Hypothermia and Cardiovascular Instability

Nestaas, Eirik; Walsh, Brian H.

doi:10.1016/j.clp.2020.05.012

Cited by 6 publications

(3 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition to the neurovascular impairment, these infants often present with multiorgan failure, hemodynamic instability and systemic hypotension. The underlying pathophysiology may be variable among patients: hypovolemia, peripheral vasoconstriction during TH and vasoregulatory impairment, as well as decreased cardiac output (CO) due to myocardial ischemia could all contribute to hemodynamic instability, and may lead to suboptimal cerebral perfusion (5)(6)(7). It has been suggested that to achieve the best possible neurodevelopmental outcome, optimization of hemodynamic management is necessary (8).…”

Section: Introductionmentioning

confidence: 99%

Time series analysis of non-invasive hemodynamic monitoring data in neonates with hypoxic-ischemic encephalopathy

et al. 2023

View full text Add to dashboard Cite

Background and aimsHemodynamic instability is common in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Rewarming is a critical period and non-invasive circulatory monitoring may help guide cardiovascular supportive therapy. The aim of the study was to provide a comprehensive analysis of cardiac function parameters during TH and its relation to neurodevelopmental outcome.MethodsIn a prospective, observational study, 26 neonates with moderate-severe HIE were enrolled, born between 2016 and 2019. A hemodynamic monitor based on electrical velocimetry (ICON, Osypka Medical GmbH, Berlin, Germany) was used. Heart rate (HR), stroke volume (SV), cardiac output (CO) data were recorded continuously throughout TH and rewarming. Neurological outcome was assessed at 2 years of age using the Bayley Scales of Infant Development II. edition. Favorable outcome was defined as >70 points on both the psychomotor and mental scales. Time-series analysis was used and features of cardiac function were described to perform logistic regression modeling for outcome prediction.ResultsFourteen (54%) patients had favorable and 12 (46%) had adverse outcome. Data collection started from median [IQR] of 11.8 [7.0; 24.3] hours (h) of life and lasted until 84.0. [81.8; 87.0] h. During TH, the mean HR of the favorable outcome group was significantly lower than that of the adverse outcome group (86 ± 13/min vs. 104 ± 18/min, p = 0.01). During rewarming HR increased similarly in both groups. SV was unaffected by rewarming, and showed a slowly increasing trend. SV of the favorable outcome group was significantly higher compared to the adverse outcome group (1.55 ± 0.23 ml/kg vs. 1.29 ± 0.30 ml/kg, p = 0.035). In line with this, CO was similar in both groups (136 ± 27 ml/kg/min vs. 134 ± 36 ml/kg/min), and a significant 25% increase in CO was observed during rewarming. Based on multiple regression modeling, HR during TH was independently associated with neurological outcome (p = 0.023).ConclusionBased on continuous hemodynamic monitoring, patients with adverse outcome have lower SV and higher HR to achieve similar CO to patients with favorable outcome during TH. HR during hypothermia is independently associated with the neurodevelopmental outcome.

show abstract

Section: Introductionmentioning

confidence: 99%

Time series analysis of non-invasive hemodynamic monitoring data in neonates with hypoxic-ischemic encephalopathy

et al. 2023

View full text Add to dashboard Cite

show abstract

“…This is because the initial cardiovascular response to oxygen depletion results in organ-specific vasoconstriction. This subsequently results in the redistribution of oxygen from non-vital organs to the heart and brain, while other organs, such as the intestines, liver, or kidneys, are underperfused [11][12][13]. As vasoreactive organs, the kidneys are very sensitive to oxygen deprivation, and this commonly (39-42%) results in oliguric or non-oliguric acute kidney injury (AKI) in this setting [14].…”

Section: Introduction: Perinatal Asphyxia Whole Body Hypothermia and Renal Impairmentmentioning

confidence: 99%

Creatinine Trends and Patterns in Neonates Undergoing Whole Body Hypothermia: A Systematic Review

et al. 2021

View full text Add to dashboard Cite

Many neonates undergoing whole body hypothermia (WBH) following moderate to severe perinatal asphyxia may also suffer from renal impairment. While recent data suggest WBH-related reno-protection, differences in serum creatinine (Scr) patterns to reference patterns were not yet reported. We therefore aimed to document Scr trends and patterns in asphyxiated neonates undergoing WBH and compared these to centiles from a reference Scr data set of non-asphyxiated (near)term neonates. Using a systematic review strategy, reports on Scr trends (mean ± SD, median or interquartile range) were collected (day 1–7) in WBH cohorts and compared to centiles of an earlier reported reference cohort of non-asphyxia cases. Based on 13 papers on asphyxia + WBH cases, a pattern of postnatal Scr trends in asphyxia + WBH cases was constructed. Compared to the reference 50th centile Scr values, mean or median Scr values at birth and up to 48 h were higher in asphyxia + WBH cases with a subsequent uncertain declining trend towards, at best, high or high–normal creatinine values afterwards. Such patterns are valuable for anticipating average changes in renal drug clearance but do not yet cover the relevant inter-patient variability observed in WBH cases, as this needs pooling of individual Screa profiles, preferably beyond the first week of life.

show abstract

“…Bozulmuş miyokardiyal kontraktilite, düşük kalp hızı ve hipotansiyon mortalitenin artmasına ve uzun dönem nörolojik sekellerin ortaya çıkmasına neden olabilmektedir. Hem hastalık süreci hem de tedavide etkinliği kanıtlanmış tek yöntem olan terapötik hipotermi hemodinamik dengesizliğe neden olabilir (1)(2)(3)(4)(5).…”

Section: Introductionunclassified

Terapötik Hipotermi Uygulanan Hipoksik İskemik Ensefalopatili Yenidoğanların Kardiyak Bulgularının Değerlendirilmesi

Azak¹,

Ceran²,

Bagrul³

et al. 2021

Turkish Journal of Pediatric Disease

View full text Add to dashboard Cite

Terapötik hipotermi tedavisi alan hipoksik iskemik ensefalopatili (HİE) yenidoğanların kardiyak bulgularının; biyobelirteçler, EKG ve ekokardiyografi ile değerlendirilmesi ve bu belirteçlerin hipoksik myokard hasarı şiddetinin belirlenmesindeki etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntemler:Evre II ve III HİE tanısı alan ve terapötik hipotermi uygulanmış 50 yenidoğan bebeğin verileri retrospektif olarak incelendi. Demografik özellikler, sistemik ve kardiyak muayene bulguları, serum CK-MB, troponin-I, EKG ve ekokardiyografi raporları kaydedildi. Evre II ve Evre III HİE'li hastaların bulguları karşılaştırıldı.Bulgular: Elli olgunun 11'inde (%22) miyokardiyal disfonksiyon saptandı. EKG kayıtlarında tüm olgular normal sinüs ritmine sahipti. EKG'de patolojik bulgu evre II'de 2 (%8.3) olguda, evre III'de ise 5 (%19.8) olguda mevcuttu. Serum CK-MB ve troponin-I olguların 30'unda (%60) yüksek izlendi. Tüm olguların 5'inde (%10) orta derecede triküspit yetersizliği, 1'inde (%2) şiddetli triküspit yetersizliği, 4'ünde (%8) sağ ventrikül hipokinezisi, 6'sında (%12) sol ventrikül hipokinezi ve 1'inde (%2) biventriküler hipokinezi mevcuttu. Evre III HİE'li olgularda enzim düzeylerinin daha yüksek, EKG ve EKO anormalliklerinin daha yaygın olduğu görüldü (p<0.05).Sonuç: Hipoksik iskemik ensefalopatili yenidoğanlarda kardiyak etkilenme prognoz açısından son derece önemlidir. Olgularda tedavinin daha iyi yönetilmesi için kardiyak değerlendirme ve yakın takip çok önemlidir. Kardiyak biyobelirteçler, EKG ve EKO perinatal asfikside miyokardiyal hasarın ciddiyetinin erken tanı ve değerlendirilmesinde faydalıdır.

show abstract

Hypothermia and Cardiovascular Instability

Cited by 6 publications

References 66 publications

Time series analysis of non-invasive hemodynamic monitoring data in neonates with hypoxic-ischemic encephalopathy

Time series analysis of non-invasive hemodynamic monitoring data in neonates with hypoxic-ischemic encephalopathy

Creatinine Trends and Patterns in Neonates Undergoing Whole Body Hypothermia: A Systematic Review

Terapötik Hipotermi Uygulanan Hipoksik İskemik Ensefalopatili Yenidoğanların Kardiyak Bulgularının Değerlendirilmesi

Contact Info

Product

Resources

About