Therapeutic Hypothermia and Temperature Management

Out-of-hospital cardiac arrest (OHCA) in children is a rare but catastrophic event, often resulting in significant neurological injury. Targeted temperature management (TTM), including therapeutic hypothermia (TH), has been proposed as a neuroprotective strategy. This systematic review and meta-analysis aims to evaluate the effects of different TTM strategies on survival and neurological outcomes in pediatric patients after OHCA. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Pooled outcomes were synthesized using odds ratios (OR) with 95% confidence intervals (CI), and the certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A total of nine studies encompassing 2107 pediatric patients were included. TH was associated with significantly higher odds of survival (OR: 1.72; 95% CI: 1.36–2.18; p < 0.0001) and favorable neurological outcome (OR: 1.64; 95% CI: 1.16–2.33; p = 0.006) compared to normothermia. Subgroup analysis demonstrated greater survival benefit at 12 months and improved neurological outcomes at 6–12 months. There were no statistically significant differences between groups in blood lactate levels, odds of arrhythmia, culture-proven infections, or length of hospital stay. The certainty of evidence for most outcomes was graded as low due to the predominance of nonrandomized studies and imprecision. TH as a TTM strategy following pediatric OHCA may offer survival and neurological advantage, particularly at longer-term follow-up, without a significant increase in adverse events. However, the low certainty of evidence highlights the need for further high-quality randomized trials to inform clinical practice and optimize neuroprotective care in this vulnerable population.

Primary dysmenorrhea is a prevalent condition causing severe menstrual pain in nulliparous women, negatively impacting daily functioning and well-being. This randomized controlled trial investigated the efficacy of cryotherapy in alleviating pain and enhancing secondary outcomes such as sleep quality, quality of life, and physical activity. Fifty-eight nulliparous women were randomly assigned to a cryotherapy group or a control group. Pain intensity was measured using the Numeric Rating Scale, whereas secondary outcomes were evaluated with the Pittsburgh Sleep Quality Index, World Health Organization Quality of Life-Brief Version, and the International Physical Activity Questionnaire. Socioeconomic factors, including household income, education, and occupation, were also assessed. Cryotherapy significantly reduced pain intensity from a baseline of 7.1 ± 1.4 to 1.8 ± 1.7 (p < 0.001) compared with a modest reduction in the control group (5.9 ± 1.9–5.4 ± 2.1). Sleep quality improved more in the cryotherapy group (6.90 ± 3.0 to 5.03 ± 2.5) than in the control group (6.88 ± 3.6 to 5.68 ± 2.8). However, no statistically significant changes were observed in the quality of life or physical activity levels, likely because menstrual pain alone may not sufficiently influence these domains, which are affected by broader psychosocial and behavioral factors. These findings demonstrate that cryotherapy is a simple, cost-effective intervention for managing primary dysmenorrhea, providing substantial pain relief and modest improvements in sleep quality. Further research is recommended to evaluate its long-term benefits and potential for broader applications in menstrual health management.

The objective of this study was to assess the adherence to inclusion criteria for therapeutic hypothermia (TH) in neonates with hypoxic-ischemic encephalopathy (HIE) and to survey current attitudes on TH. This multicenter observational study therefore combined a retrospective analysis of the Swiss National Asphyxia and Cooling Register (2011–2023) and a prospective survey (2024) among neonatologists in the Canton of Zurich, Switzerland. A total of 456 neonates with HIE were registered in the Swiss National Asphyxia and Cooling Register in the Canton of Zurich, Switzerland, between 2011 and 2023. The rate of TH (52.6% [2011–2017] versus 52.0% [2018–2023]) as well as the incidence of off-protocol cooling remained stable over time (p = 0.614). The survey response rate was 69.5% (57/82). Difficulties with clinical grading of encephalopathy were identified. Subjectively, respondents considered themselves more generous to initiate TH. In conclusion, register data reflected good adherence to inclusion criteria for TH. The survey confirmed willingness to consider TH in milder HIE cases. However, there was no drift in clinical practice—yet?

Hypoxic-ischemic encephalopathy (HIE) affects 1.3–1.7 per 1000 live births and remains a major cause of neurodevelopmental impairment (NDI). Despite therapeutic hypothermia (TH), nearly half of infants with moderate to severe HIE experience death or NDI. Identifying early prognostic indicators before TH initiation is crucial for improving management and outcomes. We conducted a retrospective case–control study of 144 infants with HIE treated with TH at Kagoshima City Hospital (2000–2022); 100 underwent developmental evaluations at 18 months. Clinical parameters, including amplitude-integrated EEG (aEEG), Thompson scores, and resuscitation details, were analyzed. Logistic regression identified predictors of adverse outcomes: death, cerebral palsy, or developmental quotient <70. Univariate analysis revealed significant predictors, including low Apgar scores, low umbilical artery pH, aEEG abnormalities, high Thompson scores, and resuscitation details. Multivariate regression identified three independent predictors: aEEG abnormalities (adjusted odds ratios [aOR] 7.1, 95% confidence interval [CI]: 1.3–38.2), Thompson score ≥12 (aOR 5.4, 95% CI: 1.5–18.7), and chest compressions (aOR 31.6, 95% CI: 4.3–231.6). We developed and derived early prognostic model from these predictors, assigning +2 points for aEEG abnormalities, +2 points for a Thompson score ≥12, and +3 points for chest compressions. A total score ≥4 achieved high sensitivity (70.4%) and specificity (90.4%), with an area under the curve of 0.87 (95% CI: 0.77–0.94). The early prognostic model may serve as an effective tool for early risk stratification in neonates with HIE before TH initiation, supporting individualized treatment decisions. This score could help identify high-risk neonates who may benefit from additional neuroprotective strategies.

The critical care unit at the University Hospital of Wales is a 38-bedded tertiary center. In 2023, the unit admitted 1251 unscheduled patients, of which 131 were out-of-hospital cardiac arrest (OOHCA) patients. The unit also participated in the Targeted Temperature Management 2 study and adopted the findings shortly after its publication in 2021. This gave us a unique exposure into the pitfalls associated with changing surface cooling protocols. The aim of this quality and safety initiative was to explore the causes of failure to comply with normothermic temperature targets in the OOHCA population, following a protocol change away from targeted therapeutic hypothermia. This article uses surface cooling data from OOHCA survivors. We discuss our findings from analysis of surface cooling data from 36 patients—13 pre-protocol change (targeted hypothermia) and 23 post-protocol change (targeted normothermia). Concerningly, following the change to targeted normothermia, rather than therapeutic hypothermia, the fever burden increased from an average of 2 to12 hours per patient. To address this problem, we reviewed the data and identified several causes of this failure. These failures included the failure to start the therapy at the selected trigger point, the interruption of therapy, inadequate pad sizing, and the failure to select the correct protocol. Surface cooling pitfalls are not commonly discussed in the literature, and therefore there remains a risk that units may overlook them, either when transitioning between protocols or when continuing with an ongoing surface cooling device. With evidence suggesting that pyrexia contributes to poorer outcomes, it is of vital importance that staff are aware of any potential pitfalls of surface cooling devices to mitigate unnecessary fever burden.

This study aimed to determine the effects of the thermal blanket on patients’ vital signs, shivering level, chill status, and thermal comfort perception in preoperative and postoperative periods. The study was designed as a randomized controlled trial and included 44 female patients who had undergone elective gynecological surgery in a hospital in the south of Turkey. The experimental group (n = 22) was warmed using the passive warming method via a thermal blanket, and the control group (n = 22) was administered routine care via a cotton pique. The data collection tools included the “Patient Information Form,” the “Patient Follow-Up Form,” the “Shivering Level Diagnosis Form,” and the “Thermal Comfort Perception Scale.” Patients were warmed passively before (at least 10 minutes) and after surgery (at least 60 minutes) with a thermal blanket or cotton pique according to their groups. Patients’ vital signs and oxygen saturation were recorded during the preoperative and postoperative periods at 15-minute intervals. The patients’ shivering levels were recorded at 15-minute intervals, and chill status and thermal comfort perceptions were recorded at 30-minute intervals during the postoperative period. The data obtained in the research were analyzed using the SPSS 24.0 program. There were no statistically significant differences between the vital signs and oxygen saturation of the intervention and control groups during the first 60 minutes after surgery. The shivering level and coldness of the control group were higher in the postoperative period, but the difference between the groups was not statistically significant. There were no statistical differences between the groups in the time to reach 36.0°C (p > 0.05). Thermal comfort perception scores during the first 90 minutes were significantly higher in the intervention group (p < 0.05). The thermal blanket is not superior to the cotton pique used in standard care in maintaining body temperature, but it is effective in increasing thermal comfort perception.