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Bothe TL, Pilz N, Patzak A, Opatz OS. Bridging the gap: The dichotomy between measurement and reality in physiological research. Acta Physiol (Oxf) 2023; 238:e14015. [PMID: 37354109 DOI: 10.1111/apha.14015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Affiliation(s)
- T L Bothe
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - N Pilz
- Institute of Translational Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Patzak
- Institute of Translational Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - O S Opatz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Jiang L, Yang Q, Li Q, Jiang B, Laba C, Feng Y. Optimal Duration of High-Fidelity Simulator Training for Bronchoscope-Guided Intubation: A Noninferiority Randomized Trial. Simul Healthc 2023:01266021-990000000-00074. [PMID: 37440425 DOI: 10.1097/sih.0000000000000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
INTRODUCTION The optimal simulator training duration for flexible optical bronchoscopic (FOB) intubation is unknown. This study aimed to determine whether a learning curve-based training modality was noninferior to a fixed training time modality in terms of clinical FOB intubation time. METHODS This multicenter, randomized, noninferiority study was conducted from May to August 2022. Anesthesiology residents or interns were enrolled. Eligible participants were randomized in a 1:1 ratio to receive new learning curve-based simulator training (individualized training time based on performance, group New) or reference fixed training time simulator training (1 hour, group Reference). The primary outcome was the time to complete FOB intubation in patients, which was defined as the time from the introduction of the FOB into the mouth until the first capnography visualization. The margin for detecting clinical significance was defined as 10 seconds. RESULTS A total of 32 participants were included in the analysis (16 in each group). All trainees successfully intubated the patients. The mean intubation time (95% confidence interval [CI]) was 81.9 (65.7-98.1) seconds in group New and 97.0 (77.4-116.6) seconds in group Reference. The upper bound of the 1-sided 97.5% CI for the mean difference of clinical intubation time between groups was 9.3 seconds. Noninferiority was claimed. The mean duration of the training in group New was 28.4 (95% CI, 23.5-33.4) minutes. The total number of training procedures on simulators in group New was significantly less than that in group Reference (P < 0.01). CONCLUSIONS The clinical FOB intubation time in group New was noninferior to that in group Reference.
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Affiliation(s)
- Luyang Jiang
- From the Department of Anesthesiology (L.J., Q.L., B.J., Y.F.), Peking University People's Hospital, Beijing, China; and Department of Anesthesiology (Q.Y., B.J., C.L.), Tibet Autonomous Region People's Hospital, Lhasa, Tibet, China
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Xu X, Rioux TP, Castellani MP. Three dimensional models of human thermoregulation: A review. J Therm Biol 2023; 112:103491. [PMID: 36796931 DOI: 10.1016/j.jtherbio.2023.103491] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
Numerous human thermoregulatory models have been developed and widely used in various applications such as aerospace, medicine, public health, and physiology research. This paper is a review of three dimensional (3D) models for human thermoregulation. This review begins with a short introduction of thermoregulatory model development followed by key principles for mathematical description of human thermoregulation systems. Different representations of 3D human bodies are discussed with respect to their detail and prediction capability. The human body was divided into fifteen layered cylinders in early 3D models (cylinder model). Recent 3D models have utilized medical image datasets to develop geometrically correct human models (realistic geometry model). The finite element method is mostly used to solve the governing equations and get numerical solutions. The realistic geometry models provide a high degree of anatomical realism and predict whole-body thermoregulatory responses at high resolution and at organ and tissue levels. Thus, 3D models extend to a wide range of applications where temperature distribution is critical, such as hypothermia/hyperthermia therapy and physiology research. The development of thermoregulatory models will continue with the growth in computational power, advancement in numerical methods and simulation software, advances in modern imaging techniques, and progress in the basic science of thermal physiology.
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Affiliation(s)
- Xiaojiang Xu
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, USA.
| | - Timothy P Rioux
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, USA
| | - Michael P Castellani
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, USA; Oak Ridge Institute for Science and Education (ORISE), USA
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Masè M, Werner A, Putzer G, Avancini G, Falla M, Brugger H, Micarelli A, Strapazzon G. Low Ambient Temperature Exposition Impairs the Accuracy of a Non-invasive Heat-Flux Thermometer. Front Physiol 2022; 13:830059. [PMID: 35309078 PMCID: PMC8931521 DOI: 10.3389/fphys.2022.830059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Indirect core body temperature (CBT) monitoring from skin sensors is gaining attention for in-field applications thanks to non-invasivity, portability, and easy probe positioning. Among skin sensors, heat-flux devices, such as the so-called Double Sensor (DS), have demonstrated reliability under various experimental and clinical conditions. Still, their accuracy at low ambient temperatures is unknown. In this randomized cross-over trial, we tested the effects of cold temperature exposition on DS performance in tracking CBT. Methods Twenty-one participants were exposed to a warm (23.2 ± 0.4°C) and cold (−18.7 ± 1.0°C) room condition for 10 min, following a randomized cross-over design. The accuracy of the DS to estimate CBT in both settings was assessed by quantitative comparison with esophageal (reference) and tympanic (comparator) thermometers, using Bland–Altman and correlation analyses (Pearson’s correlation coefficient, r, and Lin’s concordance correlation coefficient, CCC). Results In the warm room setting, the DS showed a moderate agreement with the esophageal sensor [bias = 0.09 (−1.51; 1.69) °C, r = 0.40 (p = 0.069), CCC = 0.22 (−0.006; 0.43)] and tympanic sensor [bias = 2.74 (1.13; 4.35) °C, r = 0.54 (p < 0.05), CCC = 0.09 (0.008; 0.16)]. DS accuracy significantly deteriorated in the cold room setting, where DS temperature overestimated esophageal temperature [bias = 2.16 (−0.89; 5.22) °C, r = 0.02 (0.94), CCC = 0.002 (−0.05; 0.06)]. Previous exposition to the cold influenced temperature values measured by the DS in the warm room setting, where significant differences (p < 0.00001) in DS temperature were observed between randomization groups. Conclusion DS accuracy is influenced by environmental conditions and previous exposure to cold settings. These results suggest the present inadequacy of the DS device for in-field applications in low-temperature environments and advocate further technological advancements and proper sensor insulation to improve performance in these conditions.
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Affiliation(s)
- Michela Masè
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Andreas Werner
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- German Air Force – Centre of Aerospace Medicine, Aviation Physiology Training Centre, Aviation Physiology Diagnostic and Research, Königsbrück, Germany
| | - Gabriel Putzer
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Giovanni Avancini
- Department of Anaesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Centre for Mind/Brain Sciences, CIMeC, University of Trento, Rovereto, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- *Correspondence: Giacomo Strapazzon,
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Paal P, Pasquier M, Darocha T, Lechner R, Kosinski S, Wallner B, Zafren K, Brugger H. Accidental Hypothermia: 2021 Update. Int J Environ Res Public Health 2022; 19:501. [PMID: 35010760 PMCID: PMC8744717 DOI: 10.3390/ijerph19010501] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022]
Abstract
Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.
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Affiliation(s)
- Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, 5020 Salzburg, Austria
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
| | - Mathieu Pasquier
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Department of Emergency Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, 40-001 Katowice, Poland;
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Military Hospital, 89081 Ulm, Germany;
| | - Sylweriusz Kosinski
- Faculty of Health Sciences, Jagiellonian University Medical College, 34-500 Krakow, Poland;
| | - Bernd Wallner
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK 99508, USA
- Department of Emergency Medicine, Stanford University Medical Center, Stanford University, Palo Alto, CA 94304, USA
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Barteit S, Boudo V, Ouedraogo A, Zabré P, Ouremi L, Sié A, Munga S, Obor D, Kwaro D, Huhn S, Bunker A, Sauerborn R, Gunga HC, Maggioni MA, Bärnighausen T. Feasibility, acceptability and validation of wearable devices for climate change and health research in the low-resource contexts of Burkina Faso and Kenya: Study protocol. PLoS One 2021; 16:e0257170. [PMID: 34591893 PMCID: PMC8483291 DOI: 10.1371/journal.pone.0257170] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022] Open
Abstract
As the epidemiological transition progresses throughout sub-Saharan Africa, life lived with diseases is an increasingly important part of a population's burden of disease. The burden of disease of climate-sensitive health outcomes is projected to increase considerably within the next decades. Objectively measured, reliable population health data is still limited and is primarily based on perceived illness from recall. Technological advances like non-invasive, consumer-grade wearable devices may play a vital role in alleviating this data gap and in obtaining insights on the disease burden in vulnerable populations, such as heat stress on human cardiovascular response. The overall goal of this study is to investigate whether consumer-grade wearable devices are an acceptable, feasible and valid means to generate data on the individual level in low-resource contexts. Three hundred individuals are recruited from the two study locations in the Nouna health and demographic surveillance system (HDSS), Burkina Faso, and the Siaya HDSS, Kenya. Participants complete a structured questionnaire that comprises question items on acceptability and feasibility under the supervision of trained data collectors. Validity will be evaluated by comparing consumer-grade wearable devices to research-grade devices. Furthermore, we will collect demographic data as well as the data generated by wearable devices. This study will provide insights into the usage of consumer-grade wearable devices to measure individual vital signs in low-resource contexts, such as Burkina Faso and Kenya. Vital signs comprising activity (steps), sleep (duration, quality) and heart rate (hr) are important measures to gain insights on individual behavior and activity patterns in low-resource contexts. These vital signs may be associated with weather variables-as we gather them from weather stations that we have setup as part of this study to cover the whole Nouna and Siaya HDSSs-in order to explore changes in behavior and other variables, such as activity, sleep, hr, during extreme weather events like heat stress exposure. Furthermore, wearable data could be linked to health outcomes and weather events. As a result, consumer-grade wearables may serve as a supporting technology for generating reliable measurements in low-resource contexts and investigating key links between weather occurrences and health outcomes. Thus, wearable devices may provide insights to better inform mitigation and adaptation interventions in these low-resource settings that are direly faced by climate change-induced changes, such as extreme weather events.
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Affiliation(s)
- Sandra Barteit
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | | | | | - Pascal Zabré
- Centre de Recherche en Santé, Nouna, Burkina Faso
| | | | - Ali Sié
- Centre de Recherche en Santé, Nouna, Burkina Faso
| | | | - David Obor
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sophie Huhn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Aditi Bunker
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hanns-Christian Gunga
- Institute of Physiology, Center for Space Medicine and extreme Environment Berlin, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martina A. Maggioni
- Institute of Physiology, Center for Space Medicine and extreme Environment Berlin, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Biomedical Sciences for health, Università degli Studi di Milano, Milan, Italy
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.MLP. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
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Cerri M, Hitrec T, Luppi M, Amici R. Be cool to be far: Exploiting hibernation for space exploration. Neurosci Biobehav Rev 2021; 128:218-232. [PMID: 34144115 DOI: 10.1016/j.neubiorev.2021.03.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 01/08/2023]
Abstract
In mammals, torpor/hibernation is a state that is characterized by an active reduction in metabolic rate followed by a progressive decrease in body temperature. Torpor was successfully mimicked in non-hibernators by inhibiting the activity of neurons within the brainstem region of the Raphe Pallidus, or by activating the adenosine A1 receptors in the brain. This state, called synthetic torpor, may be exploited for many medical applications, and for space exploration, providing many benefits for biological adaptation to the space environment, among which an enhanced protection from cosmic rays. As regards the use of synthetic torpor in space, to fully evaluate the degree of physiological advantage provided by this state, it is strongly advisable to move from Earth-based experiments to 'in the field' tests, possibly on board the International Space Station.
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Affiliation(s)
- Matteo Cerri
- Department of Biomedical and NeuroMotor Sciences, Alma Mater Studiorum -University of Bologna, Piazza di Porta S.Donato, 2 40126, Bologna, Italy.
| | - Timna Hitrec
- Department of Biomedical and NeuroMotor Sciences, Alma Mater Studiorum -University of Bologna, Piazza di Porta S.Donato, 2 40126, Bologna, Italy.
| | - Marco Luppi
- Department of Biomedical and NeuroMotor Sciences, Alma Mater Studiorum -University of Bologna, Piazza di Porta S.Donato, 2 40126, Bologna, Italy.
| | - Roberto Amici
- Department of Biomedical and NeuroMotor Sciences, Alma Mater Studiorum -University of Bologna, Piazza di Porta S.Donato, 2 40126, Bologna, Italy.
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Janke D, Kagelmann N, Storm C, Maggioni MA, Kienast C, Gunga HC, Opatz O. Measuring Core Body Temperature Using a Non-invasive, Disposable Double-Sensor During Targeted Temperature Management in Post-cardiac Arrest Patients. Front Med (Lausanne) 2021; 8:666908. [PMID: 34026794 PMCID: PMC8132874 DOI: 10.3389/fmed.2021.666908] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/22/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Precisely measuring the core body temperature during targeted temperature management after return of spontaneous circulation is mandatory, as deviations from the recommended temperature might result in side effects such as electrolyte imbalances or infections. However, previous methods are invasive and lack easy handling. A disposable, non-invasive temperature sensor using the heat flux approach (Double Sensor), was tested against the standard method: an esophagus thermometer. Methods: The sensor was placed on the forehead of adult patients (n = 25, M/F, median age 61 years) with return of spontaneous circulation after cardiac arrest undergoing targeted temperature management. The recorded temperatures were compared to the established measurement method of an esophageal thermometer. A paired t-test was performed to examine differences between methods. A Bland-Altman-Plot and the intraclass correlation coefficient were used to assess agreement and reliability. To rule out possible influence on measurements, the patients' medication was recorded as well. Results: Over the span of 1 year and 3 months, data from 25 patients were recorded. The t-test showed no significant difference between the two measuring methods (t = 1.47, p = 0.14, n = 1,319). Bland-Altman results showed a mean bias of 0.02°C (95% confidence interval 0.00–0.04) and 95% limits of agreement of −1.023°C and 1.066°C. The intraclass correlation coefficient was 0.94. No skin irritation or allergic reaction was observed where the sensor was placed. In six patients the bias differed noticeably from the rest of the participants, but no sex-based or ethnicity-based differences could be identified. Influences on the measurements of the Double Sensor by drugs administered could also be ruled out. Conclusions: This study could demonstrate that measuring the core body temperature with the non-invasive, disposable sensor shows excellent reliability during targeted temperature management after survived cardiac arrest. Nonetheless, clinical research concerning the implementation of the sensor in other fields of application should be supported, as well as verifying our results by a larger patient cohort to possibly improve the limits of agreement.
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Affiliation(s)
- David Janke
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Niklas Kagelmann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Christian Storm
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Internal Medicine, Nephrology and Intensive Care, Berlin, Germany
| | - Martina A Maggioni
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Camilla Kienast
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Hanns-Christian Gunga
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Oliver Opatz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
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Zafren K, Paal P, Brugger H, Lechner R. Induced Hypothermia to 4.2°C with Neurologically Intact Survival: A Forgotten Case Series. Wilderness Environ Med 2020; 31:367-370. [PMID: 32482520 DOI: 10.1016/j.wem.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/22/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
The lowest recorded core temperature from which a person with accidental hypothermia has survived neurologically intact is 11.8°C in a 2-y-old boy. The lowest recorded temperature from which an adult has been resuscitated neurologically intact is 13.7°C in a 29-y-old woman. The lowest core temperature with survival from induced hypothermia has been quoted as 9°C. We discovered a case series (n=50) from 1961 in which 5 patients with core temperatures below 11.8°C survived neurologically intact. The lowest core temperature in this group was 4.2°C. The authors also presented cardiovascular and other physiologic data at various core temperatures. The patients in the case series showed a wide variation in individual physiological responses to hypothermia. It is not known whether survival from accidental hypothermia is possible with a core temperature below 11.8°C, but this case series suggests that the lower limit for successful resuscitation may be far lower. We advise against using core temperature alone to decide whether a hypothermic patient in cardiac arrest has a chance of survival.
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Affiliation(s)
- Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA; International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Zürich, Switzerland
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Zürich, Switzerland; Institute of Mountain Emergency Medicine, EURAC Research, Via Ipazia 2, Bolzano, Italy; Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Armed Forces Hospital Ulm, Ulm, Germany.
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Abstract
Cardiac arrest with a degree of concurrent hypothermia is not a rare presentation. This presentation, often in remote areas, poses a challenge for the prehospital physician because the cause of the arrest will significantly alter decision making and prognostication. Survival from cardiac arrest secondary to accidental hypothermia is significantly greater than that of normothermic arrests when appropriate triage and management decisions are made. The complexity of this decision benefits from a specific algorithm to follow in the event of such a casualty presenting. This article systematically reviews the literature on cardiac arrest secondary to accidental hypothermia and provides recommendations in addition to a novel algorithm to aid the responding prehospital clinician in deciding if a hypothermic resuscitation standard operating procedure should be implemented.
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Affiliation(s)
- Robert Willmore
- Institute of Pre-Hospital Care at London's Air Ambulance, The Royal London Hospital, London, UK.
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Stahn AC, Werner A, Opatz O, Maggioni MA, Steinach M, von Ahlefeld VW, Moore A, Crucian BE, Smith SM, Zwart SR, Schlabs T, Mendt S, Trippel T, Koralewski E, Koch J, Choukèr A, Reitz G, Shang P, Röcker L, Kirsch KA, Gunga HC. Increased core body temperature in astronauts during long-duration space missions. Sci Rep 2017; 7:16180. [PMID: 29170507 PMCID: PMC5701078 DOI: 10.1038/s41598-017-15560-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/27/2017] [Indexed: 12/12/2022] Open
Abstract
Humans’ core body temperature (CBT) is strictly controlled within a narrow range. Various studies dealt with the impact of physical activity, clothing, and environmental factors on CBT regulation under terrestrial conditions. However, the effects of weightlessness on human thermoregulation are not well understood. Specifically, studies, investigating the effects of long-duration spaceflight on CBT at rest and during exercise are clearly lacking. We here show that during exercise CBT rises higher and faster in space than on Earth. Moreover, we observed for the first time a sustained increased astronauts’ CBT also under resting conditions. This increase of about 1 °C developed gradually over 2.5 months and was associated with augmented concentrations of interleukin-1 receptor antagonist, a key anti-inflammatory protein. Since even minor increases in CBT can impair physical and cognitive performance, both findings have a considerable impact on astronauts’ health and well-being during future long-term spaceflights. Moreover, our findings also pinpoint crucial physiological challenges for spacefaring civilizations, and raise questions about the assumption of a thermoregulatory set point in humans, and our evolutionary ability to adapt to climate changes on Earth.
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Affiliation(s)
- Alexander C Stahn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany.,Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 1019 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Andreas Werner
- German Air Force, Centre of Aerospace Medicine, Aviation Physiology Training Centre, Aviation Physiology Diagnostics and Science, Steinborner Str. 43, 01936, Königsbrück, Germany
| | - Oliver Opatz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany
| | - Martina A Maggioni
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Luigi Mangiagalli 31, 20133, Milan, Italy
| | - Mathias Steinach
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany
| | - Victoria Weller von Ahlefeld
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany
| | - Alan Moore
- Department of Health and Kinesiology, Lamar University, Beaumont, TX, 77710, USA
| | - Brian E Crucian
- Biomedical Research and Environmental Sciences Division, NASA Johnson Space Center, Houston, TX, 77058, USA
| | - Scott M Smith
- Biomedical Research and Environmental Sciences Division, NASA Johnson Space Center, Houston, TX, 77058, USA
| | - Sara R Zwart
- Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA
| | - Thomas Schlabs
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany
| | - Stefan Mendt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany
| | - Tobias Trippel
- Charité Medizinische Klinik, Charité Universitätsmedizin Berlin, Kardiologie, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Eberhard Koralewski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany
| | - Jochim Koch
- Drägerwerk AG & Co. KGaA, Moislinger Allee 53-55, Lubeck, 23558, Germany
| | - Alexander Choukèr
- Department of Anaesthesiology, Hospital of the University of Munich, Marchioninistrasse 15, München, 81377, Germany
| | - Günther Reitz
- DLR, Institut für Luft- und Raumfahrtmedizin, Abteilung Strahlenbiologie, Linder Höhe, Köln, 51147, Germany.,Nuclear Physics Institute of the Czech Academy of Sciences, Department of Radiation Dosimetry, Na Truhlářce 39/64, Praha 8, 180 00, Czech Republic
| | - Peng Shang
- Key Laboratory for Space Bioscience & Biotechnology, Institute of Special Environnments Biophysics, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072, China
| | - Lothar Röcker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany
| | - Karl A Kirsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany
| | - Hanns-Christian Gunga
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, CharitéCrossOver (CCO), Charitéplatz 1, Berlin, 10117, Germany.
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Drescher U, Koschate J, Hoffmann U, Schneider S, Werner A. Effect of acute ambient temperature exposure on cardio-pulmonary and respiratory kinetics in men. Int J Hyperthermia 2017; 34:442-454. [DOI: 10.1080/02656736.2017.1354402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Uwe Drescher
- Institute of Physiology and Anatomy, German Sport University Cologne, Cologne, Germany
| | - Jessica Koschate
- Institute of Physiology and Anatomy, German Sport University Cologne, Cologne, Germany
| | - Uwe Hoffmann
- Institute of Physiology and Anatomy, German Sport University Cologne, Cologne, Germany
| | - Stefan Schneider
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Australia
| | - Andreas Werner
- Center for Space Medicine and Extreme Environments, Institute for Physiology, Charité University Medicine, Berlin, Germany
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13
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Altrichter S, Salow J, Ardelean E, Church MK, Werner A, Maurer M. Development of a standardized pulse-controlled ergometry test for diagnosing and investigating cholinergic urticaria. J Dermatol Sci 2014; 75:88-93. [DOI: 10.1016/j.jdermsci.2014.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/06/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
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14
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Strapazzon G, Procter E, Paal P, Brugger H. Pre-Hospital Core Temperature Measurement in Accidental and Therapeutic Hypothermia. High Alt Med Biol 2014; 15:104-11. [DOI: 10.1089/ham.2014.1008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | - Emily Procter
- EURAC Institute of Mountain Emergency Medicine, Bozen/Bolzano, Italy
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen/Bolzano, Italy
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