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CONTEXT: Hypothermia is known to influence thromboelastography (TEG). TEG reproducibility is generally low. OBJECTIVE: The aim of this study was to evaluate the rationale of TEG temperature adjustment in patients during hypothermia. We hypothesised that temperature adjustment would not be important because of low TEG reproducibility. DESIGN: Prospective observational study. SETTING: Single-centre, secondary care study performed 01/2009 to 07/2010. PATIENTS: Survivors of cardiopulmonary resuscitation in whom therapeutic hypothermia (32 to 34°C) was indicated for 24 h were recruited to the study which lasted 36 h. Four hundred samples from 30 patients (22 men and eight women) were obtained. No specific exclusion criteria were defined. MAIN OUTCOME MEASURES: Temperature adjusted and non-adjusted Kaolin-Heparinase and Rapid-TEG were done at 12-h intervals during the first 36 h. RESULTS: Bland-Altman plots were used for analysis. During hypothermia, the bias of adjusted measurements was greater in clot formation variables for both Kaolin-Heparinase-TEG (from -15 to -19%) and Rapid-TEG (-9 to -25%) compared to normothermia (from -3 to 3% for Kaolin-Heparinase-TEG and -10 to 2% for Rapid-TEG). Bias of clot strength variables was not influenced by temperature adjustment (median -1%). The 95% limits of agreement were wide for clot formation variables and independent of temperature. In Kaolin-Heparinase-TEG (R -42 to 40% normothermia, -47 to 18% hypothermia) and in Rapid-TEG (R -117 to 97% normothermia, -114 to 95% hypothermia). Limits of agreement of clot strength variables were narrower and independent of temperature in Kaolin-Heparinase-TEG (MA -16 to 13% normothermia, -9 to 10% hypothermia) and also in Rapid-TEG (MA -27 to 24% normothermia, -18 to 20% hypothermia). CONCLUSION: Although TEG analysis with temperature adjusted to the in-vivo value during hypothermia yields results with small systematic bias, the importance of temperature adjustment in clinical routine is low because of the precision limits of TEG measurement itself. Therefore, we see no need to perform TEG analysis at the in-vivo temperature.

MeSH
kardiopulmonální resuscitace metody normy MeSH
kardiovaskulární nemoci epidemiologie terapie MeSH
lidé středního věku MeSH
lidé MeSH
prospektivní studie MeSH
senioři MeSH
terapeutická hypotermie metody normy MeSH
tromboelastografie metody normy MeSH
Check Tag
lidé středního věku MeSH
lidé MeSH
mužské pohlaví MeSH
senioři MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
práce podpořená grantem MeSH

Článek

Novinky v resuscitaci novorozence
[New guidelines in the newborn resuscitation]

Liška, Karel, 1957-
Autor Autorita Neonatologické oddělení Gynekologicko-porodnické kliniky 1. LF UK a Všeobecné fakultní nemocnice v Praze

Pediatrie pro praxi. 2012 ; 13 (4) : 265-269.

Pediatr. praxi (Print)
ISSN 1213-0494
Medvik
Zdroj

V článku je podán celkový přehled resuscitace novorozence se zaměřením na změny, ke kterým došlo v období 2005–2010. Doporučení jsou určena pro resuscitaci novorozence po porodu (přechod z intrauterinního do extrauterinního prostředí), ale lze je použít i pro novorozence, kteří vyžadují resuscitaci v prvních týdnech života. Hlavní změny se týkají použití kyslíku při resuscitaci donošených novorozenců, zavedení řízené hypotermie a stabilizace nedonošených novorozenců na porodním sále.

The following article offers an overall summary of neonatal resuscitation guidelines focusing on the changes made between the years 2005–2010. These recommendations are to be used for the resuscitation of newly born infants undergoing transition from intrauterine to extrauterine life, but they can also be applied for the resuscitation of neonates during their first weeks of life. The primary changes regard the use of oxygen during resuscitation of term infants, introduction of controlled hypothermia and the stabilization of preterm infants in the delivery room.