Tag Archives: hypothermia

TTM trial and ProCESS study. Did you already changed your practice?

29 Mar
Breaking through studies have been recently published.
Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM Trial) on hypothermia and A Randomized Trial of Protocol-Based Care for Early Septic Shock (ProCESS study) on sepsis shown new prospective on two major concerning point of care.
Read more on MEDES about TTM and ProCESS
Help us to understand how those two studies impacted your daily practice.
Fill the pool and help us to figure out how the geography of sepsi management and post-resuscitative care changed on the basis of those two trials.

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Ipotermia terapeutica e rischio d’infezione. Il gioco vale la candela?

21 Gen

Dopo l’uscita del Nielsen trial (Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest), la comunità scientifica si interroga se, vista l’alta incidenza di eventi avversi collegati con l’instaurazione di un prolungato periodo di ipotermia estrema (32-34 °C), l’adozione di tale procedura, a fronte di un non chiaro effetto positivo sulla mortalità, sia giustificata  o non siano da preferire regimi di temperatura meno spinti (36°). Il documento di Nielsen evidenzia e quantifica molti dei problemi correlati all’ipotermia (polmonite, iperglicemia, aritmie cardiache, convulsioni, disturbi elettrolitici) ed ha spinto alcuni clinici a rivedere le proprie convinzioni ed ad adottare fin da ora target di temperatura moderati nei pazienti rianimati da ACR.

In una review sistematica appena pubblicata su Critical Care Medicine, gli autori hanno analizzato, nell’ambito di tutti i trial sull’ipotermia, l’incidenza di infezioni per individuarne il tipo e quantificarne l’incidenza.

Hanno individuato 23 trial che soddisfano i criteri d’inclusione per un numero complessivo di 2820 pazienti. Giungono alla conclusione che a fronte di un aumento non significativo per il rischio generico d’infezione nei pazienti ipotermici (21%) il rischio di polmonite (44%) e di sepsi (80%) è significativamente aumentato. I rischi inoltre sono direttamente correlati alla durata dell’ipotermia aumentando in modo esponeneziale nei pazienti raffreddati per più tempo.

Alla luce di questi dati e delle indicazioni emerse recentemente sui non benefici dell’ipotermia in termini di mortalità, ferve il dibattito sull’uso o meno dell’ipotemria nei pazienti rianimati.

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