Fever control and application of hypothermia using intravenous cold saline.
Fever control and application of hypothermia using intravenous cold saline.
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DOI：
10.1097/pcc.0b013e3181fe27c7
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发表时间：
2012-01
期刊：
影响因子：
--
通讯作者：
Bell MJ
中科院分区：
文献类型：
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作者：
Fink EL;Kochanek PM;Clark RS;Bell MJ
描述冷盐水在儿科神经重症监护中降低体温的用途和可行性。回顾性病历审查。儿科三级保健大学医院。2009年6月至8月期间因急性脑损伤入住儿科重症监护室并接受冷盐水静脉注射的1周至17岁儿童。没有。18例受试者接受了20次输注，平均输注体积为18 ± 10 cc/kg。8例受试者有创伤性脑损伤（TBI），2例有颅内出血，6例有心脏骤停，各1例有缺血性卒中和癫痫持续状态。平均年龄为9.5 ± 4.8岁。输注后1小时，体温分别从38.7 ± 1.1 ℃降至37.7 ± 1.2 ℃和37.0 ± 2.0 ℃降至35.3 ± 1.6 ℃，以诱导发热（n=14，p<0.05）或低温（HT）（n=6，p= 0.05）。未推注冷盐水，而是在10-15分钟内输注。HT受试者的平均动脉血压和氧合参数（PaO 2/FiO 2比值，平均气道压）不变，但心率降低（121 ± 4 vs. 109 ± 12; p<0.05）。输注冷盐水后，血清钠浓度和国际标准化比值显著升高。在TBI患者中，输注前和输注后的血糖和红细胞压积、脑灌注压或颅内压均无差异。冷盐水是降低急性颅脑损伤患儿体温的有效方法。这种方法可以被认为是治疗发热或诱导HT。应考虑进行前瞻性研究，比较安全性和有效性与其他冷却措施。
To describe the use and feasibility of cold saline to decrease body temperature in pediatric neurocritical care. Retrospective chart review. Pediatric tertiary care university hospital. Children between 1 week and 17 yrs of age admitted to the pediatric intensive care unit with acute brain injury and having received intravenous cold saline between June-August 2009. None. Eighteen subjects accounted for 20 infusions with mean infusion volume 18 ± 10 cc/kg. Eight subjects had traumatic brain injury (TBI), 2 had intracranial hemorrhage, 6 had cardiac arrest, and one each had ischemic stroke and status epilepticus. The mean age was 9.5 ± 4.8 yrs. Temperature decreased from 38.7 ± 1.1°C to 37.7 ± 1.2°C and 37.0 ± 2.0 to 35.3 ± 1.6°C one h after infusion for fever (n=14, p<.05) or hypothermia (HT) induction (n=6, p=.05), respectively. Cold saline was not bolused, rather infused over 10–15 minutes. Mean arterial blood pressure and oxygenation parameters (PaO2/FiO2 ratio, mean airway pressure) were unchanged, but heart rate decreased in HT subjects (121 ± 4 vs. 109 ± 12; p<.05). Serum sodium concentration and International normalized ratio were significantly increased after cold saline infusion. There were no differences between pre- and post-infusion serum glucose and hematocrit, nor cerebral perfusion pressure or intracranial pressure in TBI patients. Cold saline was an effective method of reducing temperature in children with acute brain injury. This approach can be considered to treat fever or to induce HT. Prospective study comparing safety and efficacy versus other cooling measures should be considered.