THERAPEUTIC HYPOTHERMIA AND TEMPERATURE MANAGEMENT Volume 4, Number 2, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/ther.2014.1506
Editorial
Great News: We Made MEDLINE! W. Dalton Dietrich, PhD
W
the best dose of hypothermia in relationship to return of spontaneous circulation and survival in out-of-hospital cardiac arrest patients. In a report by Hutchens and colleagues, an animal model of cardiac arrest and cardiopulmonary resuscitation was used to determine whether outcome was influenced by peripheral organ ischemia. An interesting observation was that after brief ischemia, events following reperfusion injury may be highly injurious in terms of longterm outcome. A study by Karnatovskaia and colleagues evaluated the effects of therapeutic hypothermia on gas exchange and respiratory mechanics. This retrospective review of consecutive cardiac arrest cases emphasizes targeted temperature management results equivalent to favorable respiratory and clinical outcomes compared with controls. A case report by Ocegueda-Pacheco and colleagues reports on the beneficial effects of therapeutic hypothermia for amniotic fluid embolism. This study included the use of therapeutic hypothermia in a patient with embolism that resulted in survival and neurological improvement. Finally, the latest special Arctic Challenge section of the Journal addresses important questions relating to the use of therapeutic hypothermia, including questions on cooling strategies that involve alternative methods other than devices. Because of the high incidence of shivering, especially in awake patients, questions regarding the effects of shivering on the patients’ temperature are also discussed. Questions pertaining to the use of various pharmacological agents, and how their effects may differ in periods where induced therapeutic hypothermia is on board, are addressed. One question considers the use of dexmedetomidine and potential adverse effects on blood pressure regulation. Other answers to various questions relevant to the field will be of interest to the readers. Again, we thank our authors for their submissions of highquality articles and for contributing to the rich information presented in our Journal. We greatly appreciate the help of our international editorial board and reviewers for ensuring timely critiques that enhance the quality of our publication. We congratulate everyone involved in our Journal on the recent acceptance into MEDLINE. As editor-in-chief, I hope you are enjoying the Journal and if you have any questions, feel free to contact me. I look forward to your participation and the continued growth of our Journal.
e recently received the outstanding news that Therapeutic Hypothermia and Temperature Management has been accepted for inclusion in MEDLINE. This is an extremely important accomplishment for our relatively young journal and emphasizes the high quality of articles that we have published since its first issue in 2011. This was our initial attempt to have the Journal indexed, and it was very gratifying to all of us to hear this great news. I would like to acknowledge our outstanding editorial board, published authors, and Mary Ann Liebert, Inc., for their important contributions. In the current issue, we continue to provide state-of-the-art panel discussions and original articles to the readership of the Journal. This issue highlights two expert panel discussions/ roundtables from the Fourth Annual Therapeutic Hypothermia and Temperature Management Conference held in Miami in March 2014. One discussion reviews current information regarding temperature management in neurological and neurosurgical intensive care units. Information regarding the reasons to cool patients and new strategies for cooling awake patients are presented. The detrimental effects of fever have now been shown in various experimental and clinical studies, and actively maintaining normothermia may be an effective way to improve patient outcome. The clinical relevance of shivering and new antishivering strategies that may allow cooling in awake subjects are also emphasized. A second roundtable discussion focuses on intraoperative temperature management. As previously discussed, the depth of hypothermia that is required to promote neuroprotection without producing risk factors is emphasized. The use of hypothermia during extensive stabilization procedures in patients with cardiac arrest is also discussed. In response to the recent Scandinavian targeted temperature management clinical study, the importance of the additional benefits of reducing temperature to 33, as compared with 36, is stated in a rich discussion. Because of the current lack of proven strategies targeting severe spinal cord injury, the beneficial effects of therapeutic hypothermia in this patient population are also summarized. These roundtable discussions continue to provide a rich source of information regarding current topics in therapeutic hypothermia and temperature management. Several original articles targeting various aspects of therapeutic hypothermia are also included in this issue. Sawyer and colleagues report on the results of an investigation of therapeutic hypothermia to ischemic ratio to help establish
—W. Dalton Dietrich, PhD Editor-in-Chief
61
Editorial
Great News: We Made MEDLINE! W. Dalton Dietrich, PhD
W
the best dose of hypothermia in relationship to return of spontaneous circulation and survival in out-of-hospital cardiac arrest patients. In a report by Hutchens and colleagues, an animal model of cardiac arrest and cardiopulmonary resuscitation was used to determine whether outcome was influenced by peripheral organ ischemia. An interesting observation was that after brief ischemia, events following reperfusion injury may be highly injurious in terms of longterm outcome. A study by Karnatovskaia and colleagues evaluated the effects of therapeutic hypothermia on gas exchange and respiratory mechanics. This retrospective review of consecutive cardiac arrest cases emphasizes targeted temperature management results equivalent to favorable respiratory and clinical outcomes compared with controls. A case report by Ocegueda-Pacheco and colleagues reports on the beneficial effects of therapeutic hypothermia for amniotic fluid embolism. This study included the use of therapeutic hypothermia in a patient with embolism that resulted in survival and neurological improvement. Finally, the latest special Arctic Challenge section of the Journal addresses important questions relating to the use of therapeutic hypothermia, including questions on cooling strategies that involve alternative methods other than devices. Because of the high incidence of shivering, especially in awake patients, questions regarding the effects of shivering on the patients’ temperature are also discussed. Questions pertaining to the use of various pharmacological agents, and how their effects may differ in periods where induced therapeutic hypothermia is on board, are addressed. One question considers the use of dexmedetomidine and potential adverse effects on blood pressure regulation. Other answers to various questions relevant to the field will be of interest to the readers. Again, we thank our authors for their submissions of highquality articles and for contributing to the rich information presented in our Journal. We greatly appreciate the help of our international editorial board and reviewers for ensuring timely critiques that enhance the quality of our publication. We congratulate everyone involved in our Journal on the recent acceptance into MEDLINE. As editor-in-chief, I hope you are enjoying the Journal and if you have any questions, feel free to contact me. I look forward to your participation and the continued growth of our Journal.
e recently received the outstanding news that Therapeutic Hypothermia and Temperature Management has been accepted for inclusion in MEDLINE. This is an extremely important accomplishment for our relatively young journal and emphasizes the high quality of articles that we have published since its first issue in 2011. This was our initial attempt to have the Journal indexed, and it was very gratifying to all of us to hear this great news. I would like to acknowledge our outstanding editorial board, published authors, and Mary Ann Liebert, Inc., for their important contributions. In the current issue, we continue to provide state-of-the-art panel discussions and original articles to the readership of the Journal. This issue highlights two expert panel discussions/ roundtables from the Fourth Annual Therapeutic Hypothermia and Temperature Management Conference held in Miami in March 2014. One discussion reviews current information regarding temperature management in neurological and neurosurgical intensive care units. Information regarding the reasons to cool patients and new strategies for cooling awake patients are presented. The detrimental effects of fever have now been shown in various experimental and clinical studies, and actively maintaining normothermia may be an effective way to improve patient outcome. The clinical relevance of shivering and new antishivering strategies that may allow cooling in awake subjects are also emphasized. A second roundtable discussion focuses on intraoperative temperature management. As previously discussed, the depth of hypothermia that is required to promote neuroprotection without producing risk factors is emphasized. The use of hypothermia during extensive stabilization procedures in patients with cardiac arrest is also discussed. In response to the recent Scandinavian targeted temperature management clinical study, the importance of the additional benefits of reducing temperature to 33, as compared with 36, is stated in a rich discussion. Because of the current lack of proven strategies targeting severe spinal cord injury, the beneficial effects of therapeutic hypothermia in this patient population are also summarized. These roundtable discussions continue to provide a rich source of information regarding current topics in therapeutic hypothermia and temperature management. Several original articles targeting various aspects of therapeutic hypothermia are also included in this issue. Sawyer and colleagues report on the results of an investigation of therapeutic hypothermia to ischemic ratio to help establish
—W. Dalton Dietrich, PhD Editor-in-Chief
61
