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Byline: Michael R. J. Sury (1), Stephen Scuplak (1) Keywords: Perioperative hypothermia; Thermoregulation; Paediatric anaesthesia Abstract: We have assessed the efficacy of a water-filled garment (ThermoWrap--Allon.sup.TM 2001) to maintain normothermia in small infants during major open abdominal or thoracic surgery. Twenty-two patients were studied in a case-matched comparison of two methods of thermal control intended to maintain core body temperature at 37degC. The standard method involved a warm air mattress with additional insulation. The ThermoWrap garment covered the head, trunk and legs and the water temperature was automatically controlled. Central and peripheral temperatures were recorded every 15 min. Nineteen infants had abdominal and three had thoracic operations. The mean weight was 3.2 kg (range 1.4--7.8 kg). Over time, the core temperature declined with standard care but not with the ThermoWrap. Core temperature was statistically lower in the standard care infants by 30 min after start of surgery. Six infants had a core temperature of less than 35degC with standard care (lowest 33.7degC) the lowest temperature with the ThermoWrap was 35.6degC. Some infants had cold hands with the ThermoWrap. Core temperature is better preserved with the ThermoWrap extra insulation of exposed arms may be necessary. An important advantage of the ThermoWrap is its ability to control body temperature automatically. Author Affiliation: (1) Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH, London, UK Article History: Registration Date: 28/11/2005 Accepted Date: 15/11/2005 Online Date: 22/12/2005

Byline: Winfried Meissner (1), Clemens Krapp (1), Eberhard Kauf (2), Barabara Dohrn (1), Konrad Reinhart (1) Keywords: Triiodothyronine Thyroxine Hypothermia Head trauma Intensive care Abstract: Abstract Objective. To examine the effect of controlled moderate hypothermia on thyroid response in head-injured patients. Design. Prospective, controlled, randomized study. Setting. University hospital intensive care unit (ICU). Patients. Twenty-eight patients with severe blunt head injury (Glasgow Coma Scale a$?9). Intervention. Patients were randomly assigned to a hypothermia or a normothermia group. Hypothermia (32--33degC) was induced within 8 h after trauma and maintained for a mean of 36 h. All patients were sedated and mechanically ventilated. Measurements and results. Thyroid-stimulating hormone( TSH), free and total triiodothyronine (FT3/TT3), reverse triiodothyronine (RT3) and thyroxine (FT4/TT4) were measured during the hypothermia or corresponding normothermia period, after regaining normothermia and 4--6 days later. Of 28 patients included in the study, 11 subjects were treated with hypothermia and 13 patients with normothermia. Four patients had to be excluded. In both groups, serum concentrations of TT3 and FT3 were just below the lower normal range whereas RT3 serum concentrations were near the upper limit of the normal range. TSH serum concentrations were not increased. No statistically significant intra- or inter-group differences were observed. Conclusions. Thyroid hormone patterns during moderate hypothermia in head-injured patients did not differ from the well known 'low T3 state' which is observed in other forms of severe illness. Author Affiliation: (1) Department of Anesthesiology and Intensive Care, Friedrich Schiller University Jena, Bachstrasse 18, 07740 Jena, Germany (2) Department of Pediatric Endocrinology, Friedrich Schiller University Jena, Bachstrasse 18, 07740 Jena, Germany Article History: Received Date: 22/05/2002 Accepted Date: 07/10/2002 Article note: Electronic Publication

Byline: Bruno Megarbane (1), Olivier Axler (1), Isabelle Chary (1), Roger Pompier (1), Francois G. Brivet (1) Keywords: Epidemiology Hypothermia Passive rewarming Prognosis factors Abstract: Objective: To describe patients admitted to intensive care unit (ICU) for hypothermia, evaluate prognostic factors, and test the hypothesis that patients found indoors have a worse outcome. Design and setting: Retrospective clinical investigation in a medical ICU. Patients: Eighty-one consecutive patients admitted to ICU, with a body temperature of 35degC or lower and rewarmed passively or with minimally invasive techniques, over a 17-year period. Measurements and results: Patients were analyzed by age, gender, and causes of hypothermia and split into two groups (indoors and outdoors), according to the location where hypothermia occurred. Prognostic factors were determined by univariate method and stepwise logistic regression. The major complications were acute renal failure (43%), aspiration pneumonia (22%), rhabdomyolysis (22%), and acute respiratory distress syndrome (12%). Principal comorbidities in the outdoor patients (21%) were alcohol and drug intoxication, and those in the indoor patients (79%) were sepsis and neuropsychiatric disorders. Stepwise logistic regression identified two variables predictive of death: illness severity at admission (SAPS II aY=40) and the location where hypothermia occurred (indoors versus outdoors). Conclusions: With equivalent body temperature, patients found indoors were more severely affected and died more frequently than those found outdoors. Author Affiliation: (1) Department of Medical Intensive Care Unit and Medical Emergency, Antoine Beclere Hospital, 157 Rue de la Porte de Trivaux, 92140 Clamart, France (2) Mailing address: Reanimation Medicale et Toxicologique, Hopital Lariboisiere, 2, rue Ambroise Pare, 75475 Paris Cedex 10, France, e-mail: bruno-megarbane@wanadoo.fr, Tel.: +33-1-49956491, Fax: +33-1-49956578 Article History: Received Date: 03/01/2000 Accepted Date: 24/08/2000 Article note: Final revision received: 18 July 2000 Electronic Publication

Byline: S. Sofer (1), E. Benkovich (1) Keywords: Key words Infantile hypothermia; Neonatal sepsis; Rewarming; Psychomotor development and outcome Abstract: Objective: To determine short- and long-term outcomes of infants with severe hypothermia (a$? 28 degC) treated in a pediatric intensive care unit (PICU).APDesign: (1) Retrospective evaluation of medical records of all patients admitted for severe infantile hypothermia from 1984 to 1993. (2) Medical and developmental evaluations of survivors of severe infantile hypothermia 3--12 years after hospital discharge.APSetting: Six-bed PICU of a university teaching hospital.APPatients: Eighteen infants who arrived at the emergency room with a rectal temperature between 20 and 28 degC.APMeasurements and results: The ages of patients ranged between 5 and 30 days. Fifteen were Bedouins and three were Jews. Clinical features included sepsis in 9 (septic shock in 5 of 9) patients, respiratory failure in 11 and overt bleeding in 5. Rewarming was applied using rapid external warming under a radiant heater. Five infants died shortly after arrival and one patient at age 6 years all of them had sepsis on arrival. Of the 12 survivors examined at ages 3--12 years, ten had normal psychomotor achievements, while the remaining two had mild (1 patient) and severe (1 patient) psychomotor retardation. Both of the latter two had sepsis on first admission for hypothermia. All nine hypothermic infants, who had no sepsis, had normal medical examinations and normal developmental achievements for their ages.APConclusion: Severe infantile hypothermia is a serious condition. When treating patients in a modern PICU, morbidity and mortality are mainly related to the presence or absence of an associated septicemia. Infants without septicemia may have normal growth and development. Author Affiliation: (1) Pediatric Intensive Care Unit, Division of Pediatrics, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, P. O.B 151, 84 101 Israel e-mail: shsofer@bgumail.bgu.ac.il Tel.: + 9 72-7-6 40 07 62 Fax: + 9 72-7-6 40 03 22, IL Article note: Received: 27 April 1999/Final revision received 8 October 1999/Accepted: 20 October 1999

Byline: G. Simbruner (1), C. Haberl (1), V. Harrison (2), L. Linley (2), A. E. Willeitner (1) Keywords: Key words Induced hypothermia; Newborn infant; Brain asphyxia; Side-effects Abstract: Objective: To assess the physiological effects and adverse side-effects of induced hypothermia in asphyxiated newborn infants as a base for future controlled, randomized trials.APDesign: Retrospective chart analysis with historical controls.APSetting: Tertiary neonatal intensive care unit of the University of Cape Town, South Africa.APPatients: Twenty-one asphyxiated newborns treated with induced hypothermia between September 1997 and February 1998 were compared to 15 asphyxiated newborn infants admitted during March to August 1997. The two groups of infants did not differ in patient characteristics or severity of asphyxia (comparison group vs hypothermia group: Apgar at 5 min 5.3 +- 3.1 vs 5.2 +- 2.3 base deficit 15.6 +- 6.3 vs 11.5 +- 7.2 and Thompson neurological score 10.1 +- 4.0 vs 9.1 +- 3.6).APInterventions: Hypothermia was induced by placing a cap formed from coolpacks, at a temperature of about 10 degC, around the head of asphyxiated newborn infants to maintain the nasopharyngeal temperature between 34 and 35 degC. Hypothermia was maintained for 3 days.APMeasurements and results: In the comparison group 4/15 infants died and in the hypothermia group 4/21 died. Hypothermia was induced at a median of 6.0 h (range 45 min to 53 h) post-partum, maintained for an average of 80 h (median 77.5 h, range 22 to 185 h) and resulted in an average nasopharyngeal temperature of 34.6 +- 0.5 degC. Hypothermia reduced abdominal skin temperature from 36.3 +- 0.5 degC to 35.1 +- 0.35 degC (p = 0.0001), heart rate from 139 +- 21 to 121 +- 13 beats/min (p < 0.0001) and respiratory rate from 67 +- 11 to 56 +- 9 breaths/min (p = 0.005). Neither episodes of bradycardia nor dysrhythmias, apnea, clinical signs of bleeding diathesis in the hypothermia group nor differences in the frequency of hypoglycaemia and urinary output, blood in urine or tracheal secretion between the two groups were observed. In the survivors the neurological score, assessed at day 2 and day 5, fell from 10.9 +- 3.5 to 8.1 +- 4.5 in the hypothermia group and rose from 8.1 +- 2.5 to 9.0 +- 3.1 in the comparison group (p = 0.003).APConclusions: Adverse effects of mild hypothermia induced for 3 days in asphyxiated newborns were significantly less than expected from previous reports on neonates with accidental hypothermia. Author Affiliation: (1) Division of Neonatology, University Children's Clinic, Ludwig-Maximilians University, Lindwurmstrasse 4, D-80 337 Munich, Germany e-mail: simbruner@kk-i.med. uni-muenchen.de Fax: + 49(89)51 60 44 19, DE (2) Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa, ZA Article note: Received: 31 December 1998 Final revision received: 30 July 1999 Accepted: 30 July 1999