Hedeflenmiş Sıcaklık Yönetimi
Özet
Bu kitap bölümünde Hedeflenmiş Sıcaklık Yönetimi (Targeted Temperature Management - TTM) konusunu ele alınarak, özellikle kalp durması sonrası nörolojik iyileşmeyi artırmak için kullanılan bu önemli tedavi yöntemini açıklanmaktadır. Hipoterminin tıbbi amaçlarla kullanımı eski çağlara kadar uzanmakta olup, modern dönemde TTM’nin koruyucu etkileri bilimsel çalışmalarla doğrulanmış ve tıbbi uygulamalarda yaygınlaşmıştır. TTM'nin etkinliğinin arkasında yatan mekanizmalar, nöroinflamasyonu azaltma, yeniden kanlanma hasarını önleme, hücre zarlarını stabilize etme ve metabolik talepleri azaltma gibi süreçleri içerir. Bu sayede beyin ve kalp gibi hayati organlar korunur. Yeniden ısınma aşamasında ise sıcaklık kontrollü bir şekilde artırılır. Tedavi sırasında ortaya çıkabilecek komplikasyonlar arasında kardiyovasküler değişiklikler, solunum sorunları, metabolik dengesizlikler ve kan pıhtılaşma bozuklukları yer almaktadır. Bölümde ayrıca, TTM’nin başarıyla uygulanabilmesi için multidisipliner bir yaklaşımın gerekliliği ve bu tedavi sırasında gelişebilecek olası komplikasyonların yönetiminin hayati öneme sahip olduğu vurgulanmaktadır.
This chapter discusses Targeted Temperature Management (TTM), elucidating this crucial therapeutic approach employed primarily to enhance neurological recovery following cardiac arrest. The application of hypothermia for therapeutic reasons originates from antiquity, and contemporary research has substantiated the protective benefits of targeted temperature management (TTM), leading to its extensive adoption in medical practice. The mechanisms behind the efficacy of TTM encompass actions such as diminishing neuroinflammation, averting reperfusion injury, stabilizing cellular membranes, and lowering metabolic requirements. This method safeguards essential organs, including the brain and heart. In the rewarming phase, the temperature is increased in a regulated manner. Potential complications during therapy including cardiovascular alterations, breathing issues, metabolic disturbances, and coagulopathy. The chapter underscores the need of a multidisciplinary approach for the effective implementation of TTM and the critical significance of addressing any problems that may arise during this treatment.
Referanslar
Hippocrates (460–375 BC) De Vetere Medicina.
Fay T. Observations on generalized refrigeration in cases of severe cerebral trauma. Assoc Res Nerv Ment Dis Proc. 1943;24:611–619.
Rosomoff HL, Safar P. Management of the comatose patient. Clin Anes. 1965;1:244–258.
Lazorthes G, Campan L. Moderate hypothermia in the treatment of head injuries. Clin Neurosurg. 1964;12:293–299.
Bernard SA, Gray TW, Buist MD, et al. Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia. New England Journal of Medicine. 2002;346(8):557-563. doi:https://doi.org/10.1056/nejmoa003289
Nielsen N, Wetterslev J, Cronberg T, et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. New England Journal of Medicine. 2013;369(23):2197-2206. doi:https://doi.org/10.1056/nejmoa1310519
Garcia-Falgueras A. Regulation of Body Temperature. Encyclopedia of Evolutionary Psychological Science. Published online October 9, 2019:1-5. doi:https://doi.org/10.1007/978-3-319-16999-6_812-1
Hanna E, Tait P. Limitations to Thermoregulation and Acclimatization Challenge Human Adaptation to Global Warming. International Journal of Environmental Research and Public Health. 2015;12(7):8034-8074. doi:https://doi.org/10.3390/ijerph120708034
Li B., Yang Y., Yao R., Liu H., & Li Y.. A simplified thermoregulation model of the human body in warm conditions. Applied Ergonomics 2017;59:387-400. https://doi.org/10.1016/j.apergo.2016.09.010e.
Tang Y, Yu H, Wang Z, Luo M, Li C. Validation of the Stolwijk and Tanabe Human Thermoregulation Models for Predicting Local Skin Temperatures of Older People under Thermal Transient Conditions. Energies. 2020;13(24):6524. doi:https://doi.org/10.3390/en13246524
Tansey EA, Johnson CD. Recent Advances in Thermoregulation. Advances in Physiology Education. 2015;39(3):139-148. doi:https://doi.org/10.1152/advan.00126.2014
Lim CL. Fundamental Concepts of Human Thermoregulation and Adaptation to Heat: A Review in the Context of Global Warming. International Journal of Environmental Research and Public Health. 2020;17(21):7795. doi:https://doi.org/10.3390/ijerph17217795
Han HS, Park J, Kim JH, Suk K. Molecular and Cellular Pathways as a Target of Therapeutic Hypothermia: Pharmacological Aspect. Current Neuropharmacology. 2012;10(1):80-87. doi:https://doi.org/10.2174/157015912799362751
Wassink G, Davidson JO, Lear CA, et al. A Working Model for Hypothermic Neuroprotection. The Journal of Physiology. 2018;596(23):5641-5654. doi:https://doi.org/10.1113/jp274928
Ye S, Weng Y, Sun S, et al. Comparison of the Durations of Mild Therapeutic Hypothermia on Outcome After Cardiopulmonary Resuscitation in the Rat. Circulation. 2012;125(1):123-129. doi:https://doi.org/10.1161/circulationaha.111.062257
Suzuki M, Seki A, Takamisawa I, et al. An inspection of therapeutic hypothermia preceding coronary reperfusion in patients with a cardiogenic shock complicating anterior ST-segment elevation myocardial infarction. IJC Heart & Vasculature. 2015;8:108-113. doi:https://doi.org/10.1016/j.ijcha.2015.06.004
Kurisu K, Yenari MA. Therapeutic Hypothermia for Ischemic stroke; Pathophysiology and Future Promise. Neuropharmacology. 2018;134:302-309. doi:https://doi.org/10.1016/j.neuropharm.2017.08.025
Yokobori S, Frantzen J, Bullock R, et al. The Use of Hypothermia Therapy in Traumatic Ischemic/Reperfusional Brain Injury: Review of the Literatures. Therapeutic Hypothermia and Temperature Management. 2011;1(4):185-192. doi:https://doi.org/10.1089/ther.2011.0012
Chavez LO, Leon M, Einav S, Varon J. Editor’s Choice- Inside the cold heart: A review of therapeutic hypothermia cardioprotection. European Heart Journal: Acute Cardiovascular Care. 2016;6(2):130-141. doi:https://doi.org/10.1177/2048872615624242
Kaneko Y, Tajiri N, Su TP, Wang Y, Borlongan CV. Combination Treatment of Hypothermia and Mesenchymal Stromal Cells Amplifies Neuroprotection in Primary Rat Neurons Exposed to Hypoxic-Ischemic-Like Injury In Vitro: Role of the Opioid System. PLOS ONE. 2012;7(10):e47583-e47583. doi:https://doi.org/10.1371/journal.pone.0047583
González-Ibarra FP, Varon J, López-Meza EG. Therapeutic Hypothermia: Critical Review of the Molecular Mechanisms of Action. Frontiers in Neurology. 2011;2. doi:https://doi.org/10.3389/fneur.2011.00004
Al-Nashash H, All AH. Neuroprotective Role of Hypothermia in Acute Spinal Cord Injury. Biomedicines. 2022;10(1):104. doi:https://doi.org/10.3390/biomedicines10010104
Kardiyak Arrest Sonrası Hedeflenmiş Sıcaklık Yönetimi Ulusal Tedavi Kılavuzu. Eylül Ofset Matbaa ve Reklam Hizm.Sn.Tic.Ltd.Şti. 2020,1.Baskı, İstanbul, ISBN : 978-605-70043-0-7.
Nguyen PL, Alreshaid L, Poblete RA, Konye G, Marehbian J, Sung G. Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest. Frontiers in Neurology. 2018;9. doi:https://doi.org/10.3389/fneur.2018.00768
Özçelik A, Alsancak Y, Gürbüz AS, İçli A, Soylu A. A Forgotten Approach after Cardiac Arrest Due to Acute Myocardial Infarction: Neuroprotective Therapeutic Hypothermia. Journal of Surgery and Medicine. doi:https://doi.org/10.28982/josam.363746
Kim DY, Park JS, Lee SH, et al. Timing of Inducing Therapeutic Hypothermia in Patients Successfully Resuscitated after out-of-hospital Cardiac Arrest. Hong Kong Journal of Emergency Medicine. 2020;28(1):43-50. doi:https://doi.org/10.1177/1024907920958566
Lee SH, Jang WJ, Cho HJ, Cho KH, Shim SY, Son DW. Initiation of Therapeutic Hypothermia with a Cooling Fan for an Asphyxiated Newborn. Journal of the Korean Society of Neonatology. 2012;19(4):269-269. doi:https://doi.org/10.5385/jksn.2012.19.4.269
Logan A, Sangkachand P, Funk M. Optimal Management of Shivering during Therapeutic Hypothermia after Cardiac Arrest. Critical Care Nurse. 2011;31(6):e18-e30. doi:https://doi.org/10.4037/ccn2011618
Wavra T, Bader MK. Bolus Cardiac Output and Accuracy in Therapeutic Hypothermia. Critical Care Nurse. 2009;29(6):71-73. doi:https://doi.org/10.4037/ccn2009817
Avery KR, O’Brien M, Pierce CD, Gazarian PK. Use of a Nursing Checklist to Facilitate Implementation of Therapeutic Hypothermia After Cardiac Arrest. Critical Care Nurse. 2015;35(1):29-37. doi:https://doi.org/10.4037/ccn2015937
Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine 2015 Guidelines for post-resuscitation Care. Intensive Care Medicine. 2015;41(12):2039-2056. doi:https://doi.org/10.1007/s00134-015-4051-3
Donnino MW, Andersen LW, Berg KM, et al. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2016;98:97-104. doi:https://doi.org/10.1016/j.resuscitation.2015.09.396
Geurts M, Macleod MR, Kollmar R, Kremer PHC, van der Worp HB. Therapeutic Hypothermia and the Risk of Infection: A Systematic Review and Meta-Analysis*. Critical Care Medicine. 2014;42(2):231-242. doi:https://doi.org/10.1097/CCM.0b013e3182a276e8
Bouwes A, Robillard LBM, Binnekade JM, et al. The influence of rewarming after therapeutic hypothermia on outcome after cardiac arrest. Resuscitation. 2012;83(8):996-1000. doi:https://doi.org/10.1016/j.resuscitation.2012.04.006
Scirica BM. Therapeutic Hypothermia After Cardiac Arrest. Circulation. 2013;127(2):244-250. doi:https://doi.org/10.1161/circulationaha.111.076851
Mazzeo AT, La Monaca E, Di Leo R, Vita G, Santamaria LB. Heart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care. Acta Anaesthesiologica Scandinavica. 2011;55(7):797-811. doi:https://doi.org/10.1111/j.1399-6576.2011.02466.x
Polderman KH. Mechanisms of action, Physiological effects, and Complications of Hypothermia. Critical care medicine. 2009;37(7 Suppl):S186-202. doi:https://doi.org/10.1097/CCM.0b013e3181aa5241
Cueni-Villoz N, Devigili A, Delodder F, et al. Increased blood glucose variability during therapeutic hypothermia and outcome after cardiac arrest. Critical Care Medicine. 2011;39(10):2225-2231. doi:https://doi.org/10.1097/CCM.0b013e31822572c9
Williams TA, McKenzie N, Inoue M. Does Therapeutic Temperature Management after Cardiac Arrest Increase the Risk of bleeding? Australian Critical Care. 2015;28(3):169-171. doi:https://doi.org/10.1016/j.aucc.2015.01.001
Referanslar
Hippocrates (460–375 BC) De Vetere Medicina.
Fay T. Observations on generalized refrigeration in cases of severe cerebral trauma. Assoc Res Nerv Ment Dis Proc. 1943;24:611–619.
Rosomoff HL, Safar P. Management of the comatose patient. Clin Anes. 1965;1:244–258.
Lazorthes G, Campan L. Moderate hypothermia in the treatment of head injuries. Clin Neurosurg. 1964;12:293–299.
Bernard SA, Gray TW, Buist MD, et al. Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia. New England Journal of Medicine. 2002;346(8):557-563. doi:https://doi.org/10.1056/nejmoa003289
Nielsen N, Wetterslev J, Cronberg T, et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. New England Journal of Medicine. 2013;369(23):2197-2206. doi:https://doi.org/10.1056/nejmoa1310519
Garcia-Falgueras A. Regulation of Body Temperature. Encyclopedia of Evolutionary Psychological Science. Published online October 9, 2019:1-5. doi:https://doi.org/10.1007/978-3-319-16999-6_812-1
Hanna E, Tait P. Limitations to Thermoregulation and Acclimatization Challenge Human Adaptation to Global Warming. International Journal of Environmental Research and Public Health. 2015;12(7):8034-8074. doi:https://doi.org/10.3390/ijerph120708034
Li B., Yang Y., Yao R., Liu H., & Li Y.. A simplified thermoregulation model of the human body in warm conditions. Applied Ergonomics 2017;59:387-400. https://doi.org/10.1016/j.apergo.2016.09.010e.
Tang Y, Yu H, Wang Z, Luo M, Li C. Validation of the Stolwijk and Tanabe Human Thermoregulation Models for Predicting Local Skin Temperatures of Older People under Thermal Transient Conditions. Energies. 2020;13(24):6524. doi:https://doi.org/10.3390/en13246524
Tansey EA, Johnson CD. Recent Advances in Thermoregulation. Advances in Physiology Education. 2015;39(3):139-148. doi:https://doi.org/10.1152/advan.00126.2014
Lim CL. Fundamental Concepts of Human Thermoregulation and Adaptation to Heat: A Review in the Context of Global Warming. International Journal of Environmental Research and Public Health. 2020;17(21):7795. doi:https://doi.org/10.3390/ijerph17217795
Han HS, Park J, Kim JH, Suk K. Molecular and Cellular Pathways as a Target of Therapeutic Hypothermia: Pharmacological Aspect. Current Neuropharmacology. 2012;10(1):80-87. doi:https://doi.org/10.2174/157015912799362751
Wassink G, Davidson JO, Lear CA, et al. A Working Model for Hypothermic Neuroprotection. The Journal of Physiology. 2018;596(23):5641-5654. doi:https://doi.org/10.1113/jp274928
Ye S, Weng Y, Sun S, et al. Comparison of the Durations of Mild Therapeutic Hypothermia on Outcome After Cardiopulmonary Resuscitation in the Rat. Circulation. 2012;125(1):123-129. doi:https://doi.org/10.1161/circulationaha.111.062257
Suzuki M, Seki A, Takamisawa I, et al. An inspection of therapeutic hypothermia preceding coronary reperfusion in patients with a cardiogenic shock complicating anterior ST-segment elevation myocardial infarction. IJC Heart & Vasculature. 2015;8:108-113. doi:https://doi.org/10.1016/j.ijcha.2015.06.004
Kurisu K, Yenari MA. Therapeutic Hypothermia for Ischemic stroke; Pathophysiology and Future Promise. Neuropharmacology. 2018;134:302-309. doi:https://doi.org/10.1016/j.neuropharm.2017.08.025
Yokobori S, Frantzen J, Bullock R, et al. The Use of Hypothermia Therapy in Traumatic Ischemic/Reperfusional Brain Injury: Review of the Literatures. Therapeutic Hypothermia and Temperature Management. 2011;1(4):185-192. doi:https://doi.org/10.1089/ther.2011.0012
Chavez LO, Leon M, Einav S, Varon J. Editor’s Choice- Inside the cold heart: A review of therapeutic hypothermia cardioprotection. European Heart Journal: Acute Cardiovascular Care. 2016;6(2):130-141. doi:https://doi.org/10.1177/2048872615624242
Kaneko Y, Tajiri N, Su TP, Wang Y, Borlongan CV. Combination Treatment of Hypothermia and Mesenchymal Stromal Cells Amplifies Neuroprotection in Primary Rat Neurons Exposed to Hypoxic-Ischemic-Like Injury In Vitro: Role of the Opioid System. PLOS ONE. 2012;7(10):e47583-e47583. doi:https://doi.org/10.1371/journal.pone.0047583
González-Ibarra FP, Varon J, López-Meza EG. Therapeutic Hypothermia: Critical Review of the Molecular Mechanisms of Action. Frontiers in Neurology. 2011;2. doi:https://doi.org/10.3389/fneur.2011.00004
Al-Nashash H, All AH. Neuroprotective Role of Hypothermia in Acute Spinal Cord Injury. Biomedicines. 2022;10(1):104. doi:https://doi.org/10.3390/biomedicines10010104
Kardiyak Arrest Sonrası Hedeflenmiş Sıcaklık Yönetimi Ulusal Tedavi Kılavuzu. Eylül Ofset Matbaa ve Reklam Hizm.Sn.Tic.Ltd.Şti. 2020,1.Baskı, İstanbul, ISBN : 978-605-70043-0-7.
Nguyen PL, Alreshaid L, Poblete RA, Konye G, Marehbian J, Sung G. Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest. Frontiers in Neurology. 2018;9. doi:https://doi.org/10.3389/fneur.2018.00768
Özçelik A, Alsancak Y, Gürbüz AS, İçli A, Soylu A. A Forgotten Approach after Cardiac Arrest Due to Acute Myocardial Infarction: Neuroprotective Therapeutic Hypothermia. Journal of Surgery and Medicine. doi:https://doi.org/10.28982/josam.363746
Kim DY, Park JS, Lee SH, et al. Timing of Inducing Therapeutic Hypothermia in Patients Successfully Resuscitated after out-of-hospital Cardiac Arrest. Hong Kong Journal of Emergency Medicine. 2020;28(1):43-50. doi:https://doi.org/10.1177/1024907920958566
Lee SH, Jang WJ, Cho HJ, Cho KH, Shim SY, Son DW. Initiation of Therapeutic Hypothermia with a Cooling Fan for an Asphyxiated Newborn. Journal of the Korean Society of Neonatology. 2012;19(4):269-269. doi:https://doi.org/10.5385/jksn.2012.19.4.269
Logan A, Sangkachand P, Funk M. Optimal Management of Shivering during Therapeutic Hypothermia after Cardiac Arrest. Critical Care Nurse. 2011;31(6):e18-e30. doi:https://doi.org/10.4037/ccn2011618
Wavra T, Bader MK. Bolus Cardiac Output and Accuracy in Therapeutic Hypothermia. Critical Care Nurse. 2009;29(6):71-73. doi:https://doi.org/10.4037/ccn2009817
Avery KR, O’Brien M, Pierce CD, Gazarian PK. Use of a Nursing Checklist to Facilitate Implementation of Therapeutic Hypothermia After Cardiac Arrest. Critical Care Nurse. 2015;35(1):29-37. doi:https://doi.org/10.4037/ccn2015937
Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine 2015 Guidelines for post-resuscitation Care. Intensive Care Medicine. 2015;41(12):2039-2056. doi:https://doi.org/10.1007/s00134-015-4051-3
Donnino MW, Andersen LW, Berg KM, et al. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2016;98:97-104. doi:https://doi.org/10.1016/j.resuscitation.2015.09.396
Geurts M, Macleod MR, Kollmar R, Kremer PHC, van der Worp HB. Therapeutic Hypothermia and the Risk of Infection: A Systematic Review and Meta-Analysis*. Critical Care Medicine. 2014;42(2):231-242. doi:https://doi.org/10.1097/CCM.0b013e3182a276e8
Bouwes A, Robillard LBM, Binnekade JM, et al. The influence of rewarming after therapeutic hypothermia on outcome after cardiac arrest. Resuscitation. 2012;83(8):996-1000. doi:https://doi.org/10.1016/j.resuscitation.2012.04.006
Scirica BM. Therapeutic Hypothermia After Cardiac Arrest. Circulation. 2013;127(2):244-250. doi:https://doi.org/10.1161/circulationaha.111.076851
Mazzeo AT, La Monaca E, Di Leo R, Vita G, Santamaria LB. Heart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care. Acta Anaesthesiologica Scandinavica. 2011;55(7):797-811. doi:https://doi.org/10.1111/j.1399-6576.2011.02466.x
Polderman KH. Mechanisms of action, Physiological effects, and Complications of Hypothermia. Critical care medicine. 2009;37(7 Suppl):S186-202. doi:https://doi.org/10.1097/CCM.0b013e3181aa5241
Cueni-Villoz N, Devigili A, Delodder F, et al. Increased blood glucose variability during therapeutic hypothermia and outcome after cardiac arrest. Critical Care Medicine. 2011;39(10):2225-2231. doi:https://doi.org/10.1097/CCM.0b013e31822572c9
Williams TA, McKenzie N, Inoue M. Does Therapeutic Temperature Management after Cardiac Arrest Increase the Risk of bleeding? Australian Critical Care. 2015;28(3):169-171. doi:https://doi.org/10.1016/j.aucc.2015.01.001
