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At least 919 records · Page 51Linked to original sources

PubMed2004

Prevention of neonatal cold injury in preterm infants.

UNLABELLED: In many parts of the world neonatal cold injury still contributes to neonatal death in preterm or growth-retarded neonates. Kangaroo Mother Care might improve the situation and is the only effective, affordable and available method to prevent neonatal hypothermia in most developing countries. In developed countries, highly sophisticated incubators and radiant warmers are available but there is increasing concern about the long-term effects of high levels of sound, disturbing light and unplanned procedures which can have a bearing on the use of these tools. A controlled clinical trial of cot-nursing with a heated, water-filled mattress is presented in this issue of Acta Paediatrica. CONCLUSION: The results from the new trial and the recently published systematic reviews by the Cochrane Library of technologies to provide warmth to preterm infants in modem neonatal intensive care units, makes it possible to suggest the place of available tools: incubators, radiant warmers, heated water-filled mattresses and care in skin-to-skin contact.

Beds↗

PubMedDate not supplied

Maximizing comfort and minimizing ischemia: a comparison of four methods of spinal immobilization.

OBJECTIVE: To determine which of four methods of spinal immobilization causes the least ischemic pain. METHODS: A prospective, nonblinded comparative trial was conducted at a statewide emergency medical services training facility using a convenience sample of emergency medical technician students. After lying motionless for 10 minutes, students evaluated each device using a 10-centimeter visual analog scale. Subjective comfort was used as a measure of ischemia. RESULTS: Comfort scores were significantly different for all methods (F = 101, p < 0.001). A backboard padded with a gurney mattress and eggcrate foam (the equivalent of a spinal rehabilitation bed) caused the least ischemic pain (9.6 cm, 95% CI, 8.9 to 9.8 cm). A backboard padded with a gurney mattress was the second most comfortable device (7.0 cm, 95%/CI, 6.4 to 7.4 cm). A backboard padded with a folded blanket was the third most comfortable (3.3 cm, 95% CI, 2.6 to 4.9 cm). The backboard alone caused the most pain (0.8 cm, 95% CI, 0.7 to 2.1 cm). CONCLUSION: Increasing the amount of padding on a backboard decreased the amount of ischemic pain caused by immobilization.

Analysis of Variance↗

PubMed1998

Comparative study of air coagulation, fibrin sealant, and suture in experimental liver injury.

OBJECTIVE: To test the effects of hot air coagulation, fibrin sealant, and horizontal mattress sutures on haemostasis and regeneration in experimental hepatectomy. DESIGN: Randomised laboratory experiment. SETTING: Teaching hospital, Spain. MATERIAL: 200 rats divided into four groups (three experimental [n=60 in each] and one control [n=20]). INTERVENTIONS: Hepatic injuries were repaired by suture, coagulation, or fibrin sealant in the three experimental groups. The control group was used only to supply baseline blood samples. 10 animals in each experimental group were killed at 3, 5, 10, 25, 40, and 60 days. MAIN OUTCOME MEASURES: Time taken to achieve haemostasis, and histopathological scores of healing. RESULTS: Mattress sutures took mean (SEM) of 346 (7) seconds to control the haemorrhage and allow the liver to regain its shape and 4 rats developed abscesses (7%). Fibrin sealant achieved haemostasis immediately and the liver regained its shape in 58 (2) seconds; 2 rats (3%) developed abscesses. Hot air coagulation achieved haemostasis in 27 (1) seconds and there were no abscesses. CONCLUSION: Fibrin sealant was the best technique because it achieved immediate haemostasis and speedy regeneration. However, hot air coagulation is a useful and cheaper alternative.

Animals↗

PubMed2005

Forceful evacuation of retained pneumoperitoneum mimics an acute recurrent inguinal hernia.

BACKGROUND: Laparoscopic exploration of the contralateral side during inguinal herniorrhaphy in infants is becoming popular. We present an unusual complication of this technique, namely forceful evacuation of retained pneumoperitoneum mimicking an acute recurrent hernia. METHODS: A 9-month-old female presented for right inguinal herniorrhaphy. Laparoscopic exploration of the left side revealed a closed left internal ring. The pneumoperitoneum was evacuated. The hernia sac had started to tear so it was closed with a running horizontal mattress suture instead of a double ligature after twisting. The internal ring was closed. Upon emergence from anesthesia, the right groin was filled with a mass that we felt was subcutaneous emphysema from evacuation of residual pneumoperitoneum. But to rule out an acute recurrent hernia, we re-explored the groin. There was a large collection of air that had dissected in the subcutaneous tissues and under Scarpa's fascia. The hernia repair was intact. Follow-up 6 months after the repair showed no evidence of a recurrence. RESULTS: This is the first report of an unusual complication of laparoscopic exploration of the contralateral side during hernia repair. Two factors contributed to it. The sac closure was a running mattress suture, which is not as airtight as a double ligature after twisting. The second is the incomplete evacuation of the pneumoperitoneum. CONCLUSION: With the increasing use of laparoscopic contralateral exploration, this case illustrates the need to evacuate the pneumoperitoneum as thoroughly as possible and to consider an airtight closure of the sac.

Acute Disease↗

PubMed2006

Effects of local and systemic warming on postoperative infections.

BACKGROUND: There is increasing recognition that attention to optimal perfusion and oxygenation, normothermia, and normoglycemia is associated with low postoperative infection rates. The results of several studies on temperature maintenance will be presented. METHODS: In a test of the value of systemic warming, patients undergoing major orthopedic, general, or urologic surgery were randomized to standard care with or without systemic warming using a disposable forced warm-air blanket. The addition of perioperative warming using a conductive carbon polymer mattress and overblanket to intraoperative warming was studied in patients undergoing major elective abdominal surgery. In a study of local warming, patients undergoing elective clean-wound surgery were randomized to local warming or non-warming. To determine the contribution of heat to eradication of methicillin-resistant Staphylococcus aureus, patients with stage III-IV pressure sores were randomized to receive or not receive local warming along with standard care. RESULTS: The intraoperative improvement of cutaneous blood flow and oxygen tension in the systemically warmed group improved tissue viability and reduced the incidence of pressure sores. A statistically significant reduction in morbidity and mortality was found in the patients having the conductive mattress as well as an overblanket. Similar findings are being reported from studies of systemic warming as an adjunct to resuscitation of patients presenting with abdominal pain and elderly patients admitted after a fall or with a suspected fractured femoral neck. Local warming with non-contact radiant heat was as good as systemic warming in preventing surgical site infections. CONCLUSIONS: Attention to keeping patients warm, together with maintenance of optimal perfusion and oxygenation and euglycemia, represents a simple effective guideline. Several methods of warming are available for use during transport and resuscitation and to achieve perioperative normothermia.

Hot Temperature↗

PubMed1995

Prevention of hypothermia during orthotopic liver transplantation: comparison of three different intraoperative warming methods.

Hypothermia is a frequent and sometimes clinically important problem during orthotopic liver transplantation. Numerous methods have been suggested to reduce intraoperative heat loss and promote active warming. In this study we compared an electric under mattress, a warm air under mattress and a forced warm air convective heating blanket. The forced air convective warming system was shown to produce significantly higher patient temperatures than the two other systems.

Adolescent↗

PubMed1998

Benefits of intraoperative skin surface warming in cardiac surgical patients.

We have investigated patients undergoing cardiac surgery with hypothermic bypass to see if the addition of skin surface warming during systemic rewarming on bypass (heated group, n = 43) would improve perioperative thermal balance compared with conventional management without skin warming (control group, n = 43) in an open, randomized, controlled study. Intraoperative skin warming with a water mattress and forced warm air over the face, neck and shoulders attenuated the afterdrop in nasopharyngeal temperature after weaning from bypass (2.3 (1.2) degrees C and 1.3 (0.5) degrees C in the control and heated groups, respectively) (P < 0.05) and resulted in higher rectal temperature 4 h after surgery. Despite similar standard coagulation tests, heated patients had lower blood loss via the chest tubes (600 (264) ml vs 956 (448) ml in control patients) (P < 0.05) and less requirements for i.v. colloid infusion (1662 (404) ml vs 1994 (389) ml) (P < 0.05). There was a significant inverse correlation between rectal temperature on arrival in the ICU and postoperative blood loss (r = 0.57, P < 0.001). These data suggest that additional skin surface warming with a water mattress and forced warm air helped to preserve perioperative thermal balance and may contribute to reduced bleeding after cardiac surgery.

Adult↗

PubMed2003

Warming by resistive heating maintains perioperative normothermia as well as forced air heating.

BACKGROUND: Even mild perioperative hypothermia is associated with several severe adverse effects. Resistive heating has possible advantages compared with other active warming systems because it can heat several fields independently. To assess this new warming system, we measured core temperature in patients during surgery who were warmed with circulating water mattresses, forced air covers or resistive heating covers. METHODS: Twenty-four patients undergoing laparoscopic cholecystectomy were randomly assigned to (i) circulating water mattress (38 degrees C), (ii) forced air warming (set to 'medium') or (iii) carbon-fibre resistive warming (38 degrees C). Warming was applied throughout anaesthesia and surgery. The groups were compared using one-way ANOVA and Student-Newman-Keuls tests. RESULTS: Confounding factors were similar among the groups. Core temperatures in each group decreased for 20 min, but subsequently increased in the forced air and resistive heating groups. There was no significant difference between the forced air and resistive heating groups at any time. In contrast, core temperature in the circulating water group continued to decrease. Consequently, core temperature in the circulating water group was significantly lower than in the other groups 30 min after anaesthetic induction and at later times. CONCLUSIONS: Resistive heating maintains core body temperature as well as forced air heating and both are better than circulating water. Resistive heating offers the advantage of adjustable heating pods.

Adult↗

PubMed1987

Computer scoring of motility patterns for states of sleep and wakefulness: human infants.

A procedure is described for continuous monitoring of sleep states and wakefulness of infants in the home, with no intervention required for the recording. The infant's motility patterns produced by respiration and body movements are recorded from a pressure-sensitive mattress in the crib onto a single channel of a small 24-h analog recorder. In this way, signals produced by the naturally occurring states are obtained during all portions of the day when the infant is in the crib. Later, in the laboratory, the signals are analyzed by computer, using a pattern recognition program with a template-matching procedure that scores the data every 30 s for Active Sleep, Quiet Sleep, Active-Quiet Transition Sleep, Sleep-Wake Transition, and Wakefulness. Computer-scored records for 2-h recordings of 10 infants were compared with direct behavioral state observations that were made at the same time as the mattress recording. The results confirmed the validity of the computer scoring procedure, both when templates were obtained from each infant's observation and when a standard set of templates from one infant were used for scoring the data from all other subjects.

Beds↗

PubMed1984

Evaluation of two devices for improving thermal control of premature infants in transport.

Two devices, a plastic heat shield and a chemically heated mattress, were evaluated for their ability to reduce the needed air temperature and the power requirements in air servo-controlled transport incubators. A single-walled transporter and a double-walled transporter were evaluated using a heated manikin modeled after a 1000-g baby. The plastic heat shield reduced required transport incubator air temperature by 0.7 degree in the single-walled and 0.5 degree in the double-walled incubator, but did not significantly reduce power consumption. The chemically heated mattress was more effective in reducing power consumption and required air temperature, but it was difficult to stabilize infant temperatures in an incubator without skin servo-control. The transport incubators tested have wide swings in air temperature even during stable operation, rendering them suboptimal to manage small premature infants.

Body Temperature Regulation↗

PubMed1991

The argon beam coagulator provides rapid hemostasis of experimental hepatic and splenic hemorrhage in anticoagulated dogs.

The argon beam coagulator (ABC) delivers radiofrequency electrical energy to tissue across a jet of argon gas, providing noncontact, monopolar, electrothermal hemostasis. This study compared the efficacy of the ABC with conventional techniques for control of traumatic hepatic and splenic hemorrhage. Standardized lacerations were made to the liver and spleen of 6 heparinized dogs. Control of bleeding was attempted with the ABC (150 W), the Nd:YAG laser (90 W, noncontact), horizontal mattress suture, microcrystalline collagen, and regenerated cellulose. If bleeding had not been controlled within 3 minutes, coagulation was attempted with the ABC in order to prevent exsanguination. Tissue from both the liver and spleen was assessed histologically for damage induced by the ABC. Delayed injury and early healing after ABC coagulation was studied in six additional dogs killed 1 and 3 weeks postoperatively. The ABC stopped bleeding from 25/25 hepatic lacerations in 48 +/- 8 seconds (mean +/- SEM) and from 18/18 splenic lacerations in 28 +/- 3 seconds. The Nd:YAG laser, mattress sutures, and topical hemostatic agents failed to control bleeding in 14 of 15 applications after 3 minutes. The ABC successfully salvaged all failures in less than 1 minute. The depth of splenic and hepatic thermal injury with the ABC ranged from 2 to 7 mm and was proportional to the duration of application. Postoperatively wound healing progressed normally without bleeding or infection at the coagulation site. The ABC appears to be a excellent instrument for achieving hemostasis in solid organ injury, and may be especially valuable in managing patients with coagulation deficits.

Animals↗

PubMed1997

Convection versus conduction cooling for induction of mild hypothermia during neurovascular procedures in adults.

Hypothermia for cerebral protection is usually achieved by administration of intravenous fluids at room temperature, cooling ambient air, ice packs, and a temperature-adjustable circulating water mattress. We compared cooling by conduction by using a water mattress to cool by convection by using a forced-air cooling device. Twenty patients were prospectively randomized to two groups: 10 patients cooled by convection (CC) and 10 patients cooled by traditional methods (TC). Two patients in the CC group were withdrawn from the study and excluded from the analysis; one patient for failure to cool despite the use of both techniques, and the other for the abrupt onset of arrhythmias and myocardial depression during hypothermia. Temperature was measured at the tympanic membrane, pulmonary artery, and esophageal probe sites and recorded every 15 min. The time required to reach the target temperature range of 33-34 degrees C was recorded. We found no differences in the temperatures measured at the three sites during cooling and rewarming. Baseline temperatures recorded from the pulmonary artery catheter before beginning "active cooling" were similar in both groups (TC, 35.0 +/- 0.2 degrees C vs. CC, 35.3 +/- 0.1 degrees C). We found no difference in the time to target temperature between TC and CC (TC, 178 +/- 25 min vs. CC, 142 +/- 21 min). One patient had some arrhythmias on cooling in the convective group, but her preoperative condition may have been responsible. In conclusion, cooling by convection appears to be a safe alternative to conduction cooling.

Adult↗

PubMed2002

The low normothermia concept--maintaining a core body temperature between 36 and 37 degrees C in acute stroke unit patients.

Elevated body temperature increases mortality and worsens outcome in acute stroke patients. In animal models of stroke, even slight hypothermia was shown to be neuroprotective. Pharmacological treatment alone (paracetamol, metamizol) usually fails to lower core body temperature below 37 degrees C. The purpose of this study was to establish the feasibility and safety of continuous body surface cooling towards low normothermic temperatures in noncomatose, nonventilated stroke unit patients. Eighteen acute stroke patients (15 ischemic infarcts, 3 hemorrhages) with baseline body core temperatures >37.0 degrees C (taken in the urinary bladder) were laid on a water-perfused cooling mattress and received pethidine and dihydroergotoxine in order to avoid shivering and peripheral vasoconstriction. The target range for core body temperature was between 36 and 37 degrees C for 24 hours. None of the patients was treated with antipyretic drugs during the cooling period. Median baseline National Institutes of Health Stroke Scale score (NIHSSS) was 15.5 (8-24). Three patients had core temperatures >38 degrees C. A temperature in the target range could be reached within 3.3 hours (median) and maintained in all but two patients. Major procedure-related adverse events were vomiting (n = 2), drop in mean arterial blood pressure >20% (n = 2), pneumonia (n = 2), and a rise in central venous pressure >20 cm H2O (n = 3) totaling 9 events in 8 of 18 patients (44%). No patient died within the first week; mortality after three months was 12%. Continuous body core temperature reduction of 1-2 degrees C may safely be attained by a cooling mattress in nonventilated stroke unit patients. Critically high temperature values can be avoided. The neuroprotective potential of this method has to be assessed in a controlled trial.

Acute Disease↗

PubMed2004

Allergen avoidance and prevention of atopy.

PURPOSE OF REVIEW: Recent increases in the prevalence of atopic disease argue strongly that environmental factors operating primarily in early life play a significant role. Exposure to food and inhalant allergens early in life may constitute a risk factor amenable to manipulation. RECENT FINDINGS: Recent observational and interventional studies have produced conflicting data regarding the effectiveness of allergen avoidance in primary and secondary prevention of atopic diseases. SUMMARY: Exclusive breast feeding for 4-6 months may protect against the development of allergic diseases in early childhood and remains good advice. Convincing proof for the preventive effects of the delayed introduction of solid foods and hydrolyzed formula in formula-fed infants is lacking. There is some evidence to support a preventive effect of house dust mite allergen avoidance before sensitization occurs. The effect of exposure to animal allergen is uncertain, with some studies showing an increase in sensitization while others suggest a protective effect. Therefore, no evidence-based advice can be given at this stage regarding allergen avoidance measures to be adopted by families with infants at high risk of atopy, except perhaps to breast feed exclusively for at least 4 months. Data regarding the secondary prevention of allergic disease by allergen avoidance were more secure until the publication this year of two randomized controlled trials which suggest that mattress impermeable covers, the main dust mite allergen avoidance measure, may not work. Allergen avoidance, however, should remain an essential part of the management of allergic diseases, even if the benefit of mattress covers is in doubt.

Allergens↗

PubMedDate not supplied

Pressure relief characteristics of a new foam overlay: a preliminary performance evaluation.

To evaluate a newly designed foam mattress to be used by patients who are susceptible to pressure ulcers, interface pressures that are produced between body and mattress were measured with the Mini-Texas interface pressure evaluator (Tee-Kay Applied Technology, Inc., Stafford, Texas). Fifteen subjects with builds that ranged from thin to large were measured at four body locations--the scapular area, sacral area, trochanter, and heel. The interface pressure measurements were found to increase with body size in the sacral and heel areas. The pressures under the sacral, scapular, and heel areas remained within a narrow range for a given body type.

Beds↗

PubMed2002

Suture algorithm for the broad or bulbous nasal tip.

The history and current status of suture techniques to correct a broad or bulbous nasal tip are reviewed. General principles for suture techniques to control tip shape are discussed; they include leaving an approximately 6-mm-wide lateral crus. The algorithm presented includes four sutures, all of which are not necessary in every case. These sutures include (1) the transdomal suture (to narrow the individual domes), (2) the interdomal suture (to provide symmetry and tip strength and sometimes to narrow the tip complex), (3) the lateral crural mattress suture (to reduce lateral crural convexity), and (4) the columella-septal suture (to prevent tip drop and adjust tip projection). The lateral crural mattress suture is the newest of these sutures. It specifically controls undesirable convexity of the lateral crus. The four-suture algorithm is principally designed for primary open rhinoplasties. However, it is also recommended for secondary rhinoplasties. A minor modification is suggested for use in closed rhinoplasties. The algorithm is intended to reduce the difficulty of determining which of the currently available rhinoplasty sutures are useful and in what order they should be used. Illustrative cases are provided. The advantages and disadvantages of this particular algorithm, compared with others that have been proposed, are also reviewed.

Algorithms↗

PubMed2005

Noninvasive measurement of heartbeat, respiration, snoring and body movements of a subject in bed via a pneumatic method.

We have developed a noninvasive pneumatics-based system by which to measure heartbeat, respiration, snoring, and body movements of a subject in bed. A thin, air-sealed cushion is placed under the bed mattress of the subject and the small movements attributable to human automatic vital functions are measured as changes in pressure using a pressure sensor having an almost flat frequency response from 0.1 to 5 kHz and a sensitivity of 56 mV/Pa. Using the newly developed system, heartbeat, respiration, apnea, snoring and body movements are clearly measured. In addition, the optimal signal-to-noise (S/N) ratio by which to evaluate the reliability of the heart rate measurement is presented. Heart rates were measured for four different body postures, 13 different subjects, four different bed mattresses, and three different sensor positions. For these measurements, the S/N ratios ranged from 15.9 to 23.5 dB, and so were determined to be reliable.

Beds↗

PubMedDate not supplied

A technique of snaring method for fitting a prosthetic valve into the annulus.

BACKGROUND: Tourniquetting technique to fit a prosthetic valve (PV) into the annulus in valve replacement surgery has been previously reported. We modified the previously reported method and designed a simpler tying technique. PATIENTS: We performed 11 aortic (AVR: including four cases for calcified aortic stenosis (AS) with a small annulus and one cases for infective endocarditis with intramuscular abscess cavity), eight mitral valve replacements (MVR), and one tricuspid valve replacement (TVR: for corrected transposition of the great arteries). TECHNIQUES AND RESULTS: A PV was implanted using 2-0 polyester mattress sutures with a pledget. Each of the two tourniquets held a suture at the bottom of the annulus and at the opposite position to fit a PV. The sutures between each snare were tied down from the bottom to the top. In MVR, after seating of a PV with two tourniquets, we could make sure that no native tissue of any preserved mitral apparatus disturbed PV leaflet motion. In calcific AS, a PV had a good fitting into the annulus because of tourniquets applied to unseated part during tying sutures. In AVR for infective endocarditis, mattress sutures supported by a Teflon pledget were placed to close the abscess cavity. After snaring on one of these sutures, we tied down the sutures, ensuring that they did not cut through the friable tissues. In TVR, we found that native leaflets interfered with PV motion after seating down the prosthesis and those leaflets were resected before tying down the sutures. Postoperative transesophageal echocardiography showed no paravalvular leakage in any patients and excellent PV functions.

Aortic Valve↗