VALUE OF MILD HYPOTHERMIA IN PATIENTS WHO HAVE SEVERE CIRCULATORY INSUFFICIENCY EVEN AFTER INTRAAORTIC BALLOON PUMP

Citation
N. Yahagi et al., VALUE OF MILD HYPOTHERMIA IN PATIENTS WHO HAVE SEVERE CIRCULATORY INSUFFICIENCY EVEN AFTER INTRAAORTIC BALLOON PUMP, Journal of clinical anesthesia, 10(2), 1998, pp. 120-125
Citations number
20
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Anesthesiology
ISSN journal
0952-8180
Volume
10
Issue
2
Year of publication
1998
Pages
120 - 125
Database
ISI
SICI code
0952-8180(1998)10:2<120:VOMHIP>2.0.ZU;2-6
Abstract
Study Objective: To evaluate the effectiveness of mild hypothermia in postcardiac surgical patients with severe heart failure in spite of co nventional medical therapy and the use of intra-aortic balloon pumping (IABP). Design: Prospective, clinical study. Setting: Teaching hospit al. Patients: 10 postcardiac surgical patients with severe heart failu re despite the use of IABP with massive doses of catecholamine. Interv entions: Patients underwent mild hyperthermia produced by surface cool ing (to approximately 34.5 degrees C). Hemodynamic criteria for the in duction of hyperthermia included a cardiac index (CI) of less than 2.2 L/min/m(2) with a pulmonary capillary wedge pressure (PCWP) of up to 18 mmHg despite the use of IABP with massive doses of catecholamine. M easurements and Main Results: After control measurements had been take n at normal core body temperature (37 degrees C), patients were cooled to approximately 34.5 degrees C (using a cooling blanket and gastric lavage with cold water) to decrease tissue oxygen (O-2) demand. Patien ts showed significant improvements in CI (1.9 +/- 0.3 to 2.2 +/- 0.3 L /min/m(2)), mixed venous O-2 saturation, (SvO(2); 55 +/- 7 to 64 +/- 6 %), and urine output (2.1 +/- 1.1 to 3.4 +/- 2.2 ml/kg/hr). Patients w ere rewarmed while SvO(2) was being monitored. The duration of the hyp othermia was 38 +/- 41 hours, Oxygen delivery increased in 8 of the 10 patients, the mean value (+/- SD) for the group rising from 309 +/- 6 5 ml/min/m(2) to 358 +/- 57 ml/min/m(2) as temperature was reduced fro m 36.7 +/- 0.4 degrees C to 34.7 +/- 0.3 degrees C, All patients were successfully weaned from IABP at 140 +/- 107 hours after admission to the intensive care unit. Conclusions: Mild hypothermia is a simple and useful procedure for improving the circulation of postcardiac surgica l patients with severe heart failure despite the use of IABP. (C) 1998 by Elsevier Science Inc.