“Caution! Contents Should Be Cold”: Developing a Whole-Body Hypothermia Program

2011 ◽  
Vol 30 (4) ◽  
pp. 225-230 ◽  
Author(s):  
Regina Reynolds ◽  
Samara Talmage
Keyword(s):  
Health Care Professionals ◽  
Clinical Care ◽  
Perinatal Period ◽  
Whole Body ◽  
Brain Health ◽  
Head Cooling ◽  
Care Practices ◽  
The Brain ◽  
Ischemic Encephalopathy ◽  
Care Path

Hypoxic-ischemic encephalopathy (HIE) is characterized as brain injury that results from lack of oxygen or blood flow to the brain in the perinatal period. Neonatal whole-body hypothermia and selective head cooling are becoming increasingly common care practices across the U.S. and Canada for infants with moderate-to-severe HIE because of the demonstrated ability of these approaches to reduce reperfusion injury to the brain. Health care professionals must develop a clinical care path for these fragile infants. For best results, induced hypothermia should be initiated within six hours of birth; therefore, care must be organized and provided without delay. This article provides bedside clinicians with care recommendations for infants being treated with these new interventions.

scholarly journals Preconditioning and Postinsult Therapies for Perinatal Hypoxic–Ischemic Injury at Term

2010 ◽  
Vol 113 (1) ◽  
pp. 233-249 ◽  
Author(s):  
Robert D. Sanders ◽  
Helen J. Manning ◽  
Nicola J. Robertson ◽  
Daqing Ma ◽  
A. David Edwards ◽  
...  
Keyword(s):  
Perinatal Period ◽  
Rapid Identification ◽  
Postnatal Period ◽  
Hypoxic Ischemic Encephalopathy ◽  
Current Status ◽  
Neuroprotective Agents ◽  
Period 2 ◽  
Neuroprotective Strategies ◽  
The Brain ◽  
Ischemic Encephalopathy

Perinatal hypoxic-ischemic encephalopathy can be a devastating complication of childbirth. Herein, the authors review the pathophysiology of hypoxic-ischemic encephalopathy and the current status of neuroprotective strategies to ameliorate the injury centering on four themes: (1) monitoring in the perinatal period, (2) rapid identification of affected neonates to allow timely institution of therapy, (3) preconditioning therapy (a therapeutic that reduces the brain vulnerability) before hypoxic-ischemic encephalopathy, and (4) prompt institution of postinsult therapies to ameliorate the evolving injury. Recent clinical trials have demonstrated the significant benefit for hypothermic therapy in the postnatal period; furthermore, there is accumulating preclinical evidence that adjunctive therapies can enhance hypothermic neuroprotection. Advances in the understanding of preconditioning may lead to the administration of neuroprotective agents earlier during childbirth. Although most of these neuroprotective strategies have not yet entered clinical practice, there is a significant hope that further developments will enhance hypothermic neuroprotection.

scholarly journals Selective head cooling and whole body cooling as neuroprotective agents in severe perinatal asphyxia

2019 ◽  
Vol 65 (8) ◽  
pp. 1116-1121 ◽  
Author(s):  
Mahara Nonato ◽  
Larissa Gheler ◽  
João Vitor Balestrieri ◽  
Marise Audi ◽  
Mirto Prandini
Keyword(s):  
Perinatal Asphyxia ◽  
Brain Structures ◽  
Brain Parenchyma ◽  
Cerebral Injury ◽  
Whole Body ◽  
Cortical Region ◽  
Head Cooling ◽  
Body Cooling ◽  
The Brain ◽  
Full Body

SUMMARY INTRODUCTION The possibility that hypothermia has a therapeutic role during or after resuscitation from severe perinatal asphyxia has been a longstanding focus of research. Studies designed around this fact have shown that moderate cerebral hypothermia, initiated as early as possible, has been associated with potent, long-lasting neuroprotection in perinatal patients. OBJECTIVES To review the benefits of hypothermia in improving cellular function, based on the cellular characteristics of hypoxic-ischemic cerebral injury and compare the results of two different methods of cooling the brain parenchyma. METHODS Medline, Lilacs, Scielo, and PubMed were searched for articles registered between 1990 and 2019 in Portuguese and English, focused on trials comparing the safety and effectiveness of total body cooling with selective head cooling with HIE. RESULTS We found that full-body cooling provides homogenous cooling to all brain structures, including the peripheral and central regions of the brain. Selective head cooling provides a more extensive cooling to the cortical region of the brain than to the central structures. CONCLUSIONS Both methods demonstrated to have neuroprotective properties, although full-body cooling provides a broader area of protection. Recently, head cooling combined with some body cooling has been applied, which is the most promising approach. The challenge for the future is to find ways of improving the effectiveness of the treatment.

scholarly journals Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

2015 ◽  
Vol 50 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Aytug Atici ◽  
Yalcin Celik ◽  
Selvi Gulasi ◽  
Ali Haydar Turhan ◽  
Cetin Okuyaz ◽  
...  
Keyword(s):  
Hypoxic Ischemic Encephalopathy ◽  
Whole Body ◽  
Short Term ◽  
Head Cooling ◽  
Body Cooling ◽  
Whole Body Cooling ◽  
Ischemic Encephalopathy

Confronting the grey zone after severe brain injury

2019 ◽  
Vol 3 (6) ◽  
pp. 707-711 ◽  
Author(s):  
Andrew Peterson ◽  
Adrian M. Owen
Keyword(s):  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Clinical Care ◽  
Grey Zone ◽  
Severe Brain Injury ◽  
New Methods ◽  
Legal Decision Making ◽  
Technological Developments ◽  
The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

scholarly journals Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2635
Author(s):  
Koen Huysentruyt ◽  
Kim Brunet-Wood ◽  
Robert Bandsma ◽  
Leah Gramlich ◽  
Bonnie Fleming-Carroll ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Care Pathway ◽  
Clinical Care ◽  
Tertiary Care ◽  
Nationwide Survey ◽  
Nutritional Screening ◽  
Pediatric Hospitals ◽  
Adoption And Implementation ◽  
Clinical Care Pathway

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

scholarly journals Social Volunteering in Aging Adults Increases Regions of the Amygdala and Correlates With Enhanced Generativity

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 795-795
Author(s):  
Michelle Carlson
Keyword(s):  
Social Engagement ◽  
Controlled Trial ◽  
Well Being ◽  
Health Study ◽  
Brain Health ◽  
Volunteer Program ◽  
Intention To Treat ◽  
Intervention Impact ◽  
Aging Adults ◽  
The Brain

Abstract The Brain Health Study (BHS) of the Baltimore Experience Corps Trial (BECT) examined whether a randomized, controlled trial of an intergenerational social volunteer program, entitled Experience Corps, increased subregions of the amygdala related to socioemotional memory and risk for Alzheimer’s disease in aging adults. We further assessed functional correlates of these intervention-related changes and changes in aging adults’ developmental need to be generative, or, to give back to the well-being of others. The BHS simultaneously randomized 112 men and women (59 intervention; 53 control) within BECT to evaluate intervention impact on biomarkers of brain health at baseline and annual follow-ups during the two-year trial. Intention-to-treat analyses revealed program-specific increases in the shape of the centromedial and basomedial regions of the left amygdala (p’s≤0.05 adjusted), which were correlated with increases in generativity (p’s =0.06). Meaningful social engagement buffered amygdalar declines important to preservation of emotionally salient memory and risk for dementia. Part of a symposium sponsored by Brain Interest Group.

scholarly journals Has molecular imaging delivered to drug development?

2017 ◽  
Vol 375 (2107) ◽  
pp. 20170112 ◽  
Author(s):  
Philip S. Murphy ◽  
Neel Patel ◽  
Timothy J. McCarthy
Keyword(s):  
Molecular Imaging ◽  
Drug Development ◽  
Clinical Studies ◽  
Pharmaceutical Research ◽  
Whole Body ◽  
Drug Candidate ◽  
Clinical Drug Development ◽  
Target Binding ◽  
The Brain ◽  
Clinical Drug

Pharmaceutical research and development requires a systematic interrogation of a candidate molecule through clinical studies. To ensure resources are spent on only the most promising molecules, early clinical studies must understand fundamental attributes of the drug candidate, including exposure at the target site, target binding and pharmacological response in disease. Molecular imaging has the potential to quantitatively characterize these properties in small, efficient clinical studies. Specific benefits of molecular imaging in this setting (compared to blood and tissue sampling) include non-invasiveness and the ability to survey the whole body temporally. These methods have been adopted primarily for neuroscience drug development, catalysed by the inability to access the brain compartment by other means. If we believe molecular imaging is a technology platform able to underpin clinical drug development, why is it not adopted further to enable earlier decisions? This article considers current drug development needs, progress towards integration of molecular imaging into studies, current impediments and proposed models to broaden use and increase impact. This article is part of the themed issue ‘Challenges for chemistry in molecular imaging’.

Medical stabilization of adolescents with nutritional insufficiency: a clinical care path

2015 ◽  
Vol 21 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Sarah E. Strandjord ◽  
Erin H. Sieke ◽  
Miranda Richmond ◽  
Arjun Khadilkar ◽  
Ellen S. Rome
Keyword(s):  
Clinical Care ◽  
Medical Stabilization ◽  
Care Path ◽  
Nutritional Insufficiency
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