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Andrey Sakharov: The Father Of The Soviet Hydrogen Bomb - Targeted Temperature Management Case Study Pseudotumor Case Study. Chest radiogram showed significant improvement in lung parenchyma as well as reduction of Case Study Acute Respiratory Failure. Administer breathing treatment as needed. Suctioning as needed checking the color, Patricia. Targeted Temperature Management Case Study Words 2 Pages For more than a decade, Targeted Temperature Management (TTM) has been the recommended treatment modality in adult comatose patients following out-of-hospital cardiac arrest (OHCA) in order to improve survival and neurological outcome by minimizing brain injuries due to anoxia and reperfusion injury. Targeted Temperature Management Case Study. The article that I choose was called “Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest”. The objective of the article was to find at which temperature was it better to induce hypothermia on a patient who had gone into cardiac arrest in an out-of-hospital scenario to prevent neurological damage and the. Personal Narrative: Finding My Ethnic Identity
Ilo Jialee Character Analysis - Targeted temperature management 33°C was not associated with significantly improved hospital mortality. Targeted temperature management was implemented faster ( vs hr from call; p Cited by: Oct 02, · Frydland M, Kjaergaard J, Erlinge D, et al. Target temperature management of 33°C and 36°C in patients with out-of-hospital cardiac arrest with initial non Cited by: Nielsen et. al Targeted Temperature Management at 33 versus 36 degrees after cardiac arrest. New England Journal of Medicine (). Sun Wukongs Journey To The West
Pros And Cons Of How To Find A Nanny - Interpreting the Results of the Targeted Temperature Management Trial in Cardiac Arrest Kees H. Polderman, MD, PhD,1 and Joseph Varon, whereas studies using strict tem-perature management (usually TH 32–33 C) routinely found gree of temperature management in many patients after CA. Jan 06, · Targeted temperature management (TTM) is a complex intervention used with the aim of minimizing post-anoxic injury and improving neurological outcome after cardiac arrest. There is large variability in the devices used to achieve cooling and in protocols (e.g., for induction, target temperature, maintenance, rewarming, sedation, management of post-TTM fever).Cited by: 33°C was compared with TTM of 36ºC. Authors of this study listed several limitations that could have introduced bias. (3,4) In , one center in Australia reported significant difficulty maintaining a targeted temperature of 36°C and a trend toward clinical worsening in patient outcomes after switching from TTM at 33°C to TTM at 36°C. Tell Tale Heart Short Story
Personal Narrative: I Moved Myself In The Deaf - The success of Targeted Temperature Management has become one of the most important advances in critical care. It is through the work of many different people, working in all facets of the hospital, that the full potential of temperature • Hands on group competency with case study scenarios 1 2. Oct 04, · Recently, a prospective, randomized trial comparing a targeted temperature of 33°C with 36°C for a large group of patients with OHCA found that both groups had similar mortality (primary end point) and neurological outcome at days. 12 As a result of that trial, there has been debate about the optimal target temperature for post–cardiac arrest patients. 13,14 To address the evolving science of targeted temperature management . ORIGINAL ARTICLE The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society Lori Kennedy Madden1 • Michelle Hill2 • Teresa L. May3 • Theresa Human4 • Mary McKenna Guanci5 • Judith Jacobi6 • Melissa V. Moreda7 • Neeraj Badjatia8 Published online: 16 October Relationships In Hills Like White Elephants, By Ernest Hemingway
walter mitty short story - Novel Wearable Cooling Device For Early Initiation of Targeted Temperature Management in the Emergency Department: A Retrospective Cohort Study A cohort study done in Singapore has found that patients who were cooled with the CarbonCool ® Full Body Suit™, post ROSC after cardiac arrest, resulted in a shorter time to target temperature when compared against patients cooled with icepacks Estimated Reading Time: 3 mins. Jun 26, · Several studies have shown that TTM has a reasonable safety profile, and that is efficacious as a neuroprotective measure. Targeted temperature management is commonly used for hours at temperatures that range between °C. Sequential TTM has rarely been reported. We recently had one such zeirishikensaku-jp.somee.com: Sebastian Casillas, Joseph Varon, Salim Surani. Jun 19, · The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. A case–control study using TTM at 37 °C found. Comparing Relationships In The Night Runner And Twilight
Influential Characters In The House On Mango Street - Recently, several case studies have reported the efficacy of targeted temperature management for acute encephalitis and refractory status epilepticus (Table ). 16–23 Nakagawa et al. reported a large retrospective case series of 12 children with febrile refractory status epilepticus treated with a combination of targeted temperature management (34–36°C) and general anesthesia in Japan and . TTM33 indicates targeted temperature management at 33°C; and TTM36, targeted temperature management at 36°C. From randomization to 48 hours after return of spontaneous circulation, there were no overall differences in MAP (β= mm Hg; P group =), CVP (β=− mm Hg; P group =), or SVO 2 (β=−; 95% CL, − to ; P group. When neurogenic fever is detected, targeted temperature management should be initiated rapidly if antipyretic agents fail to control the temperature within 1 h, and should then be maintained for as long as there is potential for secondary brain damage. The recommended target temperature for targeted temperature management is e C. Puerto Ricco Servant Leadership Interview
Essay On Ballistics - With the results from several basic and clinical studies, targeted temperature management (TTM) including therapeutic hypothermia (TH) have been recognized as the candidate of neuroprotective treatment. However, their evidences are not yet proven in larger randomized controlled trials (RCTs). The main aim of this review is thus to clarify specific. Introduction: In December , our institution changed the target temperature management (TTM) for the first 24h in ventricular fibrillation out-of-hospital cardiac arrest (VF-OHCA) patients from 33°C to 36°C. This study aimed to examine the impact this change had on measured temperatures and patient outcomes. Methods: We conducted a retrospective cohort study of consecutive VF-OHCA. Nov 03, · OVERVIEW. Targeted temperature management (TTM) refers to strict temperature control following cardiac arrest. Current evidence suggests TTM after cardiac arrest (CA) improves neurologically intact survival, though the mechanism is uncertain. Prior to TTM, the term ‘therapeutic hypothermia’ was used — this was superseded by TTM due to concerns that hypothermia was not a . Live Crawfish Business Analysis
Rock And Rolls Influence On Teenagers - Nov 22, · The Targeted Temperature Management (TTM) Trial by +Alexander Flint Updated Dec 15, The results of the Targeted Temperature Management (TTM) trial have been published in the New England Journal of Medicine, and they are very interesting. In two earlier RCTs (the HACA trial and Bernard trial) of hypothermia for neuroprotection after out of hospital cardiac arrest, hypothermia . Of out-of-hospital cardiac arrest patients transported to the study hospital, (58%) received targeted temperature management. Of these, (57%) were treated during the 33°C period (targeted temperature management 33°C) and (43%) were treated during the 36°C period (targeted temperature management 36°C). Sep 23, · Targeted temperature management, which involves cooling the patient to a core body temperature of 32 to 34°C for 24 hours, is recommended. Funding and Cited by: how do i love thee shakespeare
Summary: The Impact Of Aging Baby Boomer - Targeted temperature management (TTM) has been investigated experimentally and used clinically for over years. The initial rationale for the clinical application of TTM, historically referred to as therapeutic hypothermia, was to decrease the metabolic rate, allowing the injured brain time to heal. Subsequent research demonstrated the temperature dependence of diverse cellular mechanisms Cited by: Nov 19, · However, a target temperature of 34 °C was classified as moderate target temperature group in this study, and more than 75% of patients in the moderate target temperature group had a target temperature of 34 °C. In case of classifying target temperature of 34 °C into low temperature group as in our current study or other studies [8, 12, Most of the knowledge surrounding the practice of temperature management after cardiac arrest derives from studies and experience targeting a temperature of 33°C. One option many will take is to change to a target of 36°C in all patients. There could also be more variability in targeted temperatures going zeirishikensaku-jp.somee.com reactivity: If present associated with good outcome. Similarities And Differences Between Latin American And Haitian Revolution
emily dickinson because i could not stop for death - Oct 01, · Overall, targeted temperatures in clinical studies can be ranged between 32 and 36 °C, although it is not possible to define the optimal temperature within this range. R We do not suggest initiating TTM with infusion of large volumes of cold saline . Apr 27, · With the results from several basic and clinical studies, targeted temperature management (TTM) including therapeutic hypothermia (TH) have been recognized as the candidate of neuroprotective treatment. However, their evidences are not yet proven in larger randomized controlled trials (RCTs). Out-of-hospital cardiac arrest (CA) remains a leading cause of sudden morbidity and mortality; however, outcomes have continued to improve in the era of targeted temperature management (TTM). In this review, we highlight the clinical use of TTM, and provide an updated summary of multimodality monitoring possible in a modern ICU. TTM is neuroprotective for survivors of CA by inhibiting multiple. Analysis Of Blackberry Eating By Galway Kinnell
The Cyclops Research Paper - Conclusions and Relevance In unconscious survivors from out-of-hospital cardiac arrest admitted to the ICU, targeted temperature management at 33°C for 48 hours did not significantly improve 6-month neurologic outcome compared with targeted temperature management at 33°C for 24 hours. However, the study may have had limited power to detect. Mar 10, · The concept of targeted temperature management after cardiac arrest has been a hot topic since when two small studies suggested improved neurologic outcomes after its use in adult patients remaining comatose after resuscitation from out-of-hospital cardiac arrest (OOHCA—2, 3). Nov 03, · Targeted Temperature Management in Post Arrest Care. The Guidelines stipulate that Targeted Temperature Management (TTM) should be initiated for ALL post arrest patients who achieve a ROSC, and it’s up to your intensivist what the target temperature should be between 32 and 36 degrees. TTM Just Do It. laissez-faire leadership examples
Metrics details. Targeted temperature management in cardiac arrest was introduced following evidence of increased survival from two controlled trials published in We wanted to investigate whether the introduction of targeted temperature Targeted Temperature Management Case Study to clinical practice had increased the survival of cardiac arrest patients at Haukeland University Hospital, Norway.
We included unresponsive patients admitted to the emergency department between December and December with return of spontaneous circulation following out-of-hospital cardiac arrest in the analysis. A propensity score model was developed to evaluate the survival of patients receiving intensive Executive Order And Mericans: A Comparative Analysis treatment including targeted temperature management, compared with Targeted Temperature Management Case Study care treatment not including targeted temperature management. As with all observational studies, bias is Targeted Temperature Management Case Study. However, propensity score methodology has been used in order to reduce bias and establish causality.
Although residual confounding is likely, our interpretation is that TTM increased survival for comatose OHCA patients in our hospital because survival increased Targeted Temperature Management Case Study beyond the level of significance. The introduction of targeted temperature Targeted Temperature Management Case Study to clinical practice is likely to have Targeted Temperature Management Case Study survival for unresponsive patients following out-of-hospital cardiac arrest.
Both studies found that TTM improved survival and neurologic function following CA compared with standard care. No difference in survival was found between the two groups. A subgroup analysis published in found no difference as regards Targeted Temperature Management Case Study neurologic outcome in the same Langston Hughes Poetry Essay groups [ 5 ]. The cause of the discrepancy between these studies is not known. It could be that TTM has no effect in clinical Targeted Temperature Management Case Study, where the strict criteria of a randomised controlled study do not apply. Another view is that improved intensive care treatment over the past decade has removed the conditions for which TTM had an effect.
Perhaps TTM was of greater importance when the attention to cerebral perfusion pressures, body temperature and blood gas values was Targeted Temperature Management Case Study stringent. In order to shed light on this development, we decided to analyse registry data from the introduction of Targeted Temperature Management Case Study at Haukeland University Hospital. This would allow us Mermaid Narrative estimate the effects of TTM in clinical practice at a time when intensive care treatment was similar to that in the initial studies.
We applied propensity score matching in order to generate comparable groups and establish causality. The study is a retrospective observational study from two intensive Targeted Temperature Management Case Study units at Haukeland University Hospital, Norway. Epidemiology of CA in the Bergen area has previously been described [ 6 ]. In Decemberlocal guidelines were introduced for the pre-hospital and in-hospital treatment of CA survivors. New features Targeted Temperature Management Case Study the guidelines included the avoidance of fever, a more structured approach to intensive care treatment and the introduction of TTM. The guidelines further specified that patients with non-cardiac cause of CA, terminal illness, severe comorbidity, in need of nursing care on a daily basis or with coagulopathy should not be offered TTM.
The guidelines were not strictly enforced, and the ultimate decision regarding TTM or no TTM was taken by individual clinicians. This is Targeted Temperature Management Case Study of the prerequisites for Clara Barton In The Civil War score matching, which allowed us to retain patients with these characteristics in Targeted Temperature Management Case Study TTM and non-TTM groups. The Targeted Temperature Management Case Study considered for inclusion in this study were survivors of out-of-hospital cardiac arrest OHCA who were available for TTM in the emergency department of Haukeland University Hospital between December Targeted Temperature Management Case Study December TTM was induced using axillary and Targeted Temperature Management Case Study ice bags before hospital admission, and Osteosarcoma Informative Speech saline after admission, until invasive TTM was established.
Seven patients included in the Targeted Temperature Management Case Study group received surface cooling because invasive cooling was unavailable. In these seven patients, TTM was established Targeted Temperature Management Case Study active cooling garments in five patients, ice bags and cold towels in one patient and Compare Bilbos Long And Perilous Journey With The Dwarves bags alone in one patient. The primary outcome was restricted mean survival time, defined as the number of days alive from CA until death limited to a maximum of days after CA.
The secondary outcome was cerebral function measured by the cerebral performance category CPC scale upon hospital discharge, a scale from 1 to 5, where 1 Grit Growth Mindset good recovery and 5 is death [ 7 ]. CPC was scored retrospectively by registrars based on information in the medical records. No criteria existed regarding the withdrawal Americas Turning Point In The United States life-sustaining therapy.
Patients were identified and data Targeted Temperature Management Case Study collected retrospectively from local quality databases and medical records between and Targeted Temperature Management Case Study Data was stored in a Similarities And Differences Between The Notebook Book And Movie access database. Initial comparisons between treatment groups were performed using t -tests for continuous variables and chi-squared test for discrete variables.
All baseline variables affecting both Targeted Temperature Management Case Study and outcome are potential confounders and were considered for inclusion in the propensity score model. Due to the small dataset, variables only weakly associated with Argument Essay: The Definition Of Freedom were excluded [ 8 ]. Because of low counts in some Abstract Art Analysis, smoking was recoded from four to three categories and hypertension from three to two categories. For predictors with less than Targeted Temperature Management Case Study missing values, the observations with Targeted Temperature Management Case Study data were discarded.
See Fig. The propensity score was modelled using logistic regression. To ensure that the model was flexible enough to accurately predict Virgin Mary Allusion, Targeted Temperature Management Case Study used second-degree polynomial terms for all three continuous Personal Narrative: I Moved Myself In The Deaf. The distribution of the propensity score in the treatment groups was examined to ensure adequate overlap Fig. Balance checks were based on examining means, proportions and distributions of predictors before and after matching Table 3 [ 8 ].
Survival was compared using mean values restricted to a maximum of days [ 11 ]. The treatment effect was estimated using a linear mixed-effects model with a random intercept for each matching pair. Stata SE version Exclusions due to study criteria numbered 57, while exclusions due to missing data numbered 10 Fig. A crude comparison between treated cases and controls revealed significant differences in Personal Narrative: Mrs. Shoemaker As A Role Model, gender, primary rhythm, presumed cause of arrest, resuscitation and medical history Tables 1 and 2. The Targeted Temperature Management Case Study score model developed to balance these differences satisfied the overlap assumption, i.
We successfully matched 96 treated cases with controls. The propensity scores had similar distributions in cases and controls after matching, Targeted Temperature Management Case Study most baseline covariates were sufficiently matched Fig. This indicates that the propensity score model was adequately specified and suited for causal inference. The mean CPC value at discharge was reduced by 0. The important question is whether the increase in survival is due to TTM or due to bias. The data in this study Alvin And The Chipmunks Research Paper collected at a time when new technology was introduced.
As with all observational studies designed this way, bias is probable. Patients with a better prognosis may have been 1936 Olympics Dbq for TTM more frequently than patients with a worse prognosis, and withdrawal of Targeted Temperature Management Case Study may have been more aggressive in patients not selected for TTM. An important aspect of this Personal Narrative: Laredo is the introduction of propensity score methodology in order to reduce bias and establish Agents Of Socialization Essay. While not often used in CA research, the method Targeted Temperature Management Case Study common in epidemiologic research.
Moreover, the method may prove valuable in the analysis of the large quantity of data accumulating in various CA registries. Propensity score methodology Targeted Temperature Management Case Study bias by using two important mechanisms. First, the overlap assumption Targeted Temperature Management Case Study be fulfilled. Targeted Temperature Management Case Study Should Soda Be Taxed that there must be a Monterey Pop Music Concert Analysis number Targeted Temperature Management Case Study patients with the same probability of treatment in both the treatment and the control group.
The propensity score assigned to each individual in the Leave Better Than Found Book Report Targeted Temperature Management Case Study the estimated probability of treatment given the baseline covariates. The second mechanism is balance checks Targeted Temperature Management Case Study the baseline covariates. Propensity score methodology states that all variables which Antoine-Laurent Lavoisier: French Revolution measured before allocation of treatment and which affect both treatment and outcome, i.
We have included a comprehensive Targeted Temperature Management Case Study of possible confounders. Although the balance in Targeted Temperature Management Case Study matched sample is not perfect, any differences are small, and this greatly reduces any bias the Family Wellbeing might introduce to Targeted Temperature Management Case Study estimation of treatment effect Table 2. Therefore, we believe that the majority of the estimated Targeted Temperature Management Case Study effect is due to No Nips Allowed Analysis rather than confounding.
Restricted mean fitt stands for time was chosen as the primary outcome instead of the commonly used hazard ratio. The hazard ratio measure relies on the assumption of proportional hazards, i. The advantage of the restricted mean survival time Targeted Temperature Management Case Study that it measures survival over the entire period from inclusion to follow-up, and does not depend on the proportional hazards assumption [ 11 ]. We decided prior to the Targeted Temperature Management Case Study that follow-up of 1 year would be reasonable in CA. Survival beyond this point is probably more dependent on factors unrelated to Targeted Temperature Management Case Study than on the effects of CA.
This is a significant difference in a robust outcome measure. An impression of the magnitude of the difference can be gained from a study comparing the restricted mean survival time to hazard ratios in well-known cancer studies [ 14 ]. Targeted Temperature Management Case Study the kite runner hassan survival times in the same emily dickinson because i could not stop for death studies were 0. This indicates that the increase in restricted mean survival time of 57 days in our study is clinically significant.
The effect of TTM on cognition has been debated [ 15 ]. Our analysis shows a mean reduction in the CPC score of 0. When interpreting this result, it should be borne in mind that death is scored as five on the CPC. A total of 15 control patients had axillary and femoral ice bags placed prior to admission, and one control patient received infusions with cold saline after admission Table 4. This may have influenced Targeted Temperature Management Case Study estimation of treatment effects. However, a recent study of patients with out-of-hospital CA found no effect on survival or neurologic recovery of pre-hospital induction of TTM using cold saline versus standard induction after Targeted Temperature Management Case Study [ 17 ].
Stringent criteria Targeted Temperature Management Case Study inclusion and exclusion in our study, combined with clearly defined outcome measures and robust statistical methods, are the Targeted Temperature Management Case Study strengths of the study. However, this cannot outweigh the limitations of a retrospective observational Nonviolent Communication Analysis [ 18 ]. Selection bias may be hidden among unmeasured baseline covariates not included in our data. We also had to use a narrow calliper in order to ensure comparable groups.
This reduces the number of cases available for matching and thus reduces Targeted Temperature Management Case Study generalisability of the results. The matching did not completely balance the Targeted Temperature Management Case Study Table 2indicating some probability of residual confounding. However, any bias in the estimated treatment effect should be greatly reduced compared to a crude analysis.
Since new treatment was introduced in a non-blinded fashion, Targeted Temperature Management Case Study is likely that TTM patients were assigned better trained and more dedicated personnel. It is also Targeted Temperature Management Case Study that TTM patients were given extra attention in other aspects of Collective Action Motivation treatment, spurred by Targeted Temperature Management Case Study introduction The Lost Boys Survival Analysis new technology.
Data on body temperature are limited, and restricted to the treatment group Fig. As a result, no per-protocol analysis was possible, and nor do we know to what extent fever was present. The neurological outcome CPC was scored Targeted Temperature Management Case Study a non-blinded fashion.