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Copyright of Colombian Journal of Anesthesiology / Revista Colombiana de Anestesiología is the property of Sociedad Colombiana de Anestesiologia y Reanimacion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Applied Physiology, Nutrition & Metabolism is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: An update paper on massive bleeding after major trauma. A review of protocols to address massive bleeding, and its possible complications, including coagulation abnormalities, complications related to blood storage, immunosuppression and infection, lung injury associated with transfusion, and hypothermia is carried out. Methods: Literature review and discussion with authors' experience. Results: Massive bleeding is an acute life-threatening complication of major trauma, and consequently its prompt diagnosis and treatment is of overwhelming importance. Treatment requires rapid surgical management together with the massive infusion of colloid and blood. Conclusions: Since massive transfusion provokes further problems in patients who are already severely traumatized and anaemic, once this course of action has been decided upon, a profound knowledge of its potential complications, careful monitoring and proper follow-up are all essential. To diagnose this bleeding, most authors favour, as the main first choice tool, a full-body CT scan (head to pelvis), in non-critical severe trauma cases. In addition, focused abdominal sonography for trauma (FAST, an acronym that highlights the necessity of rapid performance) is a very important diagnostic test for abdominal and thoracic bleeding. Furthermore, urgent surgical intervention should be undertaken for patients with significant free intraabdominal fluid and haemodynamic instability. Although the clinical situation and the blood haemoglobin concentration are the key factors considered in this rapid decision-making context, laboratory markers should not be based on a single haematocrit value, as its sensitivity to significant bleeding may be very low. Serum lactate and base deficit are very sensitive markers for detecting and monitoring the extent of bleeding and shock, in conjunction with repeated combined measurements of prothrombin time, activated partial thromboplastin time, fibrinogen and platelets. [ABSTRACT FROM AUTHOR]

Background: Cerebral malaria remains a medical emergency with high mortality. Hypo-perfusion due to obstructed blood vessels in the brain is thought to play a key role in the pathophysiology of cerebral malaria leading to neurological impairment, long-term neuro-cognitive sequelae and, potentially, death. Due to the rapid reversibility of vascular obstruction caused by sequestered Plasmodium falciparum, it is hypothesized that mild medical hypothermia—a standard intervention for other medical emergencies—may improve clinical outcome. This preclinical in vitro study was performed to assess the impact of mild hypothermia on parasite growth and the intrinsic activity of anti-malarials drugs. Methods: Three laboratory-adapted clones and two clinical isolates were used for growth assays and standardized drug sensitivity assessments using the standard HRP2 assay. All assays were performed in parallel under normothermic (37 °C), mild hypothermic (32 °C), and hyperthermic (41 °C) conditions. Results: Parasite growth was higher under standard temperature condition than under hypo- or hyperthermia (growth ratio 0.85; IQR 0.25-1.06 and 0.09; IQR 0.05-0.32, respectively). Chloroquine and mefloquine had comparable in vitro activity under mild hypothermic conditions (ratios for IC50 at 37 °C/32 °C: 0.88; 95 % CI 0.25-1.50 and 0.86; 95 % CI 0.36-1.36, respectively) whereas dihydroartemisinin was more active under mild hypothermic conditions (ratio for IC50 at 37 °C/32 °C: 0.27; 95 % CI 0.19-0.27). Hyperthermia led by itself to almost complete growth inhibition and precluded further testing of the activity of anti-malarial drugs. Conclusion: This preclinical evaluation demonstrates that mild medical hypothermia inhibits in vitro growth of P. falciparum and enhances the pharmacodynamic activity of artemisinin derivatives. Based on these preclinical pharmacodynamic data, the further clinical development of mild medical hypothermia as adjunctive treatment to parenteral artesunate for cerebral malaria is warranted. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine if cold water swimmers (CWS) developed hypothermia over a 6-h cold water endurance swim and whether body composition, stroke rate (SR) or personal characteristics correlated with core temperature (TC) change. Nine experienced male and female CWS who were aspiring English Channel (EC) swimmers volunteered to participate. Subjects aimed to complete their 6-h EC qualifying swim (water 15-15.8 °C/air 15-25 °C) while researchers intermittently monitored TC and SR. Data obtained included anthropometry (height, mass, segmental body composition), training volume and EC completion. Results: Of the nine swimmers who volunteered, all successfully completed their EC qualifying swim. Six CWS had complete data included in analysis. One CWS demonstrated hypothermia (34.8 °C) at 6-h. TC rate of decline was slower in the first 3 h (-0.06 °C/hr) compared to the last 3 h (-0.36 °C/hr) of the swim. Older age was significantly correlated to TC change (r = -0.901, p < 0.05) and SR change (r = -0.915, p < 0.05). Absolute and percentage body fat (BF) were not significantly associated with higher TC. Mean SR over the 6-h swim was 57.8 spm (range 48-73 spm), and a significant (p < 0.05) decline in SR was observed over the 6 h (-9.7 %). A strong, positive correlation was found between SR change between 3 and 6 h and TC over the 6 h (r = 0.840, p < 0.05) and TC from 3-6 h (r = 0.827, p < 0.05). Seven of the nine participants (77.8 %) in this study successfully completed the EC crossing. Successful EC swimmers swam in the pool and open water (OW); however, they swam significantly [t (7) = -2.433, p < 0.05] more kilometres (M = 19.09 km/wk ± 5.55) in OW than unsuccessful (M = 9 km/wk ± 1.41) EC swimmers. There was a significant relationship between EC crossing time and height (r = -0.817, p < 0.05), but no other variables and EC crossing time. Conclusions: Cold water endurance swim (CWES) of 6-h duration at 15-16 °C resulted in TC reduction in the majority of swimmers regardless of anthropometry. More research is required to determine why some CWS are able to maintain their TC throughout a CWES. Our results indicate that older swimmers are at greater risk of developing hypothermia, and that SR decline is an indicator of TC decline. Our results also suggest that OW swimming training combined with pool training is important for EC swim success. [ABSTRACT FROM AUTHOR]

Aim: Most Finnish births take place in hospital, but out-of-hospital deliveries (OHDs) have increased. This study evaluated trends and reasons for OHDs in the Tampere University Hospital catchment area.Methods: The study cohort included all planned and unplanned OHDs in the Hospital area from 1996 to 2011; the control group comprised two hospital births for each OHD. Trends in incidence and risk factors for OHDs, including neonatal morbidities, were established and compared to the controls.Results: OHDs accounted for 67 (0.10%) of the 76 773 births in the area, the proportion remaining unchanged between 1996 and 2005, but then increasing. Risk factors associated with OHDs were smoking during pregnancy, short labour, higher number of previous births, single status, residence more than 35 kilometres from the delivery unit and fewer prenatal visits. OHD cases were more likely to be admitted to the neonatal care unit than controls and to be treated for suspected infections and hypothermia.Conclusion: Smoking, short duration of labour, a higher number of previous births, single status and longer distances from the delivery unit were associated with OHDs. Eight (12%) mothers had OHDs without antenatal care, and their infants had more neonatal morbidities. [ABSTRACT FROM AUTHOR]

The article discusses how changes in temperature affects the peoples' health. Topics discussed include the effects of climate change on weather patterns and temperatures, the analysis by the Centers for Disease Control and Prevention on temperature-related deaths in the U.S. from 2006 to 2010, and the cold- and heat-related mortality in Australia and Great Britain from 1993 to 2006. Statement from Antonio Gasparrini of the London School of Hygiene and Topical Medicine is discussed.

Background: Hypothermia can result from exposure to cold or as a consequence of underlying physiologic vulnerabilities. Who, where, when and how British Columbians (and Canadians) die of hypothermia have received little research attention. The objective of this study was to describe the epidemiology of mortality due to hypothermia among residents of British Columbia. Methods: We examined all records in the death registry of the British Columbia Vital Statistics Agency between 1998 and 2012 that had an underlying or contributing cause of death coded for hypothermia or exposure to excessive natural cold. Results: Hypothermia or exposure to excessive natural cold was found to be the underlying or contributing cause in 384 deaths between 1998 and 2012. Mean age of decedents was 52 (SD 20.78) years and 73.2% were male. The annual death rate for hypothermia increased with age, ranging from 0.3 per 100 000 population among people aged 1-34 years to 1.6 per 100 000 population among those older than 75 years of age. The highest annual death rate occurred among older males (2.1 per 100 000 population) followed by older females (1.3 per 100 000 population). Although hypothermia-related deaths occurred year-round, 45.9% occurred during winter months (December, January and February) and, in particular, on days with lower temperatures (mean 0.56°C). Use of alcohol (40.1%) and other psychoactive substances (22.7%) were the most common additional causes of death identified among deaths due to hypothermia. Areas of British Columbia with the lowest population density or lowest socioeconomic status were found to have the highest crude hypothermia-related mortality rates. Interpretation: Our results showed that older people are at higher risk of hypothermia-related death. Among residents of British Columbia who died of hypothermia, the most frequent additional causes of death were alcohol and nonalcohol psychoactive substances. However, further assessment of both the occurrence and determinants of mortality due to hypothermia are needed to inform measures to reduce its impact. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Enfermagem Referência is the property of Escola Superior de Enfermagem de Coimbra and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cyclooxygenase-1 or -2--which one mediates lipopolysaccharide-induced hypothermia? Am J Physiol Regul Integr Comp Physio1297: R485--R494, 2009. First published June 10, 2009; doi: 10.1152/ajpregu.91026.2008.--Systemic inflammation is associated with either fever or hypothermia. Fever, a response to mild systemic inflammation, is mediated by cyclooxygenase (COX)-2 and not by COX-1. However, it is still disputed whether COX-2, COX-l, neither, or both mediate(s) responses to severe systemic inflammation, and, in particular, the hypothermic response. We compared the effects of SC-236 (COX-2 inhibitor) and SC-560 (COX-1 inhibitor) on the deep body temperature ([T.sub.b]) of rats injected with a lower (10 [micro]g/kg iv) or higher (1,000 [micro]g/kg iv) dose of LPS at different ambient temperatures ([T.sub.a]s). At a neutral [T.sub.a] (30[degrees]C), the rats responded to LPS with a polyphasic fever (lower dose) or a brief hypothermia followed by fever (higher dose). SC-236 (2.5 mg/kg iv) blocked the fever induced by either LPS dose, whereas SC-560 (5 mg/kg iv) altered neither the febrile response to the lower LPS dose nor the fever component of the response to the higher dose. However, SC-560 blocked the initial hypothermia caused by the higher LPS dose. At a subneutral [T.sub.a] (22[degrees]C), the rats responded to LPS with early (70-90 min, nadir) dose-dependent hypothermia. The hypothermic response to either dose was enhanced by SC-236 but blocked by SC-560. The hypothermic response to the higher LPS dose was associated with a fall in arterial blood pressure. This hypotensive response was attenuated by either SC-236 or SC-560. At the onset of LPS-induced hypothermia and hypotension, the functional activity of the COX-1 pathway (COX-1-mediated [PGE.sub.2] synthesis ex vivo) increased in the spleen but not liver, lung, kidney, or brain. The expression of splenic COX-1 was unaffected by LPS. We conclude that COX-1, but not COX-2, mediates LPS hypothermia, and that both COX isoforms are required for LPS hypotension. body temperature; thermoregulation; fever; inflammation

Body temperature drops dramatically during hibernation, but the heart retains the ability to contract and is resistant to induction of arrhythmia. Although adaptive changes in the heart prior to hibernation may be involved in the cold-resistant property, it remains unclear whether these changes are sufficient for maintaining cardiac pulsatility under an extreme hypothermic condition. We forcibly induced hypothermia in Syrian hamsters by pentobarbital anesthesia combined with cooling of the animals. This allows reproduction of a hypothermic condition in the absence of possible hibernation-specific reactions. Unlike hypothermia in natural hibernation, the forced induction of hypothermia caused atrioventricular block. Furthermore, J-waves, which are typically observed during hypothermia in nonhibernators, were recorded on an ECG. The origin of the J-wave seemed to be related to irreversible injury of the myocardium, because J-waves remained after recovery of body temperature. An abnormal ECG was also found when hypothermia was induced in hamsters that were well adapted to a cold and darkened environment or hamsters that had already experienced hibernation. These results suggest that acclimatization prior to hibernation does not have a crucial effect at least on acquisition of cardiac resistance to low temperature. In contrast, an abnormal ECG was not observed in the case of hypothermia induced by central administration of an adenosine A1-receptor agonist and subsequent cooling, confirming the importance of the adenosine system for inducing hibernation. Our results suggest that some specific mechanisms, which may be driven by a central adenosine system, operate for maintaining the proper cardiac pulsatility under extreme hypothermia. arrhythmia; electrocardiogram; hypothermia; J-wave; torpor

In cardiac arrest due to ventricular fibrillation (VF), moderate hypothermia (MH,33[degrees]C) has been shown to improve defibrillation success compared with normothermia (NR, 37[degrees]C) and severe hypothermia (SH, 30[degrees]C). The underlying mechanisms remain unclear. We hypothesized that MH might prevent reentrant excitations rotating around functional obstacles (rotors) that are responsible for the genesis of VF. In two-dimensional Langendorff-perfused rabbit hearts prepared by cryoablation (n = 13), action potential signals were recorded by a high-resolution optical mapping system. During basic stimulation (2.5-5.0 Hz), MH and SH caused signifcant prolongation of action potential duration and significant reduction of conduction velocity. Wavelength was unchanged at MH, whereas it was shortened significantly at SH at higher stimulation frequencies (4.0-5.0 Hz). The duration of direct current stimulation-induced ventficular tachycardia (VT)/VF was reduced dramatically at MH compared with NR and SH. The spiral wave (SW) excitations documented during VT at NR were by and large organized, whereas those during VT/VF at MH and SH were characterized by disorganization with frequent breakup. Phase maps during VT/VF at MH showed a higher incidence of SW collision (mutual annihilation or exit from the anatomical boundaries), which caused a temporal disappearance of phase singularity points (PS-0), compared with that at NR and SH. There was an inverse relation between PS-0 period in the observation area and VT/VF duration. MH data points were located in a longer PS-0 period and a shorter VT/VF duration zone compared with SH. MH causes a modification of SW dynamics, leading to an increase in the chance of SW collision in favor of self-termination of VT/VF. optical mapping; ventricular fibrillation

According to the World Health Organization (WHO, 1997) a newborn is normothermic when its body temperature is between 36.5°C and 37.5°C with hypothermia considered to be any temperature below this identified spectrum. Neonatal hypothermia is a potentially common and dangerous occurrence related to a number of risk factors categorised as environmental, physiological, behavioural and socioeconomic. Babies delivered by caesarean section are at particular risk of developing hypothermia. The purpose of this review is to provide an overview of the factors contributing to neonatal hypothermia including the physiology of thermoregulation, mechanisms of thermogenesis and heat loss, and the effects that neonatal hypothermia has on the newborn infant. The paper will also review the interventions, which may be adopted to prevent hypothermia occurring and to identify and intervene to reduce the impact of hypothermia including the effect of skin-to-skin contact as both a preventative and management strategy in neonatal hypothermia. [ABSTRACT FROM AUTHOR]

Background: Gases for respiratory support at birth are typically 'cold and dry', which may increase the risk of hypothermia and lung injury. Objectives: To determine the feasibility of using heated humidification from birth. Method: A humidifier targeting 37°C, a manual-fill chamber and a Neopuff Infant T-piece resuscitator and circuit were attached to a face mask and a manikin. Recordings using 20 ml H2O for humidification and a flow of 10 l/min were undertaken. Temperature and relative humidity (RH) were recorded. Additional recordings were made, each with one alteration to baseline (50 ml H2O for humidification, auto-fill chamber, a flow of 8 l/min, addition of circuit extension piece, warmed humidification H2O, increased ambient temperature and targeting 31°C). The duration of heated humidification and the response to disconnecting the power were investigated. Results: The baseline circuit achieved 95% RH and 31°C in 3 min, >99% RH in 7 min and ≥35°C in 9 min. No circuit alterations resulted in faster gas conditioning. The extended length circuit and targeting 31°C reduced the maximum temperature achieved. A flow of 8 l/min resulted in slower heating and humidification. The baseline circuit delivered heated humidification for 39 min. Without power, the temperature and humidity fell below international standards in 3 min. Conclusion: Rapid gas conditioning for newborn stabilisation is feasible using the experimental set-up, ≥20 ml H2O and a flow of 10 l/min. The circuit could be used immediately once switched on. Without power, conditioning is quickly lost. Investigation of the clinical effects of gas conditioning is warranted. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. The World Health Organization recommends maintaining a warm chain and skin-to-skin care for thermoprotection of newborn children. Since little is known about practices related to newborn hypothermia in rural Africa, this study's goal was to characterize relevant practices, attitudes, and beliefs in rural Zambia. Methods and Findings: We conducted 14 focus group discussions with mothers and grandmothers and 31 in-depth interviews with community leaders and health officers in Lufwanyama District, a rural area in the Copperbelt Province, Zambia, enrolling a total of 171 participants. We analyzed data using domain analysis. In rural Lufwanyama, community members were aware of the danger of neonatal hypothermia. Caregivers' and health workers' knowledge of thermoprotective practices included birthplace warming, drying and wrapping of the newborn, delayed bathing, and immediate and exclusive breastfeeding. However, this warm chain was not consistently maintained in the first hours postpartum, when newborns are at greatest risk. Skin-to-skin care was not practiced in the study area. Having to assume household and agricultural labor responsibilities in the immediate postnatal period was a challenge for mothers to provide continuous thermal care to their newborns. Conclusions: Understanding and addressing community-based practices on hypothermia prevention and management might help improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermoprotection for their newborns could facilitate these practices. [ABSTRACT FROM AUTHOR]

The article discusses the consequences and prevention of mild perioperative hypothermia through temperature monitoring. Topics discussed include temperature regulation by the hypothalamus by comparing integrated thermal input from the skin surface, neuraxis and deep tissue with threshold temperatures, thermoregulation during anesthesia, and perioperative hypothermia. Also discusses the major and minor consequences of perioperative hypothermia including surgical infection and tachycardia.

Background. The skin-to-skin contact (SSC) of mother and newborn is uncommon full-term newborns after delivering via cesarean section due to the possibility of hypothermia in the infants. The aim of this study was to compare mothers' and infant's temperatures after delivering via cesarean section. Material and Methods. In this randomized clinical trial, 90 infant/mothers dyads delivered via cesarean section were randomized to SSC (n = 46) and routine care (n = 44). In experimental group, skin-to-skin contact was performed for one hour and in the routine group the infant was dressed and put in the cot according to hospital routine care. The newborns' mothers' temperatures in both groups were taken at half-hour intervals. The data was analyzed using descriptive statistics, t-tests, and chi-square tests. Results. The means of the newborns' temperatures immediately after SSC (P = 0.86), half an hour (P = 0.31), and one hour (P = 0.52) after the intervention did not show statistically significant differences between the two groups. The mean scores of the infants' breastfeeding assessment in SSC (8.76 ± 3.63) and routine care (7.25 ± 3.5) groups did not show significant differences (_P = 0.048). Conclusion. Mother and infant's skin-to-skin contact is possible after delivering via cesarean section and does not increase the risk of hypothermia. [ABSTRACT FROM AUTHOR]

Aim: To identify factors influencing older people's ability to keep warm and well in winter. Method: This qualitative study used in-depth individual interviews with older people (n=50) and health and social care staff (n=25), alongside six focus groups with 43 participants and a consultation event. Temperatures were measured in the homes of the older people interviewed. Framework analysis techniques were used. Findings: The data indicated a lack of awareness among participants of the importance to a person's health of keeping warm. A summary of findings related to the themes of awareness, money, mindset and machinery is presented here, with reflections on their relevance to nursing in terms of identifying older people at risk of the negative health effects of cold, their assessment and support. Conclusion: The study revealed a number of ways older people are vulnerable to cold at home. Timely interventions from nurses in various sectors could help avoid cold-related harm. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to evaluate the effect of hypothermia on the in-vivo pharmacokinetics of 4-nitrophenol (4 NP) using rat liver homogenate and rat liver perfusion system. Methods Rat liver homogenate was incubated with 4 NP, which is mainly metabolized by cytochrome P450 2 E1, at 37, 34, 32 or 28°C. The Michaelis constant ( Km) and maximum elimination velocity ( Vmax) of 4 NP were calculated by a Hanes- Woolf plot. The hepatic extraction ratio ( Eh) of 4 NP was evaluated in a rat liver perfusion study at 37, 34, 32 or 28 °C. Moreover, the plasma concentration profiles of 4 NP after its intravenous (i.v.) administration to rats were analysed by the moment theory and were compared with in-vitro parameters. Key findings While the Km of 4 NP was not changed, the Vmax and Eh were reduced at low temperatures. The plasma concentrations of 4 NP after its i.v. administration to rats were significantly increased at 28 °C. Conclusion Changes in the pharmacokinetics of 4 NP under hypothermic conditions were caused by alterations in Vmax and Eh. We may be able to predict the disposition of a drug by in-vitro studies. [ABSTRACT FROM AUTHOR]

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

A randomized trial of hypothermia in infants is conducted with a gestational age of at least 36 weeks who were admitted to the hospital at or before six hours of age with either severe acidosis or perinatal complications and resuscitation at birth and who had moderate or severe encephalopathy. Observations suggest that whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic-ischemic encephalopathy.

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

Aim To determine the occurrence and risk factors of sudden unexpected postnatal collapse ( SUPC) in presumably healthy newborn infants. Methods All live-born infants during a 30-month period, in five major delivery wards in Stockholm, were screened, and possible cases of SUPC thoroughly investigated. Infants were ≥35 weeks of gestation, had an Apgar score >8 at 10 min and collapsed within 24 h after birth. Maternal, infant, event characteristics and outcome data were collected. Results Twenty-six cases of SUPC were found among 68 364 live-born infants, an incidence of 38/100 000 live births. Sixteen of these cases of SUPC required resuscitation with ventilation >1 min, and 14 of these remained unexplained (21/100 000). Fifteen of the 26 children were found in a prone position, during skin-to-skin contact, 18 were primipara, and 13 occurred during unsupervised breastfeeding at <2 h of age. Three cases occurred during smart cellular phone use by the mother. Five developed hypoxic-ischaemic encephalopathy ( HIE) grade 2, and 4 underwent hypothermia treatment. Twenty-five infants had a favourable neurological outcome. Conclusion SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin-to-skin contact should be implemented. [ABSTRACT FROM AUTHOR]

Objective:This mini-review aims to assess the effect pre-warming has on reducing the incidence of inadvertent peri-operative hypothermia for patients undergoing general anaesthesia.Method:A search of the MEDLINE and EMBASE databases, as well as hand-searching through the reference lists of key articles, was undertaken. Articles were included on the basis that the studies were randomised controlled trials, undertaken on patients who were undergoing surgery under general anaesthesia and were pre-warmed for 60 minutes using forced-air warming systems. This resulted in two articles being critically appraised and reviewed using guidelines based on those given in Greenhalgh and Donald (2000).Findings:The results for both of these studies showed that statistically significant differences were seen in core body temperature, with analysis of variance used to test for the significant differences between the sample means. The findings were also clinically significant, as a small drop in temperature as a result of anaesthesia and surgery can lead to IPH, and with pre-warming this can be avoided.Conclusion:The studies that were used in this review both reported that pre-warming patients for 60 minutes pre-operatively had both a statistically significant and clinically significant effect. This means that patients should receive a period of pre-warming before surgery in addition to being warmed peri-operatively, in order to reduce any drop in potential temperature that can lead to IPH. [ABSTRACT FROM PUBLISHER]

The effect of different farrowing room temperatures (15, 20, or 25°C), combined with floor heating (FH) at the birth site, on the postnatal rectal temperature of pigs, use of creep area, and latency to first colostrum uptake was investigated with 61 litters born by loose-housed sows. Pig rectal temperature was measured at birth, as well as at 0.25, 0.5, 1, 1.5, 2, 3, 4, 12, 24, and 48 h after birth. The drop in rectal temperature from birth to 0.5 h postpartum was less (P < 0.05) at room temperature of 25°C compared with 20 and 15°C. Minimum rectal temperature was less (P < 0.001) at 15°C than either 20 or 25°C, and the time it took for rectal temperature to increase above 37°C was longer (P < 0.05) when room temperature was 15°C than 20 and 25°C. Rectal temperatures at 24 (P < 0.001) and 48 h (P < 0.05) postpartum were also lower at room temperature of 15°C than 20 and 25°C. Duration of FH (12 or 48 h) did not influence (P > 0.28) the rectal temperature at 24 or 48 h after birth. More pigs used the creep area 12 to 60 h after birth of the first pig at a room temperature of 15°C with 12 h FH compared with all other treatments. During the latter part of this period, more pigs stayed in the creep area also at 20°C with 12 h FH. After 60 h, more pigs (P < 0.01) used the creep area at low compared with high room temperatures (15°C > 20°C > 25°C). Odds ratio of pigs dying before they had suckled was 6.8 times greater (P = 0.03) at 15 than 25°C (95% CI of 1.3 to 35.5), whereas the odds ratio of dying during the first 7 d was 1.6 greater (P = 0.05) for 48 vs. 12 h of FH (95% CI of 1.0 to 2.57), mainly due to more pigs being crushed. In conclusion, FH for 48 h was no more favorable than 12 h for pigs because the risk of hypothermia was equal in the 2 treatments, and the risk of dying increased with the longer FH duration. Increasing the room temperature to 25°C reduced hypothermia and the risk of pigs dying before colostrum intake. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing corrective surgery for scoliosis of spine are commonly ventilated in our institute after the operation. Postoperative mechanical ventilation (PMV) and subsequent prolongation of intensive care unit stay are associated with increase in medical expenditure and complications such as ventilator-associated pneumonia. Identification of factors which may contribute to PMV and their modification may help in allocation of resources effectively. The present study was performed to identify preoperative and intraoperative factors associated with early PMV after scoliosis surgery. Methods: One hundred and two consecutive patients who underwent operation for scoliosis correction between January 2006 to July 2011 were reviewed retrospectively. Patients requiring PMV included patients who were not extubated in the operating room and were continued on mechanical ventilation. Preoperative and intraoperative factors which were analysed included age, gender, weight, cardiorespiratory function, presence of kyphosis, number and level of vertebrae involved, surgical approach, whether thoracoplasty was done, duration of surgery, blood loss, fluids and blood transfused, hypothermia and use of antifibrinolytics. Results: The average age of the patients was 14.31±3.78 years with female preponderance (57.8%). Univariate analysis found that longer fusions of vertebrae (more than 8), blood loss, amount of crystalloids infused, blood transfused and hypothermia were significantly associated with PMV (P<0.05). Independent risk factors for PMV were longer fusion (Odds Ratio (OR), 1.290; 95% confidence interval (CI), 1.038-1.604) and hypothermia (OR, 0.096; 95% CI, 0.036-0.254; P<0.05). Conclusion: The authors identified that longer fusions and hypothermia were independent risk factors for early PMV. Implementation of measures to prevent hypothermia may result in decrease in PMV. [ABSTRACT FROM AUTHOR]

Background: We describe a runner who completed a self-paced marathon (42.195 km) in a climate chamber with a temperature difference of 100°C, starting at an ambient temperature (Tambient) of -45°C and finishing at an Tambient of +55°C. Methods: Tambient was set at -45°C at the start, and was steadily increased at a rate of 1°C at 4.5-minute intervals to +55°C. Before the start, after every 10.5 km, and at the end of the marathon, body mass, urine, and sweat production were measured and samples of venous blood and urine were collected. The runner's temperature was recorded every 10 seconds at four sites, ie, the rectum for body core temperature (Tcore), and at the forehead, right wrist, and right ankle for surface temperatures (Tskin). Results: The subject took 6.5 hours to complete the marathon, during which Tcore varied by 0.9°C (start 37.5°C, peak 38.4°C). The largest difference (▵ ) of Tskin was recorded at the ankle (▵ 16°C). The calculated amount of sweat produced increased by 888% from baseline. In the blood samples, myoglobin (+250%) showed the highest change. Of the pituitary hormones, somatotropic hormone (+391%) and prolactin (+221%) increased the most. Regarding fluid regulation hormones, renin (+1145%) and aldosterone (+313%) showed the greatest increase. Conclusion: These results show that running a marathon in a climate chamber with a total ▵Tambient of 100°C is possible, and that the Tambient to Tcore relationship is maintained. These results may offer insight into regulatory mechanisms to avoid hypothermia and hyperthermia. The same study is to be performed using more subjects with the same characteristics to validate the present findings. [ABSTRACT FROM AUTHOR]

Workers working in hot or cold environments are at risk for heat stroke and hypothermia. In Japan, 1718 people including 47 workers died of heat stroke in 2010 (Ministry of Health Labour and Welfare, Japan ). While the American Conference of Governmental Industrial Hygienists (ACGIH) recommendation lists the abnormal core temperature of workers as a criterion for halting work, no method has been established for reliably measuring core temperatures at workplaces. ISO 9886 (Ergonomics-evaluation of thermal strain by physiological measurements. ISO copyright office, Geneva, pp 3-14; 2004) recognizes urine temperature as an index of core temperature only at normal temperature. In this study we ascertained whether or not urine temperature could serve as an index for core temperature at temperatures above and below the ISO range. We measured urine temperature of 31 subjects (29.8 ± 11.9 years) using a thermocouple sensor placed in the toilet bowl at ambient temperature settings of 40, 20, and 5˚C, and compared them with rectal temperature. At all ambient temperature settings, urine temperature correlated closely with rectal temperature exhibiting small mean bias. Urine temperature changed in a synchronized manner with rectal temperature at 40˚C. A Bland and Altman analysis showed that the limits of agreement (mean bias ± 2SD) between rectal and urine temperatures were −0.39 to +0.15˚C at 40˚C (95%CI −0.44 to +0.20˚C) and −0.79 to +0.29˚C at 5˚C (−0.89 to +0.39˚C). Hence, urine temperature as measured by the present method is a practical surrogate index for rectal temperature and represents a highly reliable biological monitoring index for assessing hot and cold stresses of workers at actual workplaces. [ABSTRACT FROM AUTHOR]

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

Objectives. We measured the burden of hypothermia- and hypothermia-related health care visits, identified risk factors, and determined the health care costs associated with environmental heat or cold exposure among Medicare beneficiaries. Methods. We obtained Medicare fee-for-service claims data of inpatient and outpatient health care visits for hypothermia and hyperthermia from 2004 to 2005. We examined the distribution and differences of visits by age, sex, race, geographic regions, and direct costs. We estimated rate ratios to determine risk factors. Results. Hyperthermia-related visits (n = 10 007) were more frequent than hypothermia-related visits (n = 8761) for both years. However, hypothermiarelated visits resulted in more deaths (359 vs 42), higher mortality rates (0.50 per 100 000 vs 0.06 per 100 000), higher inpatient rates (5.29 per 100 000 vs 1.76 per 100 000), longer hospital stays (median days = 4 vs 2), and higher total health care costs ($98 million vs $36 million). Conclusions. This study highlighted the magnitude of these preventable conditions among older adults and disabled persons and the burden on the Medicare system. These results can help target public education and preparedness activities for extreme weather events. [ABSTRACT FROM AUTHOR]

Objectives. To determine the incidence as well as contributing factors to fatal hypothermia. Study design. Retrospective, registry-based analysis. Methods. Cases of fatal hypothermia were identified in the database of the National Board of Forensic Medicine for the 4 northernmost counties of Sweden and for the study period 1992-2008. Police reports, medical records and autopsy protocols were studied. Results. A total of 207 cases of fatal hypothermia were noted during the study period, giving an annual incidence of 1.35 per 100,000 inhabitants. Seventy-two percent occurred in rural areas, and 93% outdoors. Many (40%) were found within approximately 100 meters of a building. The majority (75%) occurred during the colder season (October to March). Some degree of paradoxical undressing was documented in 30%. Ethanol was detected in femoral vein blood in 43% of the victims. Contributing co-morbidity was common and included heart disease, earlier stroke, dementia, psychiatric disease, alcoholism, and recent trauma. Conclusions. With the identification of groups at high risk for fatal hypothermia, it should be possible to reduce risk through thoughtful interventions, particularly related to the highest risk subjects (rural, living alone, alcohol-imbibing, and psychiatric diagnosis-carrying) citizens. [ABSTRACT FROM AUTHOR]

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

Bleeding is a considerable clinical problem during and after pediatric heart surgery. While the primary cause of bleeding is surgical trauma, its treatment is often complicated by the presence of coagulopathy. The principle causes of coagulopathy are discussed to provide a context for treatment. The role of laboratory and point of care tests, which aim to identify the cause of bleeding in the individual patient, is also discussed. An attempt is made to examine the current evidence for available therapies, including use of blood products and, more recently proposed, approaches based on human or recombinant factor concentrates. [ABSTRACT FROM AUTHOR]

Objective:The objective of this study was to study the epidemiology of neonatal hypothermia in preterm infants using World Health Organization (WHO) temperature criteria.Study Design:A population-based cohort of 8782 very low birth weight (VLBW) infants born in California neonatal intensive care units in 2006 and 2007. Associations between admission hypothermia and maternal and neonatal characteristics and outcomes were determined using logistic regression.Result:In all, 56.2% of infants were hypothermic. Low birth weight, cesarean delivery and a low Apgar score were associated with hypothermia. Spontaneous labor, prolonged rupture of membranes and antenatal steroid administration were associated with decreased risk of hypothermia. Moderate hypothermia was associated with higher risk of intraventricular hemorrhage (IVH). Moderate and severe hypothermic conditions were associated with risk of death.Conclusion:Hypothermia by WHO criteria is prevalent in VLBW infants and is associated with IVH and mortality. Use of WHO criteria could guide the need for quality improvement projects targeted toward the most vulnerable infants. [ABSTRACT FROM AUTHOR]

Nontraumatic coma in childhood is an important pediatric emergency with a wide range of primary etiologies. This prospective descriptive study of 100 consecutive pediatric nontraumatic coma cases was done to identify etiology, clinical profile, and predictive outcome in a pediatric emergency department at a tertiary care university hospital. Most frequent etiologies were metabolic (33%), central nervous system infections (28%), and intracranial hemorrhage (13%). In the emergency department, 50% of those patients died. Hypothermia, hypotension, flaccidity, and poor Glasgow coma scale at admission correlated significantly with mortality. After 48 hours of admission, poor pulse volume, poor Glasgow coma scale, abnormal respiratory pattern/apnea, and seizures correlated significantly with mortality. On logistic regression, poor Glasgow coma scale at admission, abnormal respiratory pattern, and seizures after 48 hours of admission were independent significant predictors of mortality. Metabolic causes are the most common etiology in pediatrics nontraumatic coma. Simple clinical signs were good predictors of outcome. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypothermia is associated with an increased mortality risk for 28 days. There are few community-based data on specific risk factors for neonatal hypothermia. Estimates of association between neonatal hypothermia in the community and risk factors are needed to guide the design of interventions to reduce exposure. Methods: A cohort of 23,240 babies in rural southern Nepal was visited at home by field workers who measured axillary temperatures for 28 days (213,316 temperature measurements). The cumulative incidence of hypothermia (defined as < 35.0°C based on an analysis of the hypothermia-mortality risk relationship) was examined for any association with infant characteristics, care practices and parental, household, socioeconomic and demographic factors. Estimates were adjusted for age and ambient temperature. Results: Ten percent of the babies (n = 2342) were observed with temperatures of < 35.0°C. Adjusted prevalence ratios (Adj PR) were increased among those who weighed < 2000 g [Adj PR = 4.32 (3.73, 5.00)] or < 1500 g [Adj PR = 11.63 (8.10, 16.70)] compared to those of normal weight (> 2500 g). Risk varied inversely along the entire weight spectrum: for every 100 g decrement hypothermia risk increased by 7.4%, 13.5% and 31.3%% for babies between 3000 g and 2500 g, 2500 g and 2000 g and < 2000 g, respectively. Preterm babies (< 34 weeks), females, those who had been first breastfed after 24 h and those with hypothermic mothers were at an increased risk. In the hot season the risk disparity between smaller and larger babies increased. Hypothermia was not associated with delayed bathing, hat wearing, room warming or skin-to-skin contact: they may have been practiced reactively and thereby obscured any potential benefit. Conclusions: In addition to season in which the babies were born, weight is an important risk factor for hypothermia. Smaller babies are at higher relative risk of hypothermia during the warm period and do not receive the protective seasonal benefit apparent among larger babies. The need for year-round thermal care, early breastfeeding and maternal thermal care should be emphasized. Further work is needed to quantify the benefits of other simple neonatal thermal care practices. [ABSTRACT FROM AUTHOR]

We proposed that many Intensive Care Unit (ICU) patients would be hypothermic in the early postoperative period and that hypothermia would be associated with increased mortality. We retrospectively reviewed patients admitted to ICU after surgery. We recorded the lowest temperature in the first 24 h after surgery using tympanic membrane thermometers. We defined hypothermia as < 36 °C, and severe hypothermia as < 35 °C. We studied 5050 consecutive patients: 35% were hypothermic and 6% were severely hypothermic. In-hospital mortality was 5.6% for normothermic patients, 8.9% for all hypothermic patients (p < 0.001), and 14.7% for severely hypothermic patients (p < 0.001). Hypothermia was associated with in-hospital mortality: OR 1.83 for each degree Celsius (°C) decrease (95% CI: 1.2–2.60, p < 0.001). Given the evidence for improved outcome associated with active patient warming during surgery we suggest conducting prospective studies of active warming of patients admitted to ICU after surgery. [ABSTRACT FROM AUTHOR]

Background: Cashew nut allergy is an emerging food allergy with a high risk of systemic anaphylaxis. Currently, an adjuvant-free animal model to study cashew nut allergy is not available. Methods: BALB/c mice were exposed to cashew nut protein using a transdermal sensitization protocol that does not use adjuvant. Systemic IgE antibody response, systemic anaphylaxis to oral challenge and allergen-driven, spleen-cell, type-2 cytokine responses were studied. Results: Transdermal exposure to cashew nut resulted in a significant dose-dependent allergic response. Oral challenge of sensitized mice with cashew resulted in severe signs of systemic anaphylaxis and a significant hypothermia. Spleen cell culture with cashew nut protein resulted in allergen-driven IL-4, IL-5 and IL-13 responses only in sensitized but not in saline control mice. Conclusions: These data demonstrate that (i) transdermal exposure to cashew nut protein elicits a robust IgE response leading to clinical sensitization of mice for systemic anaphylaxis to oral cashew nut challenge; (ii) cashew nut is a potent activator of type-2 cytokines, thus explaining the mechanism of cashew allergy, and (iii) this mouse model may be useful for further basic and preclinical studies on cashew nut allergy. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Induced mild hypothermia is an emerging therapy that has been shown to reduce the combined outcome of death or severe neurodevelopmental disabilities in asphyxiated full-term infants if started within 6 h after birth. Aim: To study the feasibility and safety of inducing hypothermia in asphyxiated infants already at the referring hospital by stopping active warming. Methods: Temperatures during passive induction of hypothermia were prospectively collected from transported asphyxiated infants. Results: Between December 2006 and April 2008, 37 infants of the total birth cohort of 40 350 fulfilled the criteria for hypothermia treatment. Eighteen of 34 infants treated with induced hypothermia were outborn. The rectal temperatures of the infants were 33.0–36.4°C before transport and 31.0–36.5°C on arrival. Six of the infants had a sub-therapeutic (<33.0°C) rectal temperature on arrival. Conclusion: Passive induction of hypothermia by turning off active warming devices is possible, making an earlier start of hypothermia achievable. However, there is a substantial risk of unintended excessive cooling; therefore, continuous monitoring of the central temperature is mandatory when such a strategy is used. [ABSTRACT FROM AUTHOR]

Perioperative hypothermia is a common and serious complication of anesthesia and surgery and is associated with many adverse perioperative outcomes. It prolongs the duration of action of inhaled and intravenous anesthetics as well as the duration of action of neuromuscular drugs. Mild core hypothermia increases thermal discomfort, and is associated with delayed post anaesthetic recovery. Mild hypothermia significantly increases perioperative blood loss and augments allogeneic transfusion requirement. Only 1.9 degrees C core hypothermia triples the incidence of surgical wound infection following colon resection and increases the duration of hospitalization by 20%. Hypothermia adversely affects antibody- and cell-mediated immune defences, as well as the oxygen availability in the peripheral wound tissues. Furthermore mild hypothermia triples the incidence of postoperative adverse myocardial events. Thus, even mild hypothermia contributes significantly to patient care costs and needs to be avoided. [ABSTRACT FROM AUTHOR]

Core body temperature is one of the most tightly regulated parameters of human physiology. At any given time, body temperature differs from the expected value by no more than a few tenths of a degree. However, slight daily variations are due to circadian rhythm, and, in women, monthly variations are due to their menstrual cycle. Importantly, both anesthesia and surgery dramatically alter this delicate control, and as a result intraoperative core temperatures 1 to 3 degrees C below normal are not uncommon. Consequently, perioperative hypothermia leads to a number of complications including postoperative shivering (which unacceptably increases patients' metabolic rates), impaired coagulation, prolonged drug action, and negative postoperative nitrogen balance. In this review I will describe how anesthesia and surgery impair thermoregulation, the resulting changes in heat balance, and the physiological responses provoked by perioperative alterations in body temperature. [ABSTRACT FROM AUTHOR]

Background and Objectives Plateletpheresis is the most frequent type of apheresis, with demand for these products continuously increasing. Hypothermia is a common side-effect of apheresis, which may have an effect on the donor's body functions. The aim of this study was to examine the effects of warming methods on plateletpheresis donors’ temperature, cardiac function and cytokines. Materials and Methods Fifty plateletpheresis donors were randomly assigned to a control group ( n = 25) or a warming group ( n = 25), with air and blood warmers during plateletpheresis. The effects of the treatment were examined by comparing body temperature, heart rate, blood pressure, Holter EKG pattern, serum interleukin-1β (IL-1β), interleukin-2 (IL-2), tumour necrosis factor-α (TNF-α) concentration, the white blood count, the white blood fraction, and the platelet count at a point in time between the two groups. Results In the control group, the tympanic temperature decreased more during apheresis compared to the warming group ( P = 0·014). The decrease of diastolic blood pressure was significantly greater in the control group compared to the warming group ( P = 0·010). As for cardiac function, the frequency of abnormal beats was generally higher in the control group, but the difference was not significant. IL-2 and TNF-α decreased significantly after plateletpheresis in the control group only, while there was no change in the warming group. Conclusion The decrease of temperature during plateletpheresis resulted in changes in haemodynamics and cytokines. The warming methods used in this study can prevent the decrease of temperature in donors, and may be helpful in maintaining the haemodynamic and cytokine balance. [ABSTRACT FROM AUTHOR]

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