Is Hypothermia in the Victim of Major Trauma Protective or Harmful?

Gentilello, Larry M.; Jurkovich, Gregory J.; Stark, Michelle; Hassantash, Seyed-Ahmad; O’Keefe, Grant E.

doi:10.1097/00000658-199710000-00005

Cited by 301 publications

(139 citation statements)

References 25 publications

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“…This complication as so many other things is better to prevent than to have to treat later. Prevention is accomplished by hypothermia prevention and treatment [93][94][95][96][97] (Box 1) and shock limitation, which in turn, is guaranteed by rapid interruption of the hemorrhage and aggressive hemodynamic resuscitation. Prophylactic administration of platelets or plasma usually do not prevent coagulopathy [98,99].…”

Section: Transfusion Threshold and Coagulopathy Correctionmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Section: Transfusion Threshold and Coagulopathy Correctionmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…However, if not corrected, each has a negative influence on survival. Furthermore, subsequent prospective, randomized investigations have demonstrated that rapid rewarming in this patient population does in fact reduce resuscitative volume requirements and perhaps mortality (7,8).…”

Section: Discussionmentioning

confidence: 99%

“…Several previous studies have demonstrated the multifactorial benefits of rapid rewarming of critically injured patients, the most effective of which is extracorporeal blood rewarming (6)(7)(8)(9). The recent limited availability of disposable extracorporeal rewarming circuits caused us to seek an alternative rewarming device.…”

mentioning

confidence: 99%

Active Intravascular Rewarming for Hypothermia Associated with Traumatic Injury: Early Experience with a New Technique

Taylor¹,

Carroll²,

Lovitt³

et al. 2007

Baylor University Medical Center Proceedings

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“…Increase mortality with hypothermia upon admission [53][54][55] Increase mortality at 24 hours with slow rewarming 56 Pregnancy Shifts the oxygen delivery curve to the left Decreases blood flow to the uterus 57,58 May cause fetal bradycardia 58 patients (average intraoperative temperature 34.8°C) took approximately 40 minutes longer to meet discharge criteria from the post anesthesia care unit compared to normothermic patients (average intraoperative temperature 36.7°C) [6]. When a temperature of 36°C was added to discharge criteria, discharge time was prolonged by 90 minutes [6].…”

Section: Traumamentioning

confidence: 99%

“…Hypothermia at admission was also associated with severe functional impairment [53]. Trauma patients admitted to the intensive care unit with hypothermia who were aggressively rewarmed required less intravenous fluids, had a lower oxygen consumption on the second day after trauma, and overall had a lower rate of mortality in the first 24 hours [56]. Thus trauma patients should be rewarmed, especially in the setting of ongoing hemorrhage.…”

Section: Traumamentioning

confidence: 99%

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

Sappenfield¹,

Hong²,

Galvagno³

2013

J Anesthesiol Clin Sci

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Intraoperative management of patient body temperature is a standard of care for practicing anesthesiologists. Merely complying with the Surgical Care Improvement Project (SCIP) measurement is inadequate for optimizing perioperative outcomes. Clinicians should have a sound understanding of available temperature monitoring sites, deleterious effects of hypothermia, and indications for therapeutic hypothermia. This foundation will help physicians use indicated modalities to improve patient outcomes throughout the perioperative period. The purpose of this paper is to review appropriate intraoperative temperature monitoring, the importance of maintaining normothermia, and indications for intraoperative hypothermia.

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Is Hypothermia in the Victim of Major Trauma Protective or Harmful?

Abstract: Hypothermia increases fluid requirements and independently increases acute mortality after major trauma.

Cited by 301 publications

References 25 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Active Intravascular Rewarming for Hypothermia Associated with Traumatic Injury: Early Experience with a New Technique

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

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