Targeted temperature management(TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy(HIE).In addition, TTM is also useful for treatment of elevated intracranial pressure(ICP).H...Targeted temperature management(TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy(HIE).In addition, TTM is also useful for treatment of elevated intracranial pressure(ICP).HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit(ICU).The most common cause of HIE is cardiac arrest.Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest.Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies.Several methods of TTM have been reported in the literature.TTM can apply to various clinical conditions associated with hypoxic/ischemic brain injury and elevated ICP in Neurologic ICU.展开更多
BACKGROUND:Targeted temperature management(TTM),as a therapeutic temperature control strategy for cardiac arrest(CA),is recommended by guidelines.However,the relationship between postrewarming fever(PRF)and the progno...BACKGROUND:Targeted temperature management(TTM),as a therapeutic temperature control strategy for cardiac arrest(CA),is recommended by guidelines.However,the relationship between postrewarming fever(PRF)and the prognosis of CA patients is unclear.Therefore,we aim to summarize the studies regarding the infl uence of PRF on patients with CA.METHODS:EMBASE,PubMed,and Cochrane Central databases were searched from inception to March 13,2022.Randomized clinical trials(RCTs)and cohort studies on PRF in CA patients were included.According to the heterogeneity,the meta-analysis was performed using a random eff ects model or fi xed eff ects model to calculate the pooled odds ratios(ORs)and corresponding 95%confi dence intervals(CIs).The outcome data were unfavorable neurological outcome and mortality.RESULTS:The meta-analysis included 11 observational studies involving 3,246 patients.The results of the meta-analysis show that PRF(body temperature>38.0℃)has no eff ect on the neurological outcome of CA patients(OR 0.71,95%CI 0.43–1.17,I282%)and has a signifi cant relationship with lower mortality(OR 0.63;95%CI 0.49–0.80,I239%).However,PRF with a stricter defi nition(body temperature>38.5℃)was associated with worse neurological outcome(OR 1.44,95%CI 1.08–1.92,I245%)and higher mortality(OR 1.71,95%CI 1.25–2.35,I247%).CONCLUSION:This study suggests that PRF>38.0℃ may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM.However,PRF>38.5℃ is a potential prognostic factor for worse outcomes in CA patients.展开更多
Core body temperature(CBT)is increasingly attracting attention as crucial data during target temperature management(TTM).Accurate and continuous measurement of human CBT can effectively identify and monitor central hi...Core body temperature(CBT)is increasingly attracting attention as crucial data during target temperature management(TTM).Accurate and continuous measurement of human CBT can effectively identify and monitor central high fever,and provide a basis for the effective implementation during TTM,which is therefore of great significance for human health care and disease monitoring.The reliable core measurement sites are nasopharynx,esophagus,bladder,rectum,pulmonary artery,etc.,but the measurement methods in these sites are all invasive.At present,the medical field is more inclined to noninvasive data collection methods through monitoring an appropriate site(such as forehead,mouth,or axilla)depending on clinical circumstances,so as to ensure the comfort and security of patients to the greatest extent.This review will provide reference choosing more safe and accurate temperature measurement methods for patients during TTM by reviewing the sites and accuracy of invasive and noninvasive CBT measurements.展开更多
Cardiac or respiratory arrest lasting only a few minutes can inflict grave harm on numerous bodily organs, not least of all, the brain. Neurocognitive deficits, which are often severe and profoundly life altering, rem...Cardiac or respiratory arrest lasting only a few minutes can inflict grave harm on numerous bodily organs, not least of all, the brain. Neurocognitive deficits, which are often severe and profoundly life altering, remain a major source of morbidity among survivors.展开更多
目的为心脏骤停后复苏患者实施目标体温管理(targeted temperature management,TTM)构建科学规范,推广性强的综合护理方案。方法成立研究小组,在前期循证研究的基础上开展小组头脑风暴形成心脏骤停后患者TTM护理方案初稿,通过2轮德尔菲...目的为心脏骤停后复苏患者实施目标体温管理(targeted temperature management,TTM)构建科学规范,推广性强的综合护理方案。方法成立研究小组,在前期循证研究的基础上开展小组头脑风暴形成心脏骤停后患者TTM护理方案初稿,通过2轮德尔菲专家函询,对方案条目进行修改完善补充,确定最终方案。结果2轮专家函询的问卷回收率分别为88%和100%,专家权威系数为0.93;第2轮函询条目的重要性及可操作性评价的变异系数分别为0~0.18、0~0.13,肯德尔和谐系数分别为0.089、0.105,差异具有统计学意义(P<0.05)。最终方案包括准备阶段、低温诱导阶段、体温维持阶段、复温阶段、正常体温控制阶段5个一级条目,16个二级条目,45个三级条目。结论本研究专家积极性及权威程度较高,专家意见协调程度较好,构建的心脏骤停后患者TTM护理方案具有可靠性、针对性和可行性。展开更多
Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with ou...Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.展开更多
目的了解急诊医生心脏骤停患者脑保护的认知和实践情况。方法通过问卷调查的方式进行,在全国范围内随机选取75家医院,参研医院所有的急诊科医生均参与调查研究。结果共有1473名受访者参与研究,应答率为92.1%。89.4%受访者认为目标温度管...目的了解急诊医生心脏骤停患者脑保护的认知和实践情况。方法通过问卷调查的方式进行,在全国范围内随机选取75家医院,参研医院所有的急诊科医生均参与调查研究。结果共有1473名受访者参与研究,应答率为92.1%。89.4%受访者认为目标温度管理(target temperature management,TTM)有助于改善心脏骤停患者的神经功能,但仅有15.5%的急诊科及27.8%的受访者在临床实践中实施过TTM。对于理论上有脑保护作用,但目前缺乏相关证据支持的药物和措施,绝大多数受访者认为有脑保护作用并应用于临床实践中,应用最为普遍的三磷酸腺苷(85.9%)、减轻脑水肿的药物(73.5%)、自由基清除剂(70.8%)、营养神经药物(66.4%)、高压氧治疗(60.0%)及线粒体保护剂(45.6%)。结论急诊医生对TTM认知程度有很大改观,但实践情况仍然不理想,临床上更多选择理论上有保护作用但目前尚无确切证据的措施。展开更多
基金the National Research University Project of Thailand from Office of Higher Education Commission and Center of Excellence in Integrated Sciences for Holistic Stroke Research from Thammasat University
文摘Targeted temperature management(TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy(HIE).In addition, TTM is also useful for treatment of elevated intracranial pressure(ICP).HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit(ICU).The most common cause of HIE is cardiac arrest.Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest.Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies.Several methods of TTM have been reported in the literature.TTM can apply to various clinical conditions associated with hypoxic/ischemic brain injury and elevated ICP in Neurologic ICU.
基金supported by the National Natural Science Foundation of China(82072137,81571866).
文摘BACKGROUND:Targeted temperature management(TTM),as a therapeutic temperature control strategy for cardiac arrest(CA),is recommended by guidelines.However,the relationship between postrewarming fever(PRF)and the prognosis of CA patients is unclear.Therefore,we aim to summarize the studies regarding the infl uence of PRF on patients with CA.METHODS:EMBASE,PubMed,and Cochrane Central databases were searched from inception to March 13,2022.Randomized clinical trials(RCTs)and cohort studies on PRF in CA patients were included.According to the heterogeneity,the meta-analysis was performed using a random eff ects model or fi xed eff ects model to calculate the pooled odds ratios(ORs)and corresponding 95%confi dence intervals(CIs).The outcome data were unfavorable neurological outcome and mortality.RESULTS:The meta-analysis included 11 observational studies involving 3,246 patients.The results of the meta-analysis show that PRF(body temperature>38.0℃)has no eff ect on the neurological outcome of CA patients(OR 0.71,95%CI 0.43–1.17,I282%)and has a signifi cant relationship with lower mortality(OR 0.63;95%CI 0.49–0.80,I239%).However,PRF with a stricter defi nition(body temperature>38.5℃)was associated with worse neurological outcome(OR 1.44,95%CI 1.08–1.92,I245%)and higher mortality(OR 1.71,95%CI 1.25–2.35,I247%).CONCLUSION:This study suggests that PRF>38.0℃ may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM.However,PRF>38.5℃ is a potential prognostic factor for worse outcomes in CA patients.
基金supported by the Young Teacher Project of Beijing University of Chinese Medicine(No.:2018-JYB-JS155).
文摘Core body temperature(CBT)is increasingly attracting attention as crucial data during target temperature management(TTM).Accurate and continuous measurement of human CBT can effectively identify and monitor central high fever,and provide a basis for the effective implementation during TTM,which is therefore of great significance for human health care and disease monitoring.The reliable core measurement sites are nasopharynx,esophagus,bladder,rectum,pulmonary artery,etc.,but the measurement methods in these sites are all invasive.At present,the medical field is more inclined to noninvasive data collection methods through monitoring an appropriate site(such as forehead,mouth,or axilla)depending on clinical circumstances,so as to ensure the comfort and security of patients to the greatest extent.This review will provide reference choosing more safe and accurate temperature measurement methods for patients during TTM by reviewing the sites and accuracy of invasive and noninvasive CBT measurements.
文摘Cardiac or respiratory arrest lasting only a few minutes can inflict grave harm on numerous bodily organs, not least of all, the brain. Neurocognitive deficits, which are often severe and profoundly life altering, remain a major source of morbidity among survivors.
文摘目的为心脏骤停后复苏患者实施目标体温管理(targeted temperature management,TTM)构建科学规范,推广性强的综合护理方案。方法成立研究小组,在前期循证研究的基础上开展小组头脑风暴形成心脏骤停后患者TTM护理方案初稿,通过2轮德尔菲专家函询,对方案条目进行修改完善补充,确定最终方案。结果2轮专家函询的问卷回收率分别为88%和100%,专家权威系数为0.93;第2轮函询条目的重要性及可操作性评价的变异系数分别为0~0.18、0~0.13,肯德尔和谐系数分别为0.089、0.105,差异具有统计学意义(P<0.05)。最终方案包括准备阶段、低温诱导阶段、体温维持阶段、复温阶段、正常体温控制阶段5个一级条目,16个二级条目,45个三级条目。结论本研究专家积极性及权威程度较高,专家意见协调程度较好,构建的心脏骤停后患者TTM护理方案具有可靠性、针对性和可行性。
基金the National Natural Science Foundation of China(Grant No.81372025).
文摘Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.
文摘目的了解急诊医生心脏骤停患者脑保护的认知和实践情况。方法通过问卷调查的方式进行,在全国范围内随机选取75家医院,参研医院所有的急诊科医生均参与调查研究。结果共有1473名受访者参与研究,应答率为92.1%。89.4%受访者认为目标温度管理(target temperature management,TTM)有助于改善心脏骤停患者的神经功能,但仅有15.5%的急诊科及27.8%的受访者在临床实践中实施过TTM。对于理论上有脑保护作用,但目前缺乏相关证据支持的药物和措施,绝大多数受访者认为有脑保护作用并应用于临床实践中,应用最为普遍的三磷酸腺苷(85.9%)、减轻脑水肿的药物(73.5%)、自由基清除剂(70.8%)、营养神经药物(66.4%)、高压氧治疗(60.0%)及线粒体保护剂(45.6%)。结论急诊医生对TTM认知程度有很大改观,但实践情况仍然不理想,临床上更多选择理论上有保护作用但目前尚无确切证据的措施。
