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Targeted temperature management (TTM), previously known as therapeutic hypothermia or protective hypothermia, is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. [1]
A study conducted in 2002-2004 showed that treatment with therapeutic hypothermia for patients resuscitated after cardiac arrest due to ventricular fibrillation led to a positive outcome (Glasgow-Pittsburgh Cerebral Performance category 1 or 2) in 24 of 43 patients compared to only 11 of 43 patients in the standard resuscitation group where no ...
Consequently, safe circulatory arrest times for mild and moderate hypothermia are only 10 and 20 minutes respectively. [32] While moderate hypothermia may be satisfactory for short surgeries, deep hypothermia (20 °C to 25 °C) affords protection for times of 30 to 40 minutes at the bottom of this temperature range.
People with moderate or severe hypothermia should be moved gently. [2] In severe hypothermia, extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful. [ 2 ] In those without a pulse , cardiopulmonary resuscitation (CPR) is indicated along with the above measures. [ 2 ]
The therapeutic effect of hypothermia is not confined to metabolism and membrane stability. Hypothermia can also prevent the injuries that occur after circulation returns to the brain, or what is termed reperfusion injuries. In fact, an individual suffering from an ischemic insult continues suffering injuries well after circulation is restored.
Patients with respiratory distress and/or hypoxemia are given supplemental oxygen or ventilatory support (through non-invasive or mechanical ventilation, if needed). To remove the excess fluid, patients are given diuretic therapy and their urine output is closely monitored to quantitate the amount removed.
Guidelines on the choice of agents and how best to step up treatment for various subgroups in hypertension (high blood pressure) have changed over time and differ between countries. A Comparison of International Guidelines on Goal Blood Pressure and Initial Therapy for Adults With Hypertension (adapted from JNC 8 guidelines [ 1 ] )
For people with pre-existing cardiovascular disease, the additional workload can result in myocardial infarction and/or acute heart failure, which ultimately may lead to a cardiac arrest. A vagal response to an extreme stimulus as this one, may, in very rare cases, render per se a cardiac arrest. Hypothermia and extreme stress can both ...