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T (SDD) [28,30,31]. In one example, Kamps and coworkers reported on their use of prolonged therapeutic cooling to control intracranial pressure in patients with severe traumatic brain injury, in a setting where SDD was routinely used, and reported that infection rates were 20 in patients treated with hypothermia and 34.4 for matched controls . Most notably, the risk of ventilatorassociated pneumonia was the same in patients treated with hypothermia compared with matched controls. Conclusion: Hypothermia impairs immune function and inhibits various inflammatory responses. This is inherent to the treatment, and impairment of harmful inflammatory get Elacestrant reactions in the brain may be one of the mechanisms through which hypothermia can exert protective effects. Hypothermia-induced insulin resistance and hyperglycemia may further increase infection risks. In clinical studies, hypothermia has been mostclearly linked to infection risk in the context of accidental hypothermia; controlled therapeutic cooling appears to carry a lower risk, especially if hypothermia is used for limited periods of time (<48 hours). The risk appears to increase with prolonged use, and careful monitoring is required in these patients. Prophylactic antibiotics may be considered in high-risk patients who are cooled for prolonged periods. Control of shivering is essential for effective cooling, as shivering fights the cooling process, makes attaining target temperature difficult, is extremely uncomfortable, and can trigger massive increases in systemic and cerebral energy consumption and metabolic demand. The first step in treatment is adequate tools to recognize shivering. The Bedside Shivering Assessment Scale is a simple, validated four-point scale that enables repeated quantification of shivering at the bedside. Therapy for shivering should ideally stop or suppress the central thermoregulatory reflex rather than just uncoupling this response from skeletal muscle contraction, as the latter approach does not mitigate the ongoing cerebral and systemic stress response. Analgo-sedation with opioids, a2-receptor agonists, or propofol is almost always effective as a last resort to prevent shivering. However, nonpharmacological strategies as first-line interventions for shivering minimize the risk of excessive sedation, which can make neurological examination difficult and increase the risk of complications. The Columbia Anti Shivering protocol has been developed with these strategies in mind, and we base our approach on prospectively collected cooling data on 213 patients who underwent 1,388 patient-days of temperature modulation. Eighty-nine patients underwent hypothermia and 124 patients underwent induced normothermia. In 18 of patients and 33 of the total patientdays, only none-sedating baseline interventions were needed. The first agent used was most commonly dexmeditomidine half the time, followed by opiates and increased doses of propofol. Younger patients, men, and lower body surface area were factors associated with increased number of anti-shivering interventions. As noted by this protocol, a significant proportion of patients undergoing temperature modulation can be effectively treated for shivering without oversedation and paralysis.A10 Controlled prophylactic normothermia Gregor Broessner*, Marlene Fischer, Bettina Pfausler, Erich Schmutzhard Neurologic Intensive Care Unit, Medical University Innsbruck, Austria Critical Care 2012, 16(Suppl 2):A10 Introduction:.