Navegando por Palavras-chave "Hypothermia"
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- ItemAcesso aberto (Open Access)Análise ex vivo do efeito do aquecimento de concentrados de glóbulos vermelhos e uso de diferentes dispositivos de infusão no nível de marcadores de hemólise(Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Pires, Maria Paula de Oliveira [UNIFESP]; Pedreira, Mavilde da Luz Goncalves [UNIFESP]; Rickard, Claire Mihala; Peterlini, Maria Angélica Sorgini [UNIFESP]; http://lattes.cnpq.br/1599622257763420; http://lattes.cnpq.br/5901248667753975; http://lattes.cnpq.br/0669955447309650; Universidade Federal de São Paulo (UNIFESP)Introduction: Warming of red blood cell concentrates (RBC) before transfusion occurs especially in situations of massive transfusion, in order to avoid hypothermia and associated complications. Objectives: To describe the ex vivo effect of RBC warming on markers of hemolysis and infusion by manual and electronic devices. Materials and Methods: Ex vivo experimental research carried out after approval of ethical merit. The sample consisted of 90 RBC infusions, randomly, 45 simulations of infusions of warmed RBC, and 45 simulations of infusions of cold RBC, in three periods: before the intervention (Control), after immersion of the RBC in the water bath at 42º C (Warming), and after the warmed or cold RBC is infused by manual or electronic devices (Infusion) at a flow rate of 100 mL/h. Infusion devices were repeated nine times in each simulation by set drips systems (SD: 18; 20.0%), microdrips (MD: 18; 20.0%), linear peristaltic infusion pumps (PIP: 18; 20.0%), cassette infusion pumps (CIP: 18; 20.0%) and syringe infusion pumps (SIP: 18; 20.0%). RBC were analyzed according to hemolysis markers: hemoglobin concentration (g/dL), plasma free hemoglobin (g/dL), potassium (mmol/L) and lactate dehydrogenase, hemolysis degree (%), hematocrit (%) and total hemoglobin (U/L). In addition, the osmolality (mOsm/Kg) and pH were analyzed in the warmed RBC simulations. The data collection period was from March 2015 to February 2016. Statistical analysis was done using mean, standard deviation, standard error, median, interquartile range, minimum, maximum, tables, boxplot graphs, and the application of parametric test (t test), and non-parametric (Mann-Whitney). The software used for analysis was R 3.1.2, with significance level ≤ 0.05. Results: In the comparison between the Control and Warming stages, a significant reduction in total Hb level (p=0.002) and increase in free Hb levels (p<0.001), degree of hemolysis (p<0.001), and LDH (p<0.001). Infusion pumps presented significant changes in relation to manual devices, with increased values of free Hb (p<0.001), degree of hemolysis (p<0.001) and potassium (p<0.001). Infusion simulations with warmed RBC showed statistical differences when compared to infusion of cold RBC, with an increase in free Hb (p<0.001), degree of hemolysis (p<0.001) and LDH (p<0.001). Conclusion: Despite the variations identified in this study, hemolysis markers levels did not exceed those recommended in the literature for transfusion of RBC. The warming of RBC by immersion in a 42° C water bath and administration by infusion pumps caused a significant increase in markers of hemolysis capable of generating clinical complications in neonates, infants and unstable adults.
- ItemSomente MetadadadosBody temperature evaluation during induced pneumoperitoneum with CO2: an experimental study in pigs(Springer, 2012-06-01) Rezende, Marcelo; Prado, Orlando; Bandeira, Cesar; Petri, Andre; Montero, Edna [UNIFESP]; Universidade Estadual de Maringá (UEM); Universidade Federal de São Paulo (UNIFESP)In prolonged laparoscopic procedures, hypothermia is frequently observed. the possible influence of the vasodilating action of CO2, due to its increased levels in the blood during the laparoscopic procedures, has yet to be studied. the objective of this study was, therefore, to evaluate body temperature patterns in pigs subjected to pneumoperitoneum with CO2.Thirty male pigs were allocated into three groups of ten animals each: group I, anesthetic procedure and abdominal puncture only; group II, the same as for group I and insufflation with CO2; and group III, the same as for group I and insufflation with medical grade compressed air. After anesthetic induction and surgical preparation, rectal and esophageal temperatures were measured every 10 min. Blood was collected during the experiment for the gasometric measurement of pCO(2). Animals were insufflated with no gas loss and were kept anesthetized for 180 min. for statistical analysis, Friedman and Kruskal-Wallis tests were used at a level of significance of 95% (P < 0.05).Animals in groups I and II (P = 0.000) had a statistically significant drop in both esophageal and rectal temperatures during the experiment, but not animals in group III. However, when the groups were compared among themselves, no statistically significant differences were found at any of the times measured. A statistically significant drop in pCO(2) levels was observed for groups I and III, but not for animals in groups II.The use of CO2 did not significantly affect body temperature variation in pigs subjected to pneumoperitoneum. However, CO2 produced a temperature drop pattern different than that of compressed air, indicating that CO2 may lead to thermoregulatory changes and influence the peripheral temperature drop.
- ItemSomente MetadadadosEfetividade da manta de ar forçado aquecido na redução de complicações da hipotermia após cirurgia de revascularização do miocárdio: ensaio clínico randomizado(Universidade Federal de São Paulo (UNIFESP), 2019-12-18) Bezerra, Amanda Silva De Macedo [UNIFESP]; Barros, Alba Lucia Bottura Leite De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Despite intraoperative re-warming of patients undergoing induced hypothermia during on-pump coronary artery bypass grafting (CABG), patients remain hypothermic in the intensive care unit. Postoperative hypothermia in these patients is associated with excessive bleeding, need for blood components transfusion, respiratory failure, unplanned subsequent surgeries, increased length of hospitalization, of mechanical ventilation, and mortality. Objectives: To determine the effectiveness of postoperative use of forced air warming blanket on the reduction of excessive bleeding, arrhythmias, acute myocardial infarction (AMI) and blood product transfusion in hypothermic patients following on-pump CABG and to compare the pattern of the tympanic temperature associated with heated forced air or woolen blanket. Methods: A randomized clinical trial conducted in a public Cardiovascular hospital from January to November 2018. Two hundred patients undergoing isolated on-pump CABG were randomized to the Intervention Group (IG, submitted to postoperative warming with forced air blanket, n=100) and the Control Group (CG, submitted to postoperative warming with a sheet and a blanket, n=100). The tympanic temperature was measured over 24 hours in all participants. The primary outcome was excessive bleeding and the secondary outcomes were cardiac arrhythmias, acute myocardial infarction (AMI), blood component transfusion and the temperature patterns along time. The relationship between the intervention and the outcomes was assessed by means of bivariate logistic regression, with p<0.05 considered significant. Results: Starting two hours postoperatively, the IG had mean temperatures significantly higher than CG, maintaining this trend up to 15 hours. The IG had a 79% lower chance of bleeding compared to the GC (OR=0.21, 95% CI 0.12-0.39, p<0.001). The chance of AMI in was 94% lower in the IG compared to the CG (OR=0.06, 95% CI 0.01-0.48, p<0.001). The IG had a 77% lower chance of arrhythmias compared to the CG (OR=0.23, 95% CI=0.12-0.47, p<0.001). There was no difference between groups regarding blood product transfusion (p<0.279). Conclusions: Postoperative forced air warming decreased the incidence of excessive bleeding, AMI and arrhythmias, but did not alter the incidence of transfusion of blood components. These results indicate that forced air warming can be used after CABG until patients reach normothermia to avoid undesirable clinical outcomes.
- ItemAcesso aberto (Open Access)The effect of n-acetylcysteine on hepatic histomorphology during hypothermic preservation(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2014-01-01) Risso, Patricia Sayuri; Koike, Marcia Kiyomi; Abrahão, Marcos de Souza [UNIFESP]; Ferreira, Natalie Chaves; Montero, Edna Frasson de Souza [UNIFESP]; University City of São Paulo; São Paulo University Medical School; Universidade Federal de São Paulo (UNIFESP)PURPOSE:To evaluate the NAC effects on liver hypothermic preservation at different time intervals.METHODS:For this, we used livers of male Wistar rats weighing between 250 and 300g, undergoing preservation in Ringer solution at 4°C for up to 24 hours. Tissue samples were obtained at four moments of preservation for histological examination by hematoxylin and eosin staining: T0 = beginning of preservation, T12 = 12 hours, T18 = 18 hours and T24 = 24 hours. Will be analyzed vacuolation, hepatic apoptosis by optical microscopy and parenchymal.RESULTS: The results showed a progressive increase in hepatic injury in both groups and showed that NAC was effective at T0. The parenchyma preservation was better in the NAC group and no difference when vacuolization of the cells.CONCLUSION: Hypothermic preservation, over time, causes changes in the hepatic parenchyma with increased apoptosis, loss of architecture, vacuolization, culminating in severe injury. The administration of N-acetylcysteine protects against preservation liver injury.
- ItemAcesso aberto (Open Access)Eficácia e segurança da implantação de hipotermia cerebral exclusiva por meio do uso de cateter nasofaríngeo em seres humanos para o tratamento de traumatismo cranioencefálico grave - estudo de fase I(Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Ferreira, Raphael Einsfeld Simoes [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Paiva, Bernardo Lembo Conde de [UNIFESP]; http://lattes.cnpq.br/2407213200021772; http://lattes.cnpq.br/9709796351055284; http://lattes.cnpq.br/7930858019576181; Universidade Federal de São Paulo (UNIFESP)Objective: The objective was to determine whether a novel nasopharyngeal catheter could be used, as a new strategy, to cool the human brain (reduction of at least 2 °C) after traumatic brain injury, and the secondary objective was to assess the local and systemic effects of this therapeutic strategy. Methods: This was a non-randomized, interventional clinical trial that involved five patients with severe traumatic brain injury. The intervention consisted of inducing and maintaining selective brain cooling for 24h by positioning a catheter in the nasopharynx and circulating cold water inside the catheter in a closed loop arrangement. Core temperature was maintained greater than 35 °C using counter-warming strategies. Results: In all study participants, a brain temperature reduction of ≥ 2 °C was achieved. The mean brain temperature reduction from baseline was 2.5 ± 0.9°C (p = .04, 95% confidence interval). The mean systemic temperature was 37.3 ± 1.1 °C at baseline and 36.0 ± 0.8 °C during the intervention. The mean difference between the brain temperature and the systemic temperature during intervention was -1.2 ± 0.8 °C (p = .04). The intervention was well tolerated with no significant changes observed in the hemodynamic parameters. No relevant variations in intracranial pressure and transcranial Doppler were observed. The laboratory results underwent no major changes, aside from the K+ levels and blood counts. The K+ levels significantly varied (p = .04); however, the variation was within the normal range. Only one patient experienced an event of mild localized and superficial nasal discoloration, which was re-evaluated on the seventh day and indicated complete recovery. Conclusion: The results suggest that our non-invasive method for selective brain cooling, using a novel nasopharyngeal catheter, was effective and safe for use in humans.
- ItemAcesso aberto (Open Access)Electric countershock and cold stress effects on liver and adrenal gland(Faculdade de Medicina / USP, 2010-01-01) Ferreira, Marcelo [UNIFESP]; Abreu, Luiz Carlos de; Valenti, Vitor Engrácia [UNIFESP]; Meneghini, Adriano; Murad, Neif; Ferreira, Celso [UNIFESP]; Faculdade de Medicina do ABC Disciplina de Cardiologia Departamento de Clínica Médica; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina do ABC Departamento de Morfologia e FisiologiaOBJECTIVES: Cold exposure induces glycogen and lipid depletion in the liver and the adrenal gland, respectively. However, no previous study has determined the effects of electrical countershock on those tissues. We aimed to evaluate the effects of electrical countershock on lipid depletion in the adrenal gland and on glycogen depletion in the liver. METHODS: We used 40 male Wistar rats divided into four groups: the control group, in which the animals were subjected to a resting period of seven days; the electrical discharge group, in which the animals were subjected to a resting period followed by administration of ten 300-mV electrical discharges; the electrical post-discharge group, in which the animals received ten electrical shocks (300 mV) followed by rest for seven consecutive days; and the cold stress group, in which the animals were subjected to a resting period and were then exposed to -8ºC temperatures for four hours. All animals underwent a laparotomy after treatment. The lipid and glycogen depletions are presented using intensity levels (where + = low intensity and ++++ = high intensity, with intermediate levels in between). RESULTS: The rats exposed to the cold stress presented the highest glycogen and lipid depletion in the liver and the adrenal gland, respectively. Furthermore, we noted that the electrical countershock significantly increased lipid depletion in the adrenal gland and glycogen depletion in the liver. One week after the electrical countershock, the liver and adrenal gland profiles were similar to that of the control group. CONCLUSION: Electrical countershock immediately increased the glycogen depletion in the liver and the lipid depletion in the adrenal gland of rats.
- ItemSomente MetadadadosEstudo funcional e morfológico da hipotermia localizada e sistêmica no fígado de cães(Universidade Federal de São Paulo (UNIFESP), 2003) Siqueira, Venilton José [UNIFESP]; Taha, Murched Omar [UNIFESP]Os efeitos da hipotermia sistemica e da hipotermia seletiva, sobre as funcoes morfologicas e celulares do figado foram estudados em caes, machos, sem raca definida, com media de peso de 13 kg, distribuidos em dois grupos de 10 animais. O primeiro grupo (GI) foi submetido a hipotermia seletiva ou topica, sob anestesia geral totalmente intravenosa, e ventilacao controlada. Apos a laparotomia, mediana supraumbilical, foram coletados amostras sanguineas da veia esplenica e fragmentos hepaticos do lobo diafragmatico (TO), quando o figado foi isolado com papel aluminio e totalmente coberto com gelo picado. Um termometro de precisao foi inserido no lobo diafragmatico ate a proximidade da veia cava, sendo fixado a pele. Apos a temperatura baixar 10ºC da temperatura inicial, mais duas amostras de sangue e fragmentos hepaticos foram coletados: Test e T60. O animal foi sacrificado. No segundo grupo (GII), submetido a hipotermia sistemica de conducao, apos anestesia, monitorizacao e laparotomia da mesma forma que o grupo GI, coletou-se amostras de TO., ato continuo, todo o corpo do animal foi coberto com gelo em gel. Apos a estabilizacao da temperatura em 10°C abaixo da temperatura inicial, foram coletadas as amostras de TEST. Sessenta minutos apos, novas amostras foram coletadas (T60). Foram realizadas dosagens bioquimicas de ALT, AST e BD. Os fragmentos hepaticos dos dois grupos em TO, Test. T60 foram enviados para o laboratorio de histopatologia da UNIFENAS e preparados para contagem de celulas com degeneracao hidropica e outras alteracoes celulares visiveis a microscopia de luz. Amostras dos fragmentos tambem foram enviados ao laboratorio de biologia molecular da UNIFESP Escola Paulista de Medicina para microscopia eletronica de transmissao, para a contagem de lisossomos nos hepatocitos. Para o tratamento estatistico das variaveis estudadas, aplicou-se o teste de MANN-WHITNEY e a ANALISE DE VARIANCIA POR POSTOS DE FRIEDMANN, onde os valores de GI foram significativamente maiores que GII, concluindo, que a hipotermia topica ou seletiva (GI), provocou maiores anifestacoes de injuria hepatica tanto no perfil enzimatico estudado quanto no numero de degeneracoes hidropicas celulares e outros achados que a hipotermia sistemica de conducao (GII)
- ItemAcesso aberto (Open Access)Estudo funcional e morfológico da hipotermia sistêmica ou tópica no fígado de cães(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2005-04-01) Siqueira, Venilton José; Taha, Murched Omar [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Gomes, Paulo De Oliveira [UNIFESP]; Juliano, Yara [UNIFESP]; Bruzzadelli, Renata Marcon Zanelatto; Caputto, Lucélia Rita Galdino; Universidade José do Rosário Vellano Faculdade de Medicina Veterinária; Universidade Federal de São Paulo (UNIFESP); UNIFENAS Faculdade de Medicina VeterináriaPURPOSE: To compare hepatic lesions produced by two types of hypothermia; the systemic and the local or topic. METHODS: Twenty dogs distributed in two groups were studied: the first submitted to local hypothermia and the second to systemic hypothermia. In all groups, biochemical dosages for alanina allytransferase (A.L.T.), aspartate aminotrasnferase (A.S.T.) and direct bilirubin (T.D.), conventional optical microscopy and electronic transmission microscopy were performed in times T0, Test, and T60, that is, before the hypothermia (T0), after temperature stabilization at 10° lower than initial temperature (Test), and after sixty minutes of hypothermia (T60). RESULTS: The data analysis, both of the biochemical profile and of the microscopy showed that in the group of animals with selective hypothermia, the hepatic lesions were more intense when compared to the systemic hypothermia group. CONCLUSION: The selective hypothermia causes more lesions to the liver than the systemic.
- ItemSomente MetadadadosIntercorrências clínicas em transportes intra-hospitalares em unidade neonatal(Universidade Federal de São Paulo (UNIFESP), 2009) Vieira, Anna Luiza Pires [UNIFESP]; Santos, Amélia Miyashiro Nunes dos [UNIFESP]Objetivo: Determinar a frequência, os fatores associados às intercorrências clínicas e desenvolver e validar um escore preditivo para tais intercorrências em transportes intra- hospitalares de pacientes internados em unidade neonatal. Método: Estudo transversal aninhado em uma coorte prospectiva de crianças internadas em uma unidade neonatal submetidas a 1197 transportes intra-hospitalares realizado por uma equipe de neonatologistas treinada de jan/1997 a dez/2008 em um hospital público universitário. Fatores associados à presença de intercorrências clínicas e à hipotermia durante o transporte foram estudados por regressão logística univariada e múltipla. Para desenvolvimento do escore preditivo foram utilizados os 543 transportes realizados nos anos pares e para sua validação, os 654 transportes dos anos ímpares. Utilizou-se a regressão logística para desenvolver o escore preditivo. O poder discriminatório do escore foi analisado pela curva ROC e a calibração do modelo pelo teste de Hosmer Lemeshow. Resultados: Foram transportadas 641crianças (idade gestacional ao nascer: 35,1+3,8 semanas; peso ao nascer: 2328+906g). As patologias de base das crianças transportadas foram: malformações (71,9 por cento), infecções (7,6 por cento), desconforto respiratório: (4,1 por cento), asfixia: (3,3 por cento) e outros (13,1 por cento). Os pacientes foram transportados para: procedimentos cirúrgicos (22,6 por cento), tomografia (20,9 por cento), exames contrastados (18,2 por cento), ressonância magnética (10,6 por cento), ultrassom (10,4 por cento), EEG (6,0 por cento) e outros (11,3 por cento). As intercorrências clínicas ocorreram em 327 (27,3 por cento) transportes, sendo mais frequentes: hipotermia, hiperóxia e queda de saturação. Os fatores associados às intercorrências clínicas foram (OR; IC95 por cento): duração >120 minutos (1,5; 0,9-2,3), ano de 1997 (2,0; 1,1- 3,7), uso de oxigênio inalatório (4,7; 3,2-6,8), ventilação mecânica ou manual (5,0; 3,4- 7,6), idade gestacional <28sem (1,9; 1,0-3,5), malformações do SNC (1,7; 1,0-2,8); cirurgias (1,7; 1,0-2,5) e anos de 2001 e 2003 (protetores). A hipotermia ocorreu em 15,2 por cento dos transportes e se associou ao: peso ao transporte <1000g (3,7; 1,4-2,1), peso 1000-2500g (1,5; 1,0-2,2), temperatura pré-transporte <36,5o C (2,0; 1,4-2,8), malformações do SNC (2,8; 1,8-4,4); cirurgias (1,7; 1,0-2,7), uso de oxigênio inalatório (1,6; 1,0-2,5); ventilação mecânica ou manual (2,4, 1,5-3,9) e 2001, 2003 e 2006 (protetores). A analise da regressão logística múltipla com os transportes realizados nos anos pares determinou as 5 variáveis do escore preditivo com: idade gestacional ao nascer [<28 semanas (6 pontos); 28-34 (4pt); >34 (2pt)], temperatura pré-transporte [<36,3 e >37 C (4pt); 36,3-36,4 (3pt); 36,5-37 (2pt)], doença de base [malformação do SNC (4pt); malformação gastrintestinal (3pt); outros (2pt)], destino do transporte [cirurgia (5pt); ressonância magnética ou tomografia (3pt); outros (2pt) e assistência respiratória pré- transporte (ventilação manual ou mecânica (12pt); oxigênio suplementar (9pt); sem oxigênio (2pt)]. O poder discriminatório do escore proposto apresentou acurácia medida pela área sob a ROC de 0, 775 (IC95 por cento: 0, 733-0, 818) na amostra utilizada para seu desenvolvimento e 0, 733 (IC95 por cento: 0, 690-0, 775) na amostra destinada à sua validação. As frequências esperadas e observadas de alterações clínicas foram semelhantes para pacientes com escore >22 pontos (63 vs 51 por cento); 17-22 pontos (38 vs 39 por cento); 14-16 pontos (25 vs 26 por cento); <14 pontos (9 vs 10 por cento), p=0,751. Conclusões: A frequência de intercorrências clínicas durante o transporte foi elevada e se associou ao ano do transporte, idade gestacional, peso do paciente ao transporte, presença de malformações do SNC, transporte para realização de cirurgia, necessidade de assistência respiratória, temperatura pré-transporte e duração do transporte. O escore preditivo desenvolvido e validado neste estudo é prático, de baixo custo e de fácil aplicação e pode ser útil para avaliar tais riscos. É importante garantir condições clínicas e técnicas adequadas para a realização do transporte intra-hospitalar e propiciar educação continuada à equipe de transporte..