Low survival rate occurs in patients who initially experience a spontaneous return of circulation after cardiac arrest（CA）. In this study, we induced asphyxial CA in adult male Sprague-Daley rats, maintained their b...Low survival rate occurs in patients who initially experience a spontaneous return of circulation after cardiac arrest（CA）. In this study, we induced asphyxial CA in adult male Sprague-Daley rats, maintained their body temperature at 37 ± 0.5°C, and then observed the survival rate during the post-resuscitation phase. We examined neuronal damage in the hippocampus using cresyl violet（CV） and Fluore-Jade B（F-J B） staining, and pro-inflammatory response using ionized calcium-binding adapter molecule 1（Iba-1）, glial fibrillary acidic protein（GFAP）, and tumor necrosis factor-alpha（TNF-α） immunohistochemistry in the hippocampus after asphyxial CA in rats under normothermia. Our results show that the survival rate decreased gradually post-CA（about 63% at 6 hours, 37% at 1 day, and 8% at 2 days post-CA）. Rats were sacrificed at these points in time post-CA, and no neuronal damage was found in the hippocampus until 1 day post-CA. However, some neurons in the stratum pyramidale of the CA region in the hippocampus were dead 2 days post-CA. Iba-1 immunoreactive microglia in the CA1 region did not change until 1 day postCA, and they were activated（enlarged cell bodies with short and thicken processes） in all layers 2 days postCA. Meanwhile, GFAP-immunoreactive astrocytes did not change significantly until 2 days post-CA. TNF-α immunoreactivity decreased significantly in neurons of the stratum pyramidale in the CA1 region 6 hours post-CA, decreased gradually until 1 day post-CA, and increased significantly again 2 days post-CA. These findings suggest that low survival rate of normothermic rats in the early period of asphyxia-induced CA is related to increased TNF-α immunoreactivity, but not to neuronal damage in the hippocampal CA1 region.展开更多
Used for over 3600 years, hypothermia, or targeted temperature management(TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycard...Used for over 3600 years, hypothermia, or targeted temperature management(TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycardia/ventricular fibrillation cardiac arrest, intracerebral pressure control, and normothermia in the neurocritical care population. Even in these disease processes, a number of questions exist. Data on disease specific therapeutic markers, therapeutic depth and duration, and prognostication are limited. Despite ample experimental data, clinical evidence for stroke, refractory status epilepticus, hepatic encephalopathy, and intensive care unit is only at the safety and proof-of-concept stage. This review explores the deleterious nature of fever, the theoretical role of TTM in the critically ill, and summarizes the clinical evidence for TTM in adults.展开更多
Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CP...Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CPB）at different levels of temperature with cardioplegic arrest on the developing fetus. Methods Twelve pregnant goats were randomly divided into hypothermic CPB group（H group）： cardiopulmonary bypass with perfusion at 30-32℃（n=6） and normothermic CPB group（N group）： cardiopulmonary bypass with perfusion at 36℃-38℃（n=6）. Fetal cardiopulmonary bypass was maintained including 30 minutes of cardiac arrest. Fetal mean arterial blood pressure（MAP） and heart rate（HR） were monitored. Fetal arterial blood samples were analyzed. The pulse index（PI） and resistance index（RI） of the fetal umbilical artery were recorded. Results The maternal weight,fetal weight and pump flow had no significant difference between the 2 groups. After clamp removal, two fetal hearts did not auto-beat in H group. The fetal HR and MAP b were significantly different（P〈0.05） etween the 2 groups. There was remarkable decreasing in post-CPB fetal HR and MAP in H group. A stable decrease in partial pressure of oxygen with a concomitant stable increase of carbon dioxide partial pressure in H group was noted.The lactic acid in H group was significantly higher than that in the N group（P〈0.05）. The PI and RI in H group were significantly elevated 1 hour after off CPB and further markedly increased 2 hours after off bypass. Conclusions Fetal CPB could be performed under both hypothermic and normothermic conditions. However, normothermic bypass may provide better delivery of oxygen to fetal tissue.展开更多
Unintended peri-operative hypothermia is very common in surgical patients and is associated with adverse outcomes. Perioperative use of forced-air and intravenous fluid warmers is recommended for hypothermia preventio...Unintended peri-operative hypothermia is very common in surgical patients and is associated with adverse outcomes. Perioperative use of forced-air and intravenous fluid warmers is recommended for hypothermia prevention. This study evaluated the ease of use of Fluido? Compact, a new fluid warming device, and its ability to help as part of the intraoperative patient temperature management. It was used in 36 patients undergoing scheduled surgery at risk of hypothermia under regional, general or combined anesthesia, of more than one hour duration and with a predicted intravenous fluid administration of at least 1000 ml. The fluid warmer is very easy to set up. The disposable cassette has a very low (3 ml) priming volume and it is easy to handle and to place inside the warming module. Once connected to the main power outlet, it is ready to deliver fluid at target temperature in just a few seconds. Control panel is intuitive, and the one button operation system makes it safe and convenient. The combination of peri-operative patient surface warming with Mistral?-Air forced-air warming system and intravenous fluid warming with Fluido? Compact, that allowed the administration of IV perfusions at body temperature at the rate needed thus avoiding heat loss, helps to maintain intraoperative core temperature between 36.4°C and 36.8°C. A group of patients undergo a variety of surgical procedures with neuraxial, general or combined epidural-general anesthesia.展开更多
基金supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)the Ministry of Education(NRF-2014R1A1A2057263)+2 种基金by the Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Science,ICT&Future Planning(NRF-2017R1A2B4009079&NRF-2017R1A2B4008403)by the Bio-Synergy Research Project(NRF-2015M3A9C4076322)of the Ministry of ScienceICT and Future Planning through the National Research Foundation
文摘Low survival rate occurs in patients who initially experience a spontaneous return of circulation after cardiac arrest（CA）. In this study, we induced asphyxial CA in adult male Sprague-Daley rats, maintained their body temperature at 37 ± 0.5°C, and then observed the survival rate during the post-resuscitation phase. We examined neuronal damage in the hippocampus using cresyl violet（CV） and Fluore-Jade B（F-J B） staining, and pro-inflammatory response using ionized calcium-binding adapter molecule 1（Iba-1）, glial fibrillary acidic protein（GFAP）, and tumor necrosis factor-alpha（TNF-α） immunohistochemistry in the hippocampus after asphyxial CA in rats under normothermia. Our results show that the survival rate decreased gradually post-CA（about 63% at 6 hours, 37% at 1 day, and 8% at 2 days post-CA）. Rats were sacrificed at these points in time post-CA, and no neuronal damage was found in the hippocampus until 1 day post-CA. However, some neurons in the stratum pyramidale of the CA region in the hippocampus were dead 2 days post-CA. Iba-1 immunoreactive microglia in the CA1 region did not change until 1 day postCA, and they were activated（enlarged cell bodies with short and thicken processes） in all layers 2 days postCA. Meanwhile, GFAP-immunoreactive astrocytes did not change significantly until 2 days post-CA. TNF-α immunoreactivity decreased significantly in neurons of the stratum pyramidale in the CA1 region 6 hours post-CA, decreased gradually until 1 day post-CA, and increased significantly again 2 days post-CA. These findings suggest that low survival rate of normothermic rats in the early period of asphyxia-induced CA is related to increased TNF-α immunoreactivity, but not to neuronal damage in the hippocampal CA1 region.
文摘Used for over 3600 years, hypothermia, or targeted temperature management(TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycardia/ventricular fibrillation cardiac arrest, intracerebral pressure control, and normothermia in the neurocritical care population. Even in these disease processes, a number of questions exist. Data on disease specific therapeutic markers, therapeutic depth and duration, and prognostication are limited. Despite ample experimental data, clinical evidence for stroke, refractory status epilepticus, hepatic encephalopathy, and intensive care unit is only at the safety and proof-of-concept stage. This review explores the deleterious nature of fever, the theoretical role of TTM in the critically ill, and summarizes the clinical evidence for TTM in adults.
基金supported by the National Natural Science Foundation of China(No.81370274)Guangdong Provincial Natural Science Foundation(No.2016A030310313)
文摘Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CPB）at different levels of temperature with cardioplegic arrest on the developing fetus. Methods Twelve pregnant goats were randomly divided into hypothermic CPB group（H group）： cardiopulmonary bypass with perfusion at 30-32℃（n=6） and normothermic CPB group（N group）： cardiopulmonary bypass with perfusion at 36℃-38℃（n=6）. Fetal cardiopulmonary bypass was maintained including 30 minutes of cardiac arrest. Fetal mean arterial blood pressure（MAP） and heart rate（HR） were monitored. Fetal arterial blood samples were analyzed. The pulse index（PI） and resistance index（RI） of the fetal umbilical artery were recorded. Results The maternal weight,fetal weight and pump flow had no significant difference between the 2 groups. After clamp removal, two fetal hearts did not auto-beat in H group. The fetal HR and MAP b were significantly different（P〈0.05） etween the 2 groups. There was remarkable decreasing in post-CPB fetal HR and MAP in H group. A stable decrease in partial pressure of oxygen with a concomitant stable increase of carbon dioxide partial pressure in H group was noted.The lactic acid in H group was significantly higher than that in the N group（P〈0.05）. The PI and RI in H group were significantly elevated 1 hour after off CPB and further markedly increased 2 hours after off bypass. Conclusions Fetal CPB could be performed under both hypothermic and normothermic conditions. However, normothermic bypass may provide better delivery of oxygen to fetal tissue.
文摘Unintended peri-operative hypothermia is very common in surgical patients and is associated with adverse outcomes. Perioperative use of forced-air and intravenous fluid warmers is recommended for hypothermia prevention. This study evaluated the ease of use of Fluido? Compact, a new fluid warming device, and its ability to help as part of the intraoperative patient temperature management. It was used in 36 patients undergoing scheduled surgery at risk of hypothermia under regional, general or combined anesthesia, of more than one hour duration and with a predicted intravenous fluid administration of at least 1000 ml. The fluid warmer is very easy to set up. The disposable cassette has a very low (3 ml) priming volume and it is easy to handle and to place inside the warming module. Once connected to the main power outlet, it is ready to deliver fluid at target temperature in just a few seconds. Control panel is intuitive, and the one button operation system makes it safe and convenient. The combination of peri-operative patient surface warming with Mistral?-Air forced-air warming system and intravenous fluid warming with Fluido? Compact, that allowed the administration of IV perfusions at body temperature at the rate needed thus avoiding heat loss, helps to maintain intraoperative core temperature between 36.4°C and 36.8°C. A group of patients undergo a variety of surgical procedures with neuraxial, general or combined epidural-general anesthesia.
