Q95462034 Dotaz Zobrazit nápovědu

Přesná shoda Sémantické

BACKGROUND: Assessment of fluid responsiveness is an important topic in acute cardiology. Echocardiographic measurement of respiratory variations of aortic blood velocity in ventilated shock patients can accurately predict the effect of volume expansion. On the other hand, it remains unclear whether this respiratory variability is a common physiological reaction to hypovolaemia and whether its measurement is applicable also in spontaneously breathing patients.

Článek online

Nadměrné ochlazení během mírné hypotermie po srdeční zástavě - fenomén zasluhující pozornost
[Overcooling during mild hypothermia in cardiac arrest survivors -phenomenon we should keep in mind]

Vnitřní lékařství. 2008 ; 54 (6) : 609-614.

ISSN 0042-773X
Medvik
Zdroj

Mírná hypotermie (MH) u nemocných po srdeční zástavě (SZ) je standardní součástí poresuscitační péče. Následky nadměrného ochlazení, ke kterému často dochází, nejsou známy. Cíl práce: Zjistit, zda a jak často v našem souboru došlo k nadměrnému ochlazení pod tělesnou teplotu (TT) 32 °C a jaké byly následky. Soubor a metoda: Provedli jsme retrospektivní analýzu 56 konsekutivních nemocných II. interní kliniky 1. lékařské fakulty UK a VFN Praha indikovaných k MH po SZ a ochlazených na terapeutickou TT. MH byla indukována co nejdříve po návratu spontánní cirkulace na TT 33 °C a udržována v rozmezí 32-34 °C po dobu 12 hod. Ochlazovací metodou bylo povrchové chlazení ledovými obklady a nitrožilní aplikace ledového krystaloidu. Výsledky: Nadměrný pokles TT pod 32 °C jsme pozorovali u 23 nemocných (41 %). Tito pacienti měli častěji asystolii jako iniciální rytmus (34,8 vs 9,1 %), častěji byl použit kombinovaný ochlazovací postup (56,5 vs 27,3 %), měli nižší TT před zahájením MH (35,3 +- 1,3 vs 36,2 +- 1,2 °C), vyšší ochlazovací rychlost (doba potřebná k ochlazení o 1 °C 61,5 +- 53,1 vs 90,1 +- 50,0 min) a delší trvání TT < 34 °C během MH (1 244 +- 548 vs 918 +- 370 min) (vše p < 0,05) než pacienti s dobře kontrolovanou TT. Nadměrné ochlazení bylo nezávislým negativním prediktorem příznivého neurologického výsledku při dimisi (OR 0,16, 0,022-0,77, p = 0,037). Závěr: Indukce MH pomocí konvenčních metod je zatížena vysokým rizikem nadměrného ochlazení. Tento fenomén je pravděpodobně spojen s horší prognózou.

Mild hypothermia (MH) in cardiac arrest survivors has became a routine part of early postresuscitative support. Overcooling is a frequent phenomenon with the unknown outcome. AIM OF THE STUDY: To analyze the incidence and outcome ofovercooling below body core temperature (BT) of 32 degrees C. MATERIAL AND METHODS: We performed retrospective analysis of all 56 consecutive cardiac arrest survivors treated by MH who reached therapeutic BT in the 2nd Department of Internal Medicine, General Teaching Hospital, Prague. MH was initiated as soon as possible after the return of spontaneous circulation to reach BT of 33 degrees C followed by maintainance of BT 32-34 degrees C for 12 hours. Patients were cooled by surface cooling via ice-packs and by interavenous infusion of cold crystaloids. RESULTS: Overcooling below BT of 32 degrees C was observed in 23 patients (41%). This group of patients had more frequently asystole as the initial rhythm (34.8 vs 9.1%), more frequently were cooled by combinatory cooling approach (56.5 vs 27.3%), more frequently had lower baseline BT (35.3 +/- 1.3 vs 36.2 +/- 1.2 degrees C), higher cooling rate (the interval required for a decrease of BT by 1 degrees C 61.5 +/- 53.1 vs 90.1 +/- 50.0 min) (all p < 0.05) than patients with proper profile of BT during MH. Overcooling was independent negative predictor of discharge favourable neurological outcome (OR 0.16, 0.022-0.77, p = 0.037). CONCLUSION: Induction of MH by conventional cooling approach is burdened by high risk of overcooling. This phenomenon is probably associated with worse outcome.

MeSH
kardiopulmonální resuscitace MeSH
lidé středního věku MeSH
lidé MeSH
senioři MeSH
srdeční zástava terapie MeSH
tělesná teplota MeSH
terapeutická hypotermie škodlivé účinky MeSH
Check Tag
lidé středního věku MeSH
lidé MeSH
mužské pohlaví MeSH
senioři MeSH
ženské pohlaví MeSH

Článek online

Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome

Acta anaesthesiologica Scandinavica. 2008 ; 52 (2) : 188-194.

Acta Anaesthesiol Scand
Medvik
Zdroj

BACKGROUND: Induction of mild hypothermia (MH) in patients resuscitated from cardiac arrest improves their outcome. However, benefits and risks of MH in patients who remain in cardiogenic shock after the return of spontaneous circulation (ROSC) are unclear. We analysed all cardiac arrest survivors who were treated with MH in our intensive coronary care unit (CCU) and compared the outcome of patients with cardiogenic shock syndrome (CSS) with those who were circulatory stable. METHODS: We performed retrospective analysis of all consecutive cardiac arrest survivors treated by MH in our CCU from November 2002 to August 2006. They were classified into two groups, according to whether they met the criteria for cardiogenic shock or not before MH initiation. RESULTS: Out of 56 consecutive patients, 28 fulfilled criteria of cardiogenic shock before MH initiation (group A) and 28 were relatively stable (group B). In-hospital mortality was 57.1% in group A and 21.4% in group B patients (P=0.013). Favourable neurological outcome anytime during hospitalization was found in 67.9% of group A patients and in 82.1% of group B subjects (P=0.355). Favourable discharge neurological outcome was reached in 39.3% in group A and in 71.4% in group B (P=0.031). The complication rate in both groups did not differ. CONCLUSION: While in-hospital mortality in cardiac arrest survivors treated by MH was expectably higher in those with cardiogenic shock than in stable patients, the favourable neurological outcome during hospitalization was comparable in both groups. Therefore, induction of MH should be considered in cardiac arrest survivors with CSS after ROSC.