Accidental Hypothermia

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Frank Hildebrand - One of the best experts on this subject based on the ideXlab platform.

  • effects of Accidental Hypothermia on posttraumatic complications and outcome in multiple trauma patients
    Injury-international Journal of The Care of The Injured, 2013
    Co-Authors: Philipp Mommsen, Hagen Andruszkow, Cornelia Fromke, Christian Zeckey, U Wagner, M Van Griensven, Michael Frink, Christian Krettek, Frank Hildebrand
    Abstract:

    Abstract Introduction Accidental Hypothermia seems to predispose multiple trauma patients to the development of posttraumatic complications, such as Systemic Inflammatory Response Syndrome (SIRS), sepsis, Multiple Organ Dysfunction Syndrome (MODS), and increased mortality. However, the role of Accidental Hypothermia as an independent prognostic factor is controversially discussed. The aim of the present study was to evaluate the incidence of Accidental Hypothermia in multiple trauma patients and its effects on the development of posttraumatic complications and mortality. Patients and methods Inclusion criteria for patients in this retrospective study (2005–2009) were an Injury Severity Score (ISS) ≥16, age ≥16 years, admission to our Level I trauma centre within 6 h after the accident. Accidental Hypothermia was defined as body temperature less than 35 °C measured within 2 h after admission, but always before first surgical procedure in the operation theatre. The association between Accidental Hypothermia and the development of posttraumatic complications as well as mortality was investigated. Statistical analysis was performed with χ2-test, Student's t-test, ANOVA and logistic regression. Statistical significance was considered at p  Results 310 multiple trauma patients were enrolled in the present study. Patients’ mean age was 41.9 (SD 17.5) years, the mean injury severity score was 29.7 (SD 10.2). The overall incidence of Accidental Hypothermia was 36.8%. The overall incidence of posttraumatic complications was 77.4% (SIRS), 42.9% (sepsis) and 7.4% (MODS), respectively. No association was shown between Accidental Hypothermia and the development of posttraumatic complications. Overall, 8.7% died during the posttraumatic course. Despite an increased mortality rate in hypothermic patients, Hypothermia failed to be an independent risk factor for mortality in multivariate analysis. Conclusions Accidental Hypothermia is very common in multiply injured patients. However, it could be assumed that the increase of mortality in hypothermic patients is primarily caused by the injury severity and does not reflect an independent adverse effect of Hypothermia. Furthermore, Hypothermia was not shown to be an independent risk factor for posttraumatic complications.

  • Accidental Hypothermia in multiple trauma patients
    Zentralblatt Fur Chirurgie, 2012
    Co-Authors: Philipp Mommsen, Christian Zeckey, Michael Frink, Christian Krettek, Frank Hildebrand
    Abstract:

    BACKGROUND: Hypothermia, defined as a body core temperature below 35 °C, could be divided into an endogeneous, therapeutic and Accidental Hypothermia. At admission in the emergency room multiple trauma patients show a hypothermic core temperature in up to 66 %. A core temperature below 34 °C seems to be critical in these patients as this temperature limit has been demonstrated to be associated with an increased risk for post-traumatic complications and a decreased survival. In polytraumatised patients with a core temperature below 32 °C a mortality rate of 100 % has been described. MATERIAL AND METHODS: The main pathophysio-log-ical effects of Hypothermia concern the haemo-dynamic, coagulatory and immune systems. Mild Hypothermia (35-32 °C) leads to a vasoconstric-tion, tachycardia and increased cardiac output. After an increasing arrhythmia and bradycardia severe Hypothermia ( 0.5 °C / h) has been reported to be associated with an increased mortality during the further course, this procedure should only be applied in hypothermic multiple trauma patients with haemorrhagic shock. CONCLUSION: Accidental Hypothermia represents a serious problem in multiple trauma patients due to its frequency and negative pathophysiological effects. Therefore, early and effective re-warm-ing is essential in the treatment of hypothermic trauma patients. Possible protective effects of a therapeutic Hypothermia in the treatment of trauma patients after initial resuscitation and operative bleeding control have to be clarified in further experimental and clinical studies. Language: de

Philipp Mommsen - One of the best experts on this subject based on the ideXlab platform.

  • effects of Accidental Hypothermia on posttraumatic complications and outcome in multiple trauma patients
    Injury-international Journal of The Care of The Injured, 2013
    Co-Authors: Philipp Mommsen, Hagen Andruszkow, Cornelia Fromke, Christian Zeckey, U Wagner, M Van Griensven, Michael Frink, Christian Krettek, Frank Hildebrand
    Abstract:

    Abstract Introduction Accidental Hypothermia seems to predispose multiple trauma patients to the development of posttraumatic complications, such as Systemic Inflammatory Response Syndrome (SIRS), sepsis, Multiple Organ Dysfunction Syndrome (MODS), and increased mortality. However, the role of Accidental Hypothermia as an independent prognostic factor is controversially discussed. The aim of the present study was to evaluate the incidence of Accidental Hypothermia in multiple trauma patients and its effects on the development of posttraumatic complications and mortality. Patients and methods Inclusion criteria for patients in this retrospective study (2005–2009) were an Injury Severity Score (ISS) ≥16, age ≥16 years, admission to our Level I trauma centre within 6 h after the accident. Accidental Hypothermia was defined as body temperature less than 35 °C measured within 2 h after admission, but always before first surgical procedure in the operation theatre. The association between Accidental Hypothermia and the development of posttraumatic complications as well as mortality was investigated. Statistical analysis was performed with χ2-test, Student's t-test, ANOVA and logistic regression. Statistical significance was considered at p  Results 310 multiple trauma patients were enrolled in the present study. Patients’ mean age was 41.9 (SD 17.5) years, the mean injury severity score was 29.7 (SD 10.2). The overall incidence of Accidental Hypothermia was 36.8%. The overall incidence of posttraumatic complications was 77.4% (SIRS), 42.9% (sepsis) and 7.4% (MODS), respectively. No association was shown between Accidental Hypothermia and the development of posttraumatic complications. Overall, 8.7% died during the posttraumatic course. Despite an increased mortality rate in hypothermic patients, Hypothermia failed to be an independent risk factor for mortality in multivariate analysis. Conclusions Accidental Hypothermia is very common in multiply injured patients. However, it could be assumed that the increase of mortality in hypothermic patients is primarily caused by the injury severity and does not reflect an independent adverse effect of Hypothermia. Furthermore, Hypothermia was not shown to be an independent risk factor for posttraumatic complications.

  • Accidental Hypothermia in multiple trauma patients
    Zentralblatt Fur Chirurgie, 2012
    Co-Authors: Philipp Mommsen, Christian Zeckey, Michael Frink, Christian Krettek, Frank Hildebrand
    Abstract:

    BACKGROUND: Hypothermia, defined as a body core temperature below 35 °C, could be divided into an endogeneous, therapeutic and Accidental Hypothermia. At admission in the emergency room multiple trauma patients show a hypothermic core temperature in up to 66 %. A core temperature below 34 °C seems to be critical in these patients as this temperature limit has been demonstrated to be associated with an increased risk for post-traumatic complications and a decreased survival. In polytraumatised patients with a core temperature below 32 °C a mortality rate of 100 % has been described. MATERIAL AND METHODS: The main pathophysio-log-ical effects of Hypothermia concern the haemo-dynamic, coagulatory and immune systems. Mild Hypothermia (35-32 °C) leads to a vasoconstric-tion, tachycardia and increased cardiac output. After an increasing arrhythmia and bradycardia severe Hypothermia ( 0.5 °C / h) has been reported to be associated with an increased mortality during the further course, this procedure should only be applied in hypothermic multiple trauma patients with haemorrhagic shock. CONCLUSION: Accidental Hypothermia represents a serious problem in multiple trauma patients due to its frequency and negative pathophysiological effects. Therefore, early and effective re-warm-ing is essential in the treatment of hypothermic trauma patients. Possible protective effects of a therapeutic Hypothermia in the treatment of trauma patients after initial resuscitation and operative bleeding control have to be clarified in further experimental and clinical studies. Language: de

Jean Francois Payen - One of the best experts on this subject based on the ideXlab platform.

Vakhtang Tchantchaleishvili - One of the best experts on this subject based on the ideXlab platform.

  • Outcomes of Extracorporeal Life Support Use in Accidental Hypothermia: A Systematic Review.
    The Annals of Thoracic Surgery, 2020
    Co-Authors: Melissa A. Austin, Tomasz Darocha, Elizabeth J. Maynes, Thomas J. O’malley, Piotr Mazur, John W.c. Entwistle, H. Todd Massey, Rohinton J. Morris, Vakhtang Tchantchaleishvili
    Abstract:

    Abstract Background Extracorporeal life support (ECLS) has been used in the treatment of Accidental Hypothermia with hemodynamic instability with promising outcomes. This systematic review examines ECLS treatment of Accidental Hypothermia to assess outcomes. Methods An electronic search was performed to identify articles reporting ECLS use for treatment of Accidental Hypothermia. Only reports describing patients older than 16 years after January 1st, 2005 were included. 19 studies were identified comprising 47 patients. Demographic information, perioperative variables, and outcomes were extracted for analysis. Results Median patient age was 48 [IQR 29, 56] years and 72.3% (34/47) were male. On presentation, median body temperature was 24.6 [22.2, 26.0] °C, median potassium level 4.3 [3.4, 4.6] mmol/L, and median Glasgow Coma Scale (GCS) score 3 [3, 7]. Cardiac arrest occurred in 35/47 (74.5%) patients. Median time to ECLS initiation from scene was 155 [113, 245] minutes. Median ECLS duration was 18 [4, 27] hours, with median rewarming rate of 2.0 [1.5, 4.0] °C/hr. Median ICU and hospital length of stay were 8 [2, 16] and 17 [10, 36] days, respectively. In-hospital mortality was 19.1% (9/47). Median discharge GCS was 15 [15, 15] with minor long-term cognitive impairments noted in 6/47 (19.4%) patients. Survival was significantly associated with potassium on presentation (p Conclusions ECLS is a viable cardiac support option for rewarming patients with Accidental Hypothermia, while initial potassium level, initial body temperature and ECLS rewarming rate appear to be significantly associated with survival.

  • outcomes of extracorporeal life support use in Accidental Hypothermia a systematic review
    The Annals of Thoracic Surgery, 2020
    Co-Authors: Melissa A. Austin, Tomasz Darocha, Elizabeth J. Maynes, Piotr Mazur, John W.c. Entwistle, Rohinton J. Morris, Thomas J Omalley, Todd H Massey, Vakhtang Tchantchaleishvili
    Abstract:

    Background Extracorporeal life support (ECLS) has been used in the treatment of Accidental Hypothermia with hemodynamic instability, with promising outcomes. This systematic review examines ECLS treatment of Accidental Hypothermia to assess outcomes. Methods An electronic search was performed to identify articles reporting ECLS use for treatment of Accidental Hypothermia. Only reports describing patients aged more than 16 years after January 1, 2005, were included. Nineteen studies were identified comprising 47 patients. Demographic information, perioperative variables, and outcomes were extracted for analysis. Results Median patient age was 48 years (interquartile range (IQR), 29 to 56), and 72.3% (34 of 47) were male. On presentation, median body temperature was 24.6°C (IQR, 22.2° to 26°C), median potassium level 4.3 mmol/L (IQR, 3.4 to 4.6 mmol/L), and median Glasgow Coma Scale score 3 (IQR, 3 to 7). Cardiac arrest occurred in 35 of 47 patients (74.5%). Median time to ECLS initiation from scene was 155 minutes (IQR, 113 to 245). Median ECLS duration was 18 hours (IQR, 4 to 27), with median rewarming rate of 2°C per hour (IQR, 1.5° to 4°). Median intensive care unit stay and hospital length of stay were 8 days (IQR, 2 to 16) and 17 days (IQR, 10 to 36), respectively. Inhospital mortality was 19.1% (9 of 47). Median discharge Glasgow Coma Scale score was 15 (IQR, 15 to 15) with minor long-term cognitive impairments noted in 6 of 47 patients (19.4%). Survival was significantly associated with potassium on presentation (P Conclusions Extracorporeal life support is a viable cardiac support option for rewarming patients with Accidental Hypothermia, and initial potassium level, initial body temperature, and ECLS rewarming rate appear to be significantly associated with survival.

Christian Krettek - One of the best experts on this subject based on the ideXlab platform.

  • effects of Accidental Hypothermia on posttraumatic complications and outcome in multiple trauma patients
    Injury-international Journal of The Care of The Injured, 2013
    Co-Authors: Philipp Mommsen, Hagen Andruszkow, Cornelia Fromke, Christian Zeckey, U Wagner, M Van Griensven, Michael Frink, Christian Krettek, Frank Hildebrand
    Abstract:

    Abstract Introduction Accidental Hypothermia seems to predispose multiple trauma patients to the development of posttraumatic complications, such as Systemic Inflammatory Response Syndrome (SIRS), sepsis, Multiple Organ Dysfunction Syndrome (MODS), and increased mortality. However, the role of Accidental Hypothermia as an independent prognostic factor is controversially discussed. The aim of the present study was to evaluate the incidence of Accidental Hypothermia in multiple trauma patients and its effects on the development of posttraumatic complications and mortality. Patients and methods Inclusion criteria for patients in this retrospective study (2005–2009) were an Injury Severity Score (ISS) ≥16, age ≥16 years, admission to our Level I trauma centre within 6 h after the accident. Accidental Hypothermia was defined as body temperature less than 35 °C measured within 2 h after admission, but always before first surgical procedure in the operation theatre. The association between Accidental Hypothermia and the development of posttraumatic complications as well as mortality was investigated. Statistical analysis was performed with χ2-test, Student's t-test, ANOVA and logistic regression. Statistical significance was considered at p  Results 310 multiple trauma patients were enrolled in the present study. Patients’ mean age was 41.9 (SD 17.5) years, the mean injury severity score was 29.7 (SD 10.2). The overall incidence of Accidental Hypothermia was 36.8%. The overall incidence of posttraumatic complications was 77.4% (SIRS), 42.9% (sepsis) and 7.4% (MODS), respectively. No association was shown between Accidental Hypothermia and the development of posttraumatic complications. Overall, 8.7% died during the posttraumatic course. Despite an increased mortality rate in hypothermic patients, Hypothermia failed to be an independent risk factor for mortality in multivariate analysis. Conclusions Accidental Hypothermia is very common in multiply injured patients. However, it could be assumed that the increase of mortality in hypothermic patients is primarily caused by the injury severity and does not reflect an independent adverse effect of Hypothermia. Furthermore, Hypothermia was not shown to be an independent risk factor for posttraumatic complications.

  • Accidental Hypothermia in multiple trauma patients
    Zentralblatt Fur Chirurgie, 2012
    Co-Authors: Philipp Mommsen, Christian Zeckey, Michael Frink, Christian Krettek, Frank Hildebrand
    Abstract:

    BACKGROUND: Hypothermia, defined as a body core temperature below 35 °C, could be divided into an endogeneous, therapeutic and Accidental Hypothermia. At admission in the emergency room multiple trauma patients show a hypothermic core temperature in up to 66 %. A core temperature below 34 °C seems to be critical in these patients as this temperature limit has been demonstrated to be associated with an increased risk for post-traumatic complications and a decreased survival. In polytraumatised patients with a core temperature below 32 °C a mortality rate of 100 % has been described. MATERIAL AND METHODS: The main pathophysio-log-ical effects of Hypothermia concern the haemo-dynamic, coagulatory and immune systems. Mild Hypothermia (35-32 °C) leads to a vasoconstric-tion, tachycardia and increased cardiac output. After an increasing arrhythmia and bradycardia severe Hypothermia ( 0.5 °C / h) has been reported to be associated with an increased mortality during the further course, this procedure should only be applied in hypothermic multiple trauma patients with haemorrhagic shock. CONCLUSION: Accidental Hypothermia represents a serious problem in multiple trauma patients due to its frequency and negative pathophysiological effects. Therefore, early and effective re-warm-ing is essential in the treatment of hypothermic trauma patients. Possible protective effects of a therapeutic Hypothermia in the treatment of trauma patients after initial resuscitation and operative bleeding control have to be clarified in further experimental and clinical studies. Language: de