowered blood pressure and heart rate. The fetal heart rate was 130 beats per minute and reassuring. Assisted rewarming occurred over a period of 3 hours, after which her temperature stabilized at 97.9F. The remainder of the pregnancy was uneventful, and the patient delivered a term infant with no apparent adverse effects from this episode.CONCLUSION: Episodic hypothermia with hyperhidrosis should be considered as a potential cause of hypothermia during pregnancy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/11. Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature.BACKGROUND: Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest. methods: A patient with hypothermic cardiac arrest, treated by the author using TL, serves as the basis for this report. A search of the English language literature using pubmed (National Library of medicine, Bethesda, maryland) was conducted from 1966 to 2003 and 13 additional patients were identified. Demographic information, lavage method, rewarming rate, complications, and neurological outcome were analysed. RESULTS: There were numerous causes for hypothermia, with drug and alcohol intoxication being the most common (n = 4; 28.6%). Patient age ranged from 8 to 72 years (median = 36 years). Mean core temperature was 24.5 /-0.60 degrees C. Most patients were without blood pressure or pulse upon presentation to the Emergency Department and the predominant cardiac rhythm was ventricular fibrillation (VF) (n = 9; 64.3%). Thoracic lavage was accomplished by thoracotomy in seven patients and tube thoracotomy in the remaining seven. Median rewarming rate was 2.95 degrees C/h. Median time until sinus rhythm was restored was 120 min. Median length of hospital stay was 2 weeks. Four (28.6%) patients died. Complications were seen in 12 (85.7%) patients. Among survivors, neurological outcome was normal in 8 (80%) while two were left with residual impairments. CONCLUSIONS: patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. Thoracic lavage should be strongly considered for these patients if CPB is not available or contraindicated.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/11. Do thermoregulatory reflexes pass through the hypothalamus? Studies of chronic hypothermia due to hypothalamic lesion.A 38-year-old man presented with chronic hypothermia. He also had evidence of hypothalamo-pituitary dysfunction and CT scans showed a discrete hypothalamic lesion. Thermoregulatory impairment was found although there was normal circulatory control of blood pressure. reflex vasodilatation could be initiated when hypothermia was present and also in response to raised body temperature. shivering was initiated reflexly but did not otherwise occur. These observations imply that thermoregulatory reflexes are independent of central thermoregulatory mechanisms and do not pass through the hypothalamus.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/11. Fetal bradycardia associated with maternal hypothermia.A case of fetal bradycardia associated with severe maternal hypothermia (92.9F) is reported. Until maternal temperature was corrected, the baseline fetal heart rate (FHR) remained between 90-110 beats per minute without other evidence of fetal distress and despite normal maternal blood pressure and pulse. With rewarming, the FHR gradually returned to normal. Upon return of maternal hypothermia, fetal bradycardia recurred, again responding only to rewarming. This evidence suggests that low maternal temperature alone may lead to alterations of FHR.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/11. Resuscitation and intensive care monitoring following immersion hypothermia.Neurologic recovery occurred in a 3-year-old patient following immersion hypothermia and prolonged cardiopulmonary resuscitation. Recognition of hypothermia in the near-drowning victim is imperative for appropriate resuscitative efforts. intensive care monitoring (intracranial pressure, pulmonary artery catheterization) facilitates patient management and optimum neurologic recovery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/11. Rapid infusion system for neurosurgical treatment of massive intraoperative hemorrhage.Using an illustrative case of severe closed head injury that resulted in a posterior fossa epidural hematoma (EDH) and supratentorial epidural/subdural hematomas (SDH), the massive blood losses associated with operative repair of the torn sigmoid sinus and the significant fluid losses associated with refractory diabetes insipidus were treated by the intraoperative use of the Rapid Infusion System (RIS, Haemonetics). The RIS can rapidly infuse warm blood, crystalloid, or colloid at rates up to 1.5 L/min, thereby limiting the commonly associated hypotension, hypothermia, and coagulopathies. During the suboccipital craniectomy for evacuation of the EDH and repair of the sigmoid sinus, the patient required 18 units of blood replacement secondary to a large tear in the sigmoid sinus. During a separate craniotomy for evacuation of the SDH, the patient also developed diabetes insipidus, which increased the operative fluid replacement to 39 L. Despite these massive blood and fluid losses, the RIS limited the hypotension to less than 2 min and prevented hypothermia and the frequently associated coagulopathies. When used in a neurosurgical setting associated with massive blood and/or fluid losses, the RIS accomplishes three important objectives: (1) rapid infusion of intravenous fluids for maintaining perfusion pressure, (2) rapid warming of fluids despite high intravenous infusion rates of cold crystalloids, thereby preventing intraoperative hypothermia, and (3) continuous monitoring of infusion rates and totals.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/11. brain tissue oxygen pressure, carbon dioxide pressure, and pH during hypothermic circulatory arrest.BACKGROUND: This study evaluated brain tissue oxygen pressure (PO2), carbon dioxide pressure (PCO2), and pH in a patient during hypothermic circulatory arrest. methods: A combined PO2, PCO2, and pH sensor was placed in cortex tissue. brain temperature was then decreased to 17 degrees C followed by circulatory arrest for 44 minutes during an endarterectomy of the M1 segment of the middle cerebral artery. RESULTS: brain tissue PO2 increased during brain cooling from 10 mmHg-30 mmHg and decreased to zero following exsanguination. During circulatory arrest, tissue PCO2 increased to >200 mmHg and pH decreased to 6.0. Tissue PCO2 and pH recovered during circulatory rewarming but the increase in PO2 was delayed. Tissue parameters continued to improve during 2 days of postsurgical monitoring and were correlated with neurologic recovery. CONCLUSIONS: These results show that brain tissue PO2, PCO2, and pH measures indicate the severity of ischemia during hypothermic cardiac arrest and recovery in the postoperative period.- - - - - - - - - - ranking = 10keywords = pressure (Clic here for more details about this article) |
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