In:
Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 7 ( 2018-07), p. 1133-1138
Abstract:
Assess if amount of heat generated by postcardiac arrest patients to reach target temperature (T target ) during targeted temperature management is associated with outcomes by serving as a proxy for thermoregulatory ability, and whether it modifies the relationship between time to T target and outcomes. Design: Retrospective cohort study. Setting: Urban tertiary-care hospital. Patients: Successfully resuscitated targeted temperature management–treated adult postarrest patients between 2008 and 2015 with serial temperature data and T target less than or equal to 34°C. Interventions: None. Measurements and Main Results: Time to T target was defined as time from targeted temperature management initiation to first recorded patient temperature less than or equal to 34°C. Patient heat generation (“heat units”) was calculated as inverse of average water temperature × hours between initiation and T target × 100. Primary outcome was neurologic status measured by Cerebral Performance Category score; secondary outcome was survival, both at hospital discharge. Univariate analyses were performed using Wilcoxon rank-sum tests; multivariate analyses used logistic regression. Of 203 patients included, those with Cerebral Performance Category score 3–5 generated less heat before reaching T target (median, 8.1 heat units [interquartile range, 3.6–21.6 heat units] vs median, 20.0 heat units [interquartile range, 9.0–33.5 heat units] ; p = 0.001) and reached T target quicker (median, 2.3 hr [interquartile range, 1.5–4.0 hr] vs median, 3.6 hr [interquartile range, 2.0–5.0 hr] ; p = 0.01) than patients with Cerebral Performance Category score 1–2. Nonsurvivors generated less heat than survivors (median, 8.1 heat units [interquartile range, 3.6–20.8 heat units] vs median, 19.0 heat units [interquartile range, 6.5–33.5 heat units] ; p = 0.001) and reached T target quicker (median, 2.2 hr [interquartile range, 1.5–3.8 hr] vs median, 3.6 hr [interquartile range, 2.0–5.0 hr] ; p = 0.01). Controlling for average water temperature between initiation and T target , the relationship between outcomes and time to T target was no longer significant. Controlling for location, witnessed arrest, age, initial rhythm, and neuromuscular blockade use, increased heat generation was associated with better neurologic (adjusted odds ratio, 1.01 [95% CI, 1.00–1.03]; p = 0.039) and survival (adjusted odds ratio, 1.01 [95% CI, 1.00–1.03]; p = 0.045) outcomes. Conclusions: Increased heat generation during targeted temperature management initiation is associated with better outcomes at hospital discharge and may affect the relationship between time to T target and outcomes.
Type of Medium:
Online Resource
ISSN:
0090-3493
DOI:
10.1097/CCM.0000000000003154
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2018
detail.hit.zdb_id:
2034247-0
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