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At least 1,009 records · Page 56Linked to original sources
PubMed1990

Infrared thermographic measurement of circulatory compromise in trenchfoot-injured Argentine soldiers.

Passive rewarming of a cold-water stressed foot was evaluated in 33 recovered trenchfoot (TF) patients and 15 uninjured men. Infrared images were recorded prior to immersion, immediately following, and at 1-min intervals for 20 min. Individual baseline temperature (IBT) recovery was used to separate subjects into three groups designated Good and Poor Rewarming Controls (GRC and PRC) and Injured Subjects (Inj Sub). IBTs were significantly less (p less than 0.01) for Inj Sub compared to both GRC and PRC while no difference existed between GRC and PRC. This relationship changed when slopes of and areas under the mean rewarming curves were compared. Both these criteria were significantly greater (p less than 0.01) for GRC than for PRC and Inj Sub, while no difference was noted between PRC and Inj Sub. It could not be determined if the poor response of Inj Sub was inherent or a result of injury. We conclude that previously injured subjects and nearly 60% of a normal population may be at significant risk for cold injury.

Argentina↗
PubMed1991

[Deep accidental hypothermia with asystole. A successful treatment with heart-lung machine after prolonged cardiopulmonary resuscitation].

Extracorporeal circulation can be utilized successfully to rewarm accidental hypothermia victims. This paper describes a 51 year-old man who had been immersed in cold sea water for about 45 minutes. At the time of rescue his ECG was isoelectric. The core temperature was 27 degrees C. Cardiopulmonary resuscitation was performed for 190 minutes before extracorporeal circulation was established. Without active surface rewarming the temperature had dropped to 24 degrees C. Biventricular heart failure became evident during rewarming. Sternotomy and pericardiotomy were carried out to exclude cardiac tamponade, which was not found. After two hours of reperfusion the patient could be weaned from bypass supported by high-dose vasopressor infusion. He was extubated the following day. He was discharged after 12 days without any signs of permanent damage to organs.

Accidents↗
PubMed1991

[Methods of anesthesia in canine heart-lung transplants].

Hypothermia has many valuable merits compared with under cardiopulmonary bypass using pump oxygenator, as known. But, on the contrary, it has some weak points, such as, long time required for cooling and rewarming. We have developed the device for rapid cooling and rewarming by using jet water blows. It appeared that the key point in hypothermia was control of ether inhalation and timing of rewarming. We demonstrated that mongrel dog could survive for at least 72 hours after transplantation of heart-lung under simple deep hypothermia with ether anesthesia. The dog was breathing 50-100 percent oxygen gas under control through respiratory ventilator. Postoperative arterial blood gases were maintained between pH 7.3-7.5 and PO2 80-200mmHg on the other hand, PCO2 was unstable from 14 to 63mmHg. It seemed that the anesthesia in canine heart-lung transplants using profound surface hypothermia with either anesthesia was useful methods.

Anesthesia, Closed-Circuit↗
PubMed1991

Hypothermia. Cold-water drowning.

Cold-water submersion results in rapidly induced hypothermia. The body's physiologic response to this insult is, in some ways, similar to that of controlled hypothermia employed in the hospital setting, with the time sequencing being greatly enhanced. The application of hypothermic techniques employed with extracorporeal heat exchange on cardiopulmonary bypass to those of cold-water submersion requires careful differentiation, especially during rewarming phases. Conversely, protecting the brain from hypoxic injury (and thus a favorable neurologic recovery) following cold-water submersion can be favorably modified by the co-existence of hypothermia. The protective effects of safe usage of hypothermic without neurologic damage is multifaceted and influenced by age, time, temperature and intracellular pH, metabolic rate, biochemical changes, high-energy storage depots, as well as institution of rewarming techniques. Criteria for brain death established by the President's commission does not apply to the hypothermic patient. According to colleagues, rewarming to between 30 and 34 degrees C is essential before discontinuing resuscitative measures because of the multifactoral influences that the hypothermic state entails. A child who appears asystolic, apneic, and with absence of central nervous system activity after cold-water submersion, requiring intensive resuscitative efforts, may have a favorable outcome. This does not absolutely suggest a devastating outcome as we have seen in those children "frozen alive," who are hypothermic but have been effectively resuscitated, rehabilitated, and allowed to return to normal life activities. Although combined intensive and rehabilitative efforts of the medical team are essential in the care of these children, foremost in our minds should be prevention of these accidents.

Humans↗
PubMed1990

[Diagnosis and clinical relevance of microcirculation disorders in progressive scleroderma].

Microcirculation in the hands of patients with progressive systemic sclerosis shows some peculiarities. For diagnostic purposes functional thermography and the acrale rewarming test may be used. Typical features of progressive systemic sclerosis are a general hypothermia of the hands and localized hypothermic areas and refractory hyperthermic areas. In the acrale rewarming test reactive vasodilatation after cold stimuli is often not inducible and the significantly retarded rewarming shows a marked local restrict dependence. The significance of these facts for a more intensive physical therapy is discussed.

Hand↗
PubMed1990

[Continuous infusion of prostaglandin E1 facilitates weaning from cardiopulmonary bypass].

Vasodilators expedite the rewarming process and facilitate weaning from cardiopulmonary bypass (CPB). We continuously infused prostaglandin E1 (PG-E1) at 0.02-0.05 microgram.kg-1.min-1 (n = 11) or phentolamine (PHENT) at 5-10 micrograms.kg-1.min-1 (n = 13) during rewarming from mild hypothermic CPB. Rectal temperature was 33.3 +/- 1.7 degrees C in PG-E1 group vs. 31.3 +/- 1.3 degrees C in PHENT group at 30 minutes, and 34.0 +/- 1.2 degrees C vs. 32.7 +/- 1.1 degrees C at 40 minutes from the start of rewarming. There were significant differences (P less than 0.01 at 30 min, P less than 0.05 at 40 min) in rectal temperature between the two groups. There were no differences in perfusion index of CPB, arterial perfusion temperature, mean arterial pressure, systemic vascular resistance as well as esophageal, forehead or palm skin temperatures at any point between the two groups. The required time for weaning from CPB was significantly shorter in PG-E1 than in PHENT group (P less than 0.01, 36 +/- 8 min vs. 46 +/- 11 min). Our results also strongly suggest that PG-E1 preferentially improves splanchnic blood flow.

Alprostadil↗
PubMed1989

[The effect of heart surgery during extracorporeal circulation and deep hypothermia on glucose metabolism in infants and young children].

Authors examined levels of glucose, insulin, and C-peptide in the plasma of 6 infants and small children with the isolated transposition of the great arteries (3 pts) and ventricular septal defect (3 pts) in the course of open-heart surgery in deep hypothermia. The mean age of the patients was 7.2 months (6 to 15) and weight 5.6 kg (5.2-7.5). Exogenous intake of glucose during the operation was excluded. Methods of anaesthesia, operation technique, and conduction of extracorporeal circulation (ECC) were constant in all patients. Fresh ACD blood diluted with Hartman solution approximately 1:1 was used for the prime of ECC circuit (content 800 ml) to get the hematocrit 0.27 +/- 0.2 after mixing the prime with the patient's blood volume. Glycemia was determined by Beckman ERA 2001 analyzor, and levels of insulin and C-peptide by radioimmunoassay kits MJ-96 (Poland) and Novo (Denmark). Significant hyperglycemia was found in all patients during the period of hypothermia, and was overlasting to the rewarming period until the end of the operation and 1 hour postoperatively. Then level of glycemia was decreasing to the normal values which were found in the last sample (17 hours post-op). The raise of glycemia was not a stimulus to the proportional increase of insulin and C-peptide levels in plasma. It proved transitional suppress of insulin secretion in the beta cells of the pancreas in the cooling period. Levels of insulin and C-peptide significantly and concordantly increased after 20 min. of rewarming (r = 0.83). However, hyperglycemia overlasted during the course of rewarming, too.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1988

Remodeling of a rat hepatocyte plasma membrane glycoprotein. De- and reglycosylation of dipeptidyl peptidase IV.

The present paper demonstrates the terminal de- and reglycosylation of a rat hepatocyte plasma membrane glycoprotein, dipeptidyl peptidase IV (DPP IV). Cultured hepatocytes were used in pulse-chase experiments with [3H]L-fucose and [14C]N-acetyl-D-mannosamine as markers for terminal carbohydrates, [3H]D-mannose as marker of a core-sugar, and [35S]L-methionine for labeling the protein backbone. Membrane DPP IV was immunoprecipitated with a polyclonal antibody which bound selectively at 4 degrees C to the cell-surface glycoprotein. The times of maximal labeling of hepatocyte plasma membrane DPP IV were 6-9 min for [3H]L-fucose, 20 min for [3H]D-mannose, and 25 min for [35S]L-methionine. When antibodies were bound to cell-surface DPP IV at 4 degrees C, the immune complex remained stable for more than 1 h after rewarming to 37 degrees C, despite ongoing metabolic and membrane transport processes. This was shown by pulse labeling with [35S]L-methionine at 37 degrees C, followed by cooling to 4 degrees C, and addition of antibody against plasma membrane DPP IV. During rewarming, the radioactivity in the complex remained constant. In a similar experiment with [3H]L-fucose, the radioactivity in the immune complex declined rapidly, indicating a defucosylation of the plasma membrane glycoprotein. Using the same experimental design with [3H]D-mannose, the radioactivity in the immune complex remained constant, showing that the core-sugar D-mannose is not cleaved from the membrane glycoprotein. Terminal reglycosylation (refucosylation and resialylation) was demonstrated as follows. Hepatocytes were maintained at 37 degrees C in a medium supplemented with tunicamycin in order to block the de novo synthesis of N-glycosidically bound carbohydrate chains. At 4 degrees C the antibody against DPP IV bound only to cell surface glycoprotein. During the rewarming period at 37 degrees C, radioactivity from [3H]L-fucose and [14C]N-acetyl-D-mannosamine became incorporated into the immune complex. This indicates a fucosylation and sialylation of the glycoprotein originally present at the cell surface. The mechanisms whereby terminal de- and reglycosylation of plasma membrane glycoproteins may occur during membrane recycling are discussed.

Animals↗
PubMed1988

A retrospective analysis of air-evacuated hypothermia patients.

This study reviews the outcome of 17 hypothermic patients air evacuated by a civilian helicopter transport service. Age (33 +/- 23), type and duration of exposure, and rewarm methods were examined for each patient. Temperature (T), heart rate (HR), blood pressure (BP), respiratory rate (RR), Glasgow coma score (GCS), trauma score (TS), CRAMS score (CS), and cardiac rhythm in the pre-hospital setting and in the emergency department (ED) were compared to outcome. Eight of the patients had extensive exposure to a cold environment ranging from 4 h to 10 d. The remaining 9 patients were exposed to cold water ranging from 15 min to 4.5 h. By severity of hypothermia as measured in the ED, 6 patients who were hypothermic at the scene were normothermic (t greater than 35 degrees C), 5 patients were classified as mild (t = 35-31.5 degrees C), 3 as moderate (T less than 31.5-25.5 degrees C), and 3 patients were severely hypothermic (T less than 25.5 degrees C). The GCS, TS, and CS were not indicative of outcome. During rewarming, 3 patients had paradoxical temperature drops, and 5 patients had atrial fibrillation. Three patients required cardiopulmonary resuscitation in the field. Two were discharged with resolving disabilities, and 1 expired. No ventricular fibrillation or J waves occurred. All patients were effectively rewarmed without incident. All patient disabilities and the single fatality were not directly related to hypothermia. There were no long-term adverse consequences of helicopter transport in these hypothermic patients.

Adolescent↗
PubMed1988

Contribution of exercise and shivering to recovery from induced hypothermia (31.2 degrees C) in one subject.

The ability of a modestly hypothermic victim to exercise, and indeed shiver, and thereby generate sufficient heat to rewarm has been questioned. One fit healthy subject was cooled in stirred water (7.7 degrees C) to a core temperature (Tc) of 32 degrees C. Tc by esophageal probe, cardiac rhythm, blood pressure (BP) and oxygen consumption (VO2) were monitored pre-, intra-, and postcooling (exercise). The subject rewarmed spontaneously as well as by exercising on a treadmill at speeds from 0.7 to 3.5 mph. Amount of Tc afterdrop (AD) was measured and rate of Tc increase (RI) and exercise and shivering contributions to heat production were calculated. The AD was 0.8 degrees C and the RI was 5.2 degrees C.h-1. VO2 values at the onset of hypothermic exercise indicated an approximate 4-fold increase in heat production from the normothermic resting value. A small portion of this heat production resulted from exercise while the majority was from shivering. Maximal heat production occurred at the lowest Tc (31.2 degrees C.). This represented an approximate 5-fold increase over the resting normothermic value. Shivering continued to provide the majority of the heat. As Tc increased, however, although heat production remained relatively constant, the contribution of exercise increased and that of shivering decreased. It was possible for this man to do a slight exercise at a Tc as low as 31.2 degrees C and the rewarming rate from shivering was substantial. Significant heat production is initially primarily by shivering thermogenesis, but soon, at a higher Tc, by exercise as well.

Adult↗
PubMed1988

[Successful resuscitation in accidental hypothermia following drowning].

After breaking through thin ice, a 4-year-old boy drowned in a lake. A quickly alerted rescue helicopter found and recovered the child, drifting underneath the clear, thin ice. Primary resuscitation by the helicopter crew was unsuccessful. Upon arrival in the hospital the child had fixed, dilated pupils and asystole. Core temperature was 19.8 degrees C. Rewarming was conducted slowly while cardiopulmonary resuscitation was continued. Twenty minutes after arrival at the hospital, ventricular complexes appeared in the ECG (temperature 22.1 degrees C); after another 10 min this converted to sinus rhythm. At short intervals, blood gas analyses and electrolyte determinations were carried out and corrected adequately. For cerebral protection methohexital was given and the child was hyperventilated. Seventy minutes after arrival at the hospital the child was brought to the pediatric ICU with stable circulation. There, further rewarming (centrally/peripherally combined) was carried out, aiming at 1 degree C rewarming per hour until a normal temperature was reached. The patient had to be kept on the ventilator for 10 days and after another 2 weeks was discharged home. He had recovered completely without any cerebral damage. One of the reasons why 88 min of cardiac arrest were tolerated by this patient without sequelae may have been rapid and deep hypothermia.

Body Temperature Regulation↗
PubMedDate not supplied

The assessment of Raynaud's phenomenon using a radiation thermometer and a mild cold (20 degrees C) stress test.

Digital skin temperature was monitored using a radiation thermometer in 27 normal volunteers and in 24 patients with Raynaud's phenomenon before and after the application of a mild cold stress (20 degrees C for 1 minute). The test was performed in standardized environmental conditions and repeated after the ingestion of alcohol (30 mls of 25% ethyl alcohol). Three types of response were identified: "Normal" rewarming curves before alcohol in 25 of 27 volunteers and in one patient. "Abnormal" rewarming curves unaffected by alcohol in 18 patients. "Abnormal" rewarming curves normalized by alcohol in the 2 remaining volunteers and in 5 patients. This simple, practical, painless and noninvasive test may be of value in the objective assessment of the severity of Raynaud's phenomenon and in the evaluation of the effect of therapy.

Adult↗
PubMed1985

Temperature and ventilation after hypothermic cardiopulmonary bypass.

Rewarming in the postoperative period after hypothermic cardiopulmonary bypass is often associated with hemodynamic and ventilatory instability. Temperature changes, PaCO2 values, and delivered mechanical ventilation were observed for the first 12 hr in the intensive care unit in 73 patients who had undergone cardiac surgery with hypothermic cardiopulmonary bypass. Mean rectal temperature increased from 34.7 to 38.3 degrees C over the first 8 hr after admission to the intensive care unit (P less than 0.001). The temperature curve was sigmoid rather than linear, and the most rapid rate of temperature increase occurred 2-4 hr after admission. During rewarming, the most common abnormality of PaCO2 on mechanical ventilation was acute respiratory acidosis (PaCO2 greater than 45 mm Hg, pH less than 7.35), which occurred in 42% of patients. This suggests that ventilatory management in the early postoperative period after hypothermic cardiopulmonary bypass should be carefully adjusted to the increased metabolic rate during rapid rewarming.

Acid-Base Imbalance↗
PubMed1967

The management of accidental hypothermia.

Accidental general hypothermia is defined as an unintentional lowering of the body temperature in a previously conscious patient due to exposure. Even mild degrees of hypothermia may be followed by death if treatment is not instituted promptly. Hypothermic patients who are still conscious may rewarm spontaneously. They should not be left unattended and, if the facilities are available, rapid rewarming appears to be the treatment of choice. Unconscious patients who are presumed to have a lower temperature of prolonged duration may not benefit from rapid rewarming. All hypothermia victims showing signs of life are potential survivors, but even with good facilities the mortality rate may be high.

Animals↗
PubMed1982

Influence of taxol on the response of platelets to chilling.

Platelets have a characteristic lenslike appearance in circulating blood. In vitro studies have shown that the discoid shape is supported by a circumferential band of microtubules. Early studies demonstrated that chilling caused platelets to lose their disklike form and become irregularly convoluted with multiple pseudopods. The cold-induced shape change was associated with disappearance of the annular band of microtubules. Rewarming caused reassembly of the circumferential bundle and recovery of platelet discoid form. The present study has examined the influence of taxol, a microtubule stabilizing agent, on the response of platelets to low temperature. Taxol-treatment protected platelet microtubules from disassembly in the cold and preserved the discoid shape of most platelets. Addition of taxol to platelets prechilled to remove microtubules and maintained in the cold resulted in assembly of tubular polymers at low temperature. Brief exposure to taxol in the cold did not prevent recovery of platelet discoid shape on rewarming to 37 degrees C. However, the bundle of tubules was often located in the central axis, rather than in a circumferential band. Longer incubation with taxol at low temperature resulted in assembly of radiating bundles of tubules. On rewarming, these cells remained irregular in form and did not develop circumferential bands.

Alkaloids↗
PubMed1984

Effect of heated humidified gases on temperature drop after cardiopulmonary bypass.

In an attempt to prevent the decrease in nasopharyngeal temperature (NPT) ("afterdrop") after cardiac surgery, 30 patients undergoing hypothermic cardiopulmonary bypass (CPB) were randomly assigned to receive humidified heated inspired gases at 45 degrees C at the proximal end of the endotracheal tube (group I) or dry gases at room temperature (group II), from the time of termination of CPB. All patients received high flow rates on CPB during the rewarming period with the use of vasodilator drugs when necessary. Both groups were comparable with respect to total bypass time, rewarming time, and temperature at termination of CPB. In addition, the NPT was compared with the tympanic membrane temperature (TMT) in group I to assess the validity of the NPT under these conditions. The results indicate that heating and humidifying inspired gases do not prevent afterdrop and do not falsely increase the nasopharyngeal temperature. The reasons for the ineffectiveness of heated humidified gases may include a large heat deficit at termination of CPB despite a normal NPT, and the very small heat content of heated gases. Monitoring the temperature of a site that reflects the heat deficit, and a more complete rewarming during CPB are suggested as a better approach to the prevention of afterdrop.

Adult↗
PubMedDate not supplied

Clinical and laboratory evaluation of the Shiley S-100-A oxygenator-heat exchanger.

A new oxygenator the Shiley S-100-A has been evaluated. It incorporates a heat exchanger based on an anodised aluminium tube which replaces the polyurethane coated tube of the previous S-100 model. Data from 46 patients perfused with the Shiley S-100-A were reviewed and compared with figures derived from a previous group of 225 patients in whom the S-100 model was used. The gas transfer capacity of the S-100-A model is very good and comparable to that of the S-100 oxygenator at a low gas flow/blood flow ratio. However both "in vitro" and "in vivo" studies confirmed the superiority of the heat exchange capacity of the S-100-A model. The times required for cooling (from 36.5 to 29.6 degrees C) and rewarming (from 29.6 to 37 degrees C) for an adult patient of average build were 9.1 and 26 minutes for the S-100 model and 6.7 and 15 minutes for the S-100-A model respectively. In a separate group of patients cooled to and rewarmed from 26 degrees C the cooling and rewarming times were 12.4 and 23 minutes respectively.

Adult↗
PubMed1981

In vivo release of a heparin-like factor in dogs during profound hypothermia.

Experimentally induced hypothermia (20 degrees C) for 60 minutes in dogs provokes a significant decrease in the platelet count, which reverses during subsequent rewarming, and the constant release of a heparin-like factor, which reacts as a specific inhibitor of factor Xa. This phenomenon is also rapidly reversible, and heparin values are not significantly different from control levels after 90 minutes of rewarming. The mean maximal concentration of heparin-like material is 0.54 U/ml, or about double control levels. Its half-life is approximately 90 minutes. The level of circulating antithrombin III was not modified during hypothermia and rewarming.

Animals↗