The International Hypothermia Registry (IHR): Dieter's ESAO Winter Schools and Beat's International Hypothermia Registry

2017 ◽  
Vol 40 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Beat H. Walpoth ◽  
Marie Meyer ◽  
Christophe Gaudet-Blavignac ◽  
Philippe Baumann ◽  
Pierre Gilquin ◽  
...  
Keyword(s):  
Mild Hypothermia ◽  
Statistical Significance ◽  
Orphan Disease ◽  
Accidental Hypothermia ◽  
Evidence Based ◽  
Outcome Predictors ◽  
Severe Hypothermia ◽  
Life Threatening

Accidental hypothermia could be listed as an ‘orphan disease,’ since mild hypothermia is common but has no severe medical consequences, whereas severe hypothermia is rare and life-threatening. In order to increase our knowledge, find new outcome predictors, and propose better guidelines for the treatment of deep accidental hypothermia victims, we created the International Hypothermia Registry (IHR: https://www.hypothermia-registry.org ), which will allow us to gather a large number of cases in order to achieve statistical significance and issue evidence-based recommendations.

scholarly journals Clinical relevance of impaired consciousness in accidental hypothermia: A Japanese multicenter retrospective study

2021 ◽  
Author(s):  
Masahiro Fukuda ◽  
Masahiro Nozawa ◽  
Yohei Okada ◽  
Sachiko Morita ◽  
Naoki Ehara ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Core Body Temperature ◽  
Staging System ◽  
Accidental Hypothermia ◽  
Impaired Consciousness ◽  
Odds Ratios ◽  
Severe Hypothermia ◽  
Threatening Condition ◽  
Life Threatening ◽  
Core Body

Abstract Background This study aimed to investigate the association between level of impaired consciousness and severe hypothermia less than 28°C among accidental hypothermia. Severe accidental hypothermia (AH) is a life-threatening condition, and early identification can enable transport to an appropriate medical facility. The Swiss staging system has been used to classify patients with AH, but little is known regarding the association between the level of impaired consciousness and core body temperature (BT) in AH. This study aimed to clarify the association between level of impaired consciousness and core BT and determine whether the level of impaired consciousness could be used to predict severe hypothermia and in-hospital mortality among patients with AH. Results The study included 505 of 572 patients in the J-point registry. Relative to mildly impaired consciousness (Glasgow coma scale (GCS) 13–15), the adjusted odds ratios for severe hypothermia were moderate (GCS9-12) 3.26 (95% CI: 1.69–6.25) and severe (GCS < 9) 4.68 (95% CI: 2.40–9.14) for severely impaired consciousness. Relative to mildly impaired consciousness (GCS 13–15), the adjusted odds ratios for in-hospital mortality were moderate (GCS9-12) 1.65 (95% CI: 0.95–2.88) and severe (GCS < 9) 2.10 (95% CI: 1.17–3.78). Conclusions The level of impaired consciousness in patients with accidental hypothermia may predict severe hypothermia and in-hospital mortality.

scholarly journals Iceman Survived due to Cooling Device

2011 ◽  
Vol 2011 ◽  
pp. 1-2 ◽  
Author(s):  
M. Roser ◽  
F. Martens ◽  
C. Storm
Keyword(s):  
Mild Hypothermia ◽  
Feedback Mechanism ◽  
Surface Cooling ◽  
Cooling Device ◽  
Noninvasive Methods ◽  
Postresuscitation Care ◽  
Severe Hypothermia ◽  
Temperature Feedback ◽  
Life Threatening ◽  
Accidental Severe Hypothermia

Although mild hypothermia treatment is part of the standard postresuscitation care today, no standard method for treatment of accidental severe hypothermia has been yet established. Different strategies including invasive and noninvasive methods have been described in the literature. We present the case of a 75-year-old man with accidental severe hypothermia (23°C) and demonstrate that using a surface cooling device with automatic controlled temperature feedback mechanism (ArcticSun2000 Medivance, Louisville, Colorado, USA) is an effective and safe method for controlled rewarming in this life-threatening setting.

OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

2020 ◽  
pp. 43-49
Author(s):  
Андрей Анатольевич Иванов ◽  
Александр Иванович Жданов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

33 An Evidence Based Laser Therapy Algorithm for the Treatment of Burn Scars

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S26-S27
Author(s):  
Rajiv Sood
Keyword(s):  
Laser Treatment ◽  
Laser Therapy ◽  
Co2 Laser ◽  
Statistical Significance ◽  
Evidence Based ◽  
Baseline Measurement ◽  
Burn Scar ◽  
Therapy Algorithm ◽  
Laser Treatments ◽  
The Impact

Abstract Introduction Hypertrophic scarring after burn injury can be extremely painful, cause profound itching, and affect the way patients view themselves and how the outside world perceives them. We have utilized laser therapy as a modality for scar modulation for our patients since 2013. In 2014, we initiated and completed a prospective IRB approved study to evaluate the outcome of scars treated with fractional CO2 laser therapy (FLT) utilizing objective and subjective tools. Recently, we have completed a prospective study evaluating the use of pulse dye laser (PDL) therapy and the impact on post-burn pruritis. In reviewing the outcomes from these two studies, we have developed an evidence-based laser therapy algorithm for burn scar management. Methods The FLT study entailed a series of three CO2 laser treatments minimally 4–6 weeks apart with scar measurements and POSAS form completion performed prior to each laser treatment and four weeks after the last FLT. Scar measurements that included color, pliability, and scar thickness; and completion of the POSAS form were obtained prior to each laser therapy session and four weeks after the third laser treatment. The measurements of color, pliability, and scar thickness were measured with the Colorimeter, Cutometer, and ultrasound. The PDL study utilized the 5-D Itch scale to evaluate post-burn pruritis. A baseline measurement was obtained prior to any laser treatments. Each patient underwent two PDL sessions and a 5-D itch scale was completed four to six weeks after the second PDL session. The baseline measurement was then compared to the final 5-D itch scale measurement. Results Data from the FLT study is in Table 1 and shows that there were statistically significant improvements in the Patient and Observer POSAS scores, patient rated Itch score, scar thickness, and measured skin density. Changes to patient rated scar pain, scar color, and pliability were noted but were not of statistical significance. Data from the PDL study is in Table 2 and shows a statistically significant decrease in the treated patients’ post-burn pruritis. Conclusions In reviewing the outcomes of these two studies, we have developed an algorithm based on our studies. All of our patients undergoing laser therapy receive two PDL sessions that are four to six weeks apart followed by 3 FLT sessions. The use of both PDL and FLT decreases post-burn pruritis, decreases scar thickness, decreases pain, and increases patient satisfaction as shown in our research.

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

scholarly journals Three Evidence Based Methods to Compensate for a Lack of Subject Background when Ordering Chemistry Monographs

2008 ◽  
Vol 3 (3) ◽  
pp. 3
Author(s):  
Robert A. Wright
Keyword(s):  
Statistical Analysis ◽  
Statistical Significance ◽  
Evidence Base ◽  
Circulation Rate ◽  
Evidence Based ◽  
Practical Application ◽  
Present Evidence ◽  
Library System ◽  
Over Time ◽  
Selection Of

Objective – The aim of this article is to present evidence based methods for the selection of chemistry monographs, particularly for librarians lacking a background in chemistry. These methods will be described in detail, their practical application illustrated, and their efficacy tested by analyzing circulation data. Methods – Two hundred and ninety-five chemistry monographs were selected between 2005 and 2007 using rigorously-applied evidence based methods involving the Library's integrated library system (ILS), Google, and SciFinder Scholar. The average circulation rate of this group of monographs was compared to the average circulation rate of 254 chemistry monographs selected between 2002 and 2004 when the methods were not used or were in an incomplete state of development. Results – Circulations/month were on average 9% greater in the cohort of monographs selected with the rigorously-applied evidence based methods. Further statistical analysis, however, finds that this result can not be attributed to the different application of these methods. Conclusion – The methods discussed in this article appear to provide an evidence base for the selection of chemistry monographs, but their application does not change circulation rates in a statistically significant way. Further research is needed to determine if this lack of statistical significance is real or a product of the organic development and application of these methods over time, making definitive comparisons difficult.

Psychosocial Issues of Patients With Implantable Cardioverter Defibrillators

2005 ◽  
Vol 14 (4) ◽  
pp. 294-303 ◽  
Author(s):  
Sandra B. Dunbar
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Standard Therapy ◽  
Ventricular Arrhythmias ◽  
Evidence Based ◽  
Psychosocial Issues ◽  
Implantable Cardioverter Defibrillators ◽  
Life Threatening ◽  
Cardioverter Defibrillators

Use of implantable cardioverter defibrillators has become standard therapy for patients at high risk for life-threatening ventricular arrhythmias. Although acceptance of the device is generally high among patients and their families, quality of life and psychosocial issues associated with use of the defibrillators deserve greater attention to improve outcomes. Psychosocial issues, their ramifications, and theory-and evidence-based approaches to improving outcomes are described.

Life-Threatening Hemoptysis

2020 ◽  
Author(s):  
Himanshu Deshwal ◽  
Ankur Sinha ◽  
Atul C. Mehta
Keyword(s):  
Bronchial Artery ◽  
Vascular Anatomy ◽  
Massive Hemoptysis ◽  
Evidence Based ◽  
Airway Protection ◽  
Artery Embolization ◽  
Life Saving ◽  
Advanced Therapies ◽  
Life Threatening ◽  
And Control

AbstractLife-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.

scholarly journals Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

2018 ◽  
Vol 64 (6) ◽  
pp. 543-548 ◽  
Author(s):  
Sujin Ko ◽  
Seong Sook Hong ◽  
Jiyoung Hwang ◽  
Hyun-joo Kim ◽  
Yun-Woo Chang ◽  
...  
Keyword(s):  
Bowel Wall ◽  
Statistical Significance ◽  
Pneumatosis Intestinalis ◽  
Bowel Distension ◽  
Wall Defect ◽  
Ct Findings ◽  
Free Air ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Ct Features

SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word “pneumatosis” were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

scholarly journals Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension

2019 ◽  
Vol 6 (6) ◽  
pp. 384-393 ◽  
Author(s):  
Renata Cífková ◽  
Mark R Johnson ◽  
Thomas Kahan ◽  
Jana Brguljan ◽  
Bryan Williams ◽  
...  
Keyword(s):  
Postpartum Haemorrhage ◽  
De Novo ◽  
Gestational Hypertension ◽  
Severe Hypertension ◽  
Interdisciplinary Approach ◽  
Position Paper ◽  
Medical Complications ◽  
Evidence Based ◽  
Life Threatening ◽  
Peripartum Period

Abstract Hypertensive disorders are the most common medical complications in the peripartum period associated with a substantial increase in morbidity and mortality. Hypertension in the peripartum period may be due to the continuation of pre-existing or gestational hypertension, de novo development of pre-eclampsia or it may be also induced by some drugs used for analgesia or suppression of postpartum haemorrhage. Women with severe hypertension and hypertensive emergencies are at high risk of life-threatening complications, therefore, despite the lack of evidence-based data, based on expert opinion, antihypertensive treatment is recommended. Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available. Induction of labour is associated with improved maternal outcome and should be advised for women with gestational hypertension or mild pre-eclampsia at 37 weeks’ gestation. This position paper provides the first interdisciplinary approach to the management of hypertension in the peripartum period based on the best available evidence and expert consensus.

Sign in / Sign up

Export Citation Format

Share Document