Therapeutic hypothermia during neonatal transport at Regional Perinatal Centers: active vs. passive cooling

2019 ◽  
Vol 47 (3) ◽  
pp. 365-369 ◽  
Author(s):  
Rishi Lumba ◽  
Pradeep Mally ◽  
Michael Espiritu ◽  
Elena V. Wachtel
Keyword(s):  
Therapeutic Hypothermia ◽  
Core Temperature ◽  
Vital Signs ◽  
Passive Cooling ◽  
Target Temperature ◽  
Term Infants ◽  
Neurological Outcomes ◽  
Neonatal Transport ◽  
Significant Difference ◽  
Cohort Quality

Abstract Background Earlier initiation of therapeutic hypothermia in term infants with hypoxic-ischemic encephalopathy has been shown to improve neurological outcomes. The objective of the study was to compare safety and effectiveness of servo-controlled active vs. passive cooling used during neonatal transport in achieving target core temperature. Methods We undertook a prospective cohort quality improvement study with historic controls of therapeutic hypothermia during transport. Primary outcome measures were analyzed: time to cool after initiation of transport, time to achieve target temperature from birth and temperature on arrival to cooling centers. Safety was assessed by group comparison of vital signs, diagnosis of persistent pulmonary hypertension (PPHN) and coagulation profiles on arrival. Results A total of 65 infants were included in the study. Time to cool after initiation of transport and time to achieve target temperature from birth were statistically significantly shorter in the actively cooled group with time reduction of 24% with P<0.01 and 15.6% with P<0.01, respectively. On arrival to our cooling center, we noted a significance difference in the mean core temperature (active 33.8°C vs. passive 35.4°C, P<0.01). Seven percent (2/30) of infants in the passively cooled group were overcooled (temperature <33°C). Patients in the actively cooled group had significantly lower mean heart rate compared to the passively cooled group. There was no statistically significant difference in diagnosis of PPHN or coagulation profiles on admission. Conclusion Our study indicates that active cooling with a servo-controlled device on neonatal transport is safe and more effective in achieving target temperature compared to passive cooling.

scholarly journals Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: A randomized controlled trial

2020 ◽  
Author(s):  
Linlin Fan ◽  
Yingying Su ◽  
Yan Zhang ◽  
Hong Ye ◽  
Weibi Chen ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Mortality Rates ◽  
Target Temperature ◽  
Good Neurological Outcome ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Standard Medical Treatment ◽  
Hemispheric Infarction

Abstract Background: To investigate the effects of decompressive craniectomy (DC) combined with hypothermia treatment on mortality and neurological outcomes in patients with large hemispheric infarction (LHI).Methods: Patients within 48 hours of symptom onset were randomized to the following three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. Patients in the DC group were given standard medical treatment with a normothermic target temperature. Patients in the DCSC group received standard medical treatment plus 24-hour ice cap on the head for 7 days. Patients in the DCEH group were given standard medical treatment plus endovascular hypothermia with a target temperature of 34°C. The primary end-points were mortality and modified Rankin Scale (mRS) score at 6 months.Results: There were 9 patients in the DC group, 14 patients in the DCSC group and 11 patients in the DCEH group. The mortality rates of the DC, DCSC and DCEH groups at the time of discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. At 6 months, the mortality rates in the DC, DCSC and DCEH groups increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11), respectively (P=0.367). The most common cause of death after discharge was pneumonia (8 cases). Twelve cases (35.3%) achieved good neurological outcome (mRS 0-3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p=0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome, still without significant difference (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p=0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; P=0.025).Conclusions: There is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.Clinical Trial Registration - Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered, URL: http://www.chictr.org.cn.

Target Temperature Within 3 Hours

2012 ◽  
Vol 23 (3) ◽  
pp. 246-257
Author(s):  
Patty Gessner ◽  
Guy Dugan ◽  
Linda Janusek
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Evidence Based ◽  
Target Temperature ◽  
Inclusion Criteria ◽  
Neurological Outcomes ◽  
Discharge Disposition ◽  
Death Cases

Therapeutic hypothermia has been shown to improve neurological outcomes for patients who survive cardiac arrest. Timely cooling can be achieved by rapid initiation of a comprehensive targeted temperature protocol, which includes shivering assessment and management. The purpose of the study was to evaluate an updated therapeutic hypothermia protocol for patients who survive cardiac arrest. The first 6 patients who met inclusion criteria were placed on the updated protocol. These cases were compared with historical cases. Upon discharge or death, cases were analyzed for time to reach the target temperature, the use of paralytic agents, and discharge disposition. Patients placed on the updated protocol cooled 2 hours faster than did the patients from the historical cases (median = 179 vs 285 minutes). The use of paralytic agents appeared to safely accelerate the time to goal temperature. Four of the 6 patients were discharged home or to rehabilitation compared with only 1 patient from the historical cases. Implementing this evidence-based protocol for therapeutic hypothermia led to faster cooling.

scholarly journals Decompressive Craniectomy Combined With Mild Hypothermia in Patients With Large Hemispheric Infarction: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Linlin Fan ◽  
Yingying Su ◽  
Yan Zhang ◽  
Hong Ye ◽  
Weibi Chen ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Mortality Rates ◽  
Target Temperature ◽  
Good Neurological Outcome ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Standard Medical Treatment ◽  
Hemispheric Infarction

Abstract BackgroundTo investigate the effects of decompressive craniectomy (DC) combined with hypothermia treatment on mortality and neurological outcomes in patients with large hemispheric infarction (LHI).MethodsPatients within 48 hours of symptom onset were randomized to the following three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. Patients in the DC group were given standard medical treatment with a normothermic target temperature. Patients in the DCSC group received standard medical treatment plus 24-hour ice cap on the head for 7 days. Patients in the DCEH group were given standard medical treatment plus endovascular hypothermia with a target temperature of 34 °C. The primary end-points were mortality and modified Rankin Scale (mRS) score at 6 months.ResultsThere were 9 patients in the DC group, 14 patients in the DCSC group and 11 patients in the DCEH group. The mortality rates of the DC, DCSC and DCEH groups at the time of discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. At 6 months, the mortality rates in the DC, DCSC and DCEH groups increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11), respectively (P = 0.367). The most common cause of death after discharge was pneumonia (8 cases). Twelve cases (35.3%) achieved good neurological outcome (mRS 0–3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p = 0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome, still without significant difference (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p = 0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; P = 0.025).ConclusionsThere is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.Clinical Trial Registration-Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered,URL: http://www.chictr.org.cn.

scholarly journals Retinal microvascular signs in COVID-19

2021 ◽  
pp. bjophthalmol-2020-318236
Author(s):  
Ralene Sim ◽  
Gemmy Cheung ◽  
Daniel Ting ◽  
Edmund Wong ◽  
Tien Yin Wong ◽  
...  
Keyword(s):  
Medical History ◽  
Vital Signs ◽  
Plexiform Layer ◽  
Nasopharyngeal Swab ◽  
Inner Plexiform Layer ◽  
Cross Sectional ◽  
Imaging Device ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Retinal Microvascular Signs

Background/aimsTo explore if retinal findings are associated with COVID-19 infection.MethodsIn this prospective cross-sectional study, we recruited participants positive for COVID-19 by nasopharyngeal swab, with no medical history. Subjects underwent retinal imaging with an automated imaging device (3D OCT-1 Maestro, Topcon, Tokyo, Japan) to obtain colour fundus photographs (CFP) and optical coherence tomographic (OCT) scans of the macula. Data on personal biodata, medical history and vital signs were collected from electronic medical records.Results108 patients were recruited. Mean age was 36.0±5.4 years. 41 (38.0%) had symptoms of acute respiratory infection (ARI) at presentation. Of 216 eyes, 25 (11.6%) had retinal signs—eight (3.7%) with microhaemorrhages, six (2.8%) with retinal vascular tortuosity and two (0.93%) with cotton wool spots (CWS). 11 eyes (5.1%) had hyper-reflective plaques in the ganglion cell-inner plexiform layer layer on OCT, of which two also had retinal signs visible on CFP (CWS and microhaemorrhage, respectively). There was no significant difference in the prevalence of retinal signs in symptomatic versus asymptomatic patients (12 (15.0%) vs 13 (9.6%), p=0.227). Patients with retinal signs were significantly more likely to have transiently elevated blood pressure than those without (p=0.03).ConclusionOne in nine had retinal microvascular signs on ocular imaging. These signs were observed even in asymptomatic patients with normal vital signs. These retinal microvascular signs may be related to underlying cardiovascular and thrombotic alternations associated with COVID-19 infection.

scholarly journals Effect of Different SiO2 Polymorphs on the Reaction Between SiO2 and SiC in Si Production

2021 ◽  
Vol 52 (2) ◽  
pp. 792-803
Author(s):  
Marit Buhaug Folstad ◽  
Eli Ringdalen ◽  
Halvard Tveit ◽  
Merete Tangstad
Keyword(s):  
Amorphous Silica ◽  
Reaction Rate ◽  
Reduction Reaction ◽  
Minor Effect ◽  
Target Temperature ◽  
Heating Rates ◽  
Significant Difference ◽  
Sio2 Polymorphs ◽  
A Minor ◽  
Final Composition

AbstractThis work investigates the phase transformations in silica (SiO2) during heating to a target temperature between 1700 °C and 1900 °C and the effect of SiO2 polymorphs on the reduction reaction 2SiO2 + SiC = 3SiO + CO in silicon production. Different heating rates up to target temperature have been used to achieve the different compositions of quartz, amorphous silica and cristobalite. The different heating rates had a minor effect on the final composition, and longer time at temperatures > 1400 °C were necessary to achieve greater variations in the final composition. Heating above the melting temperature gave more amorphous silica and less cristobalite, as amorphous silica also may form from β-cristobalite. Isothermal furnace experiments were conducted to study the extent of the reduction reaction. This study did not find any significant difference in the effects of quartz, amorphous silica or cristobalite. Increased temperature from 1700 °C to 1900 °C increased the reaction rate.

scholarly journals Effect of Head Impact Exposures on Changes in Cognitive Testing

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876103 ◽  
Author(s):  
Eleni Diakogeorgiou ◽  
Theresa L. Miyashita
Keyword(s):  
Reaction Time ◽  
National Collegiate Athletic Association ◽  
Assessment Tool ◽  
Vital Signs ◽  
Head Impact ◽  
Cognitive Testing ◽  
Repeated Impact ◽  
Level Of Evidence ◽  
Head Impacts ◽  
Significant Difference

Background: Gaining a better understanding of head impact exposures may lead to better comprehension of the possible effects of repeated impact exposures not associated with clinical concussion. Purpose: To assess the correlation between head impacts and any differences associated with cognitive testing measurements pre- and postseason. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 34 National Collegiate Athletic Association Division I men’s lacrosse players wore lacrosse helmets instrumented with an accelerometer during the 2014 competitive season and were tested pre- and postseason with the Sport Concussion Assessment Tool (SCAT 3) and Concussion Vital Signs (CVS) computer-based neurocognitive tests. The number of head impacts >20 g and results from the 2 cognitive tests were analyzed for differences and correlation. Results: There was no significant difference between pre- and postseason SCAT 3 scores, although a significant correlation between pre- and postseason cognitive scores on the SCAT 3 and total number of impacts sustained was noted ( r = –0.362, P = .035). Statistically significant improvements on half of the CVS testing components included visual reaction time ( P = .037, d = 0.37), reaction time ( P = .001, d = 0.65), and simple reaction time ( P = .043, d = 0.37), but no correlation with head impacts was noted. Conclusion: This study did not find declines in SCAT 3 or CVS scores over the course of a season among athletes who sustained multiple head impacts but no clinical concussion. Thus, it could not be determined whether there was no cognitive decline among these athletes or whether there may have been subtle declines that could not be measured by the SCAT 3 or CVS.

STUDIES OF THE IMMUNOLOGY OF THE NEWBORN INFANT

PEDIATRICS ◽  
1953 ◽  
Vol 12 (2) ◽  
pp. 151-157
Author(s):  
JOSEPH DANCIS ◽  
JOHN J. OSBORN ◽  
HANS W. KUNZ
Keyword(s):  
Antibody Response ◽  
Newborn Infant ◽  
Premature Infants ◽  
Single Injection ◽  
Diphtheria Toxoid ◽  
Birth Date ◽  
Term Infants ◽  
Normal Birth ◽  
Significant Difference

The antibody response of premature infants immunized at birth with a single injection of diphtheria toxoid was compared to that of a group of term infants similarly immunized. No significant difference was demonstrated. A group of premature infants was immunized about the time that was estimated to be their normal birth date and the antibody response compared to that of term infants at birth. The performance of the premature infants was superior to that of the term infants. The significance of these findings is discussed.

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