歲月麻醉: 急救加護年會-sepsis, hypothermia

（上圖是Molecular signature of sepsis）

今年有兩個外賓講題：

1.Sepsis - Time to rethinking. Dr. Benjamin Man Piu Tang

2. Clinical application of Induced therapeutic hypothermia in critical care. Dr. Kees Hugo Polderman

第一位是年輕的澳洲華裔田醫師，專精於分子細胞學，遺傳學領域來解析Sepsis的治療，由於題材新穎，也尚未導入臨床實用階段，所以這位田醫師講得又慢又簡要，有點收穫！但 ........ ....................又不知道收穫在哪裡！？ XD, 在胡說些啥跟啥啊！來看看他的大作！真的是有點份量，不是Top Journal 還不發表呢？

Gene-expression profiling of peripheral blood mononuclear cells in sepsis.

Tang BM, McLean AS, Dawes IW, Huang SJ, Lin RC.

Crit Care Med. 2009 Mar;37(3):882-8.

PMID: 19237892 [PubMed - indexed for MEDLINE]

Gene-expression profiling of gram-positive and gram-negative sepsis in critically ill patients.

Tang BM, McLean AS, Dawes IW, Huang SJ, Cowley MJ, Lin RC.

Crit Care Med. 2008 Apr;36(4):1125-8.

PMID: 18379237 [PubMed - indexed for MEDLINE]

Predictive value of N-terminal pro-brain natriuretic peptide in sepsis.

Tang BM, Huang SJ, Seppelt I, McLean AS.

Crit Care Med. 2007 Oct;35(10):2464. No abstract available.

PMID: 17885399 [PubMed - indexed for MEDLINE]

The use of gene-expression profiling to identify candidate genes in human sepsis.

Tang BM, McLean AS, Dawes IW, Huang SJ, Lin RC.

Am J Respir Crit Care Med. 2007 Oct 1;176(7):676-84. Epub 2007 Jun 15.

PMID: 17575094 [PubMed - indexed for MEDLINE]

Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis.

Tang BM, Eslick GD, Craig JC, McLean AS.

Lancet Infect Dis. 2007 Mar;7(3):210-7. Review.

PMID: 17317602 [PubMed - indexed for MEDLINE]

Procalcitonin for sepsis: methodological issues in meta-analysis lead to further uncertainty.

Tang BM, Eslick GD.

Crit Care Med. 2007 Feb;35(2):679; author reply 679-80. No abstract available.

第二位是老外，好像是荷蘭人，目前在Pisssburgh，跟隨某位低溫療法的大師。發表過hypothermia 的review paper, 講得內容又多又雜，跟前一位講者剛好是一個對比。他很客氣也很好意提供e-mail歡迎去函索取發表過得論文或者討論問題。 PoldermanKH@upmc.edu

Mechanisms of action, physiological effects, and complications of hypothermia.

Polderman KH.

Crit Care Med. 2009 Jul;37(7 Suppl):S186-202. Review.

PMID: 19535947 [PubMed - indexed for MEDLINE]

Blowing hot and cold? Skin counter warming to prevent shivering during therapeutic cooling.

van Zanten AR, Polderman KH.

Crit Care Med. 2009 Jun;37(6):2106-8. No abstract available.

PMID: 19448457 [PubMed - indexed for MEDLINE]

Therapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects, and cooling methods.

Polderman KH, Herold I.

Crit Care Med. 2009 Mar;37(3):1101-20. Review.

PMID: 19237924 [PubMed - indexed for MEDLINE]

Hypothermia therapy after traumatic brain injury in children.

Polderman KH, Mayer SA, Menon D.

N Engl J Med. 2008 Sep 11;359(11):1178; author reply 1180. No abstract available.

PMID: 18784111 [PubMed - indexed for MEDLINE]

Induced hypothermia and fever control for prevention and treatment of neurological injuries.

Polderman KH.

Lancet. 2008 Jun 7;371(9628):1955-69. Review.

PMID: 18539227 [PubMed - indexed for MEDLINE]

Treating intracranial hypertension in traumatic brain injury: keep it cool!

Polderman KH, Menon DK, Girbes AR.

Intensive Care Med. 2008 Sep;34(9):1738-9; author reply 1737. Epub 2008 May 8. No abstract available.

PMID: 18463847 [PubMed - indexed for MEDLINE]

Hypothermia and neurological outcome after cardiac arrest: state of the art.

Polderman KH.

Eur J Anaesthesiol Suppl. 2008;42:23-30. Review.

PMID: 18289413 [PubMed - indexed for MEDLINE]

Equipment review: cooling catheters to induce therapeutic hypothermia?

Polderman KH, Callaghan J.

Crit Care. 2006;10(6):234. Review.

PMID: 17096865 [PubMed - indexed for MEDLINE]

Hypothermia for neonates with hypoxic-ischemic encephalopathy.

Polderman KH, Girbes AR.

N Engl J Med. 2006 Apr 13;354(15):1643-5; author reply 1643-5. No abstract available.

PMID: 16611960 [PubMed - indexed for MEDLINE]

10:

Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid.

Polderman KH, Rijnsburger ER, Peerdeman SM, Girbes AR.

Crit Care Med. 2005 Dec;33(12):2744-51.

PMID: 16352954 [PubMed - indexed for MEDLINE]

11:

Early induction of hypothermia: will sooner be better?

van Zanten AR, Polderman KH.

Crit Care Med. 2005 Jun;33(6):1449-52. No abstract available.

PMID: 15942385 [PubMed - indexed for MEDLINE]

12:

[Controlled mild-to-moderate hypothermia in the intensive care unit]

Brüx A, Girbes AR, Polderman KH.

Anaesthesist. 2005 Mar;54(3):225-44. Review. German.

PMID: 15742173 [PubMed - indexed for MEDLINE]

13:

Keeping a cool head: How to induce and maintain hypothermia.

Polderman KH.

Crit Care Med. 2004 Dec;32(12):2558-60. No abstract available.

PMID: 15599175 [PubMed - indexed for MEDLINE]

14:

Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study.

Polderman KH, Girbes AR.

Crit Care. 2004 Dec;8(6):R459-66. Epub 2004 Oct 22.

PMID: 15566592 [PubMed - indexed for MEDLINE]

15:

Novel applications of therapeutic hypothermia: report of three cases.

Hartemink KJ, Wisselink W, Rauwerda JA, Girbes AR, Polderman KH.

Crit Care. 2004 Oct;8(5):R343-6. Epub 2004 Aug 18.

PMID: 15469578 [PubMed - indexed for MEDLINE]

16:

Induced hypothermia in traumatic brain injury: considering the conflicting results of meta-analyses and moving forward.

Polderman KH, Ely EW, Badr AE, Girbes AR.

Intensive Care Med. 2004 Oct;30(10):1860-4. Epub 2004 Jul 13. No abstract available.

PMID: 15249994 [PubMed - indexed for MEDLINE]

17:

[Moderate hypothermia in traumatic brain injury: results of clinical trials]

Citerio G, Cormio M, Polderman KH.

Minerva Anestesiol. 2004 Apr;70(4):213-8. Review. Italian.

PMID: 15173698 [PubMed - indexed for MEDLINE]

18:

Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence.

Polderman KH.

Intensive Care Med. 2004 Apr;30(4):556-75. Epub 2004 Feb 6. Review.

PMID: 14767591 [PubMed - indexed for MEDLINE]

19:

Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality--Part 2: Practical aspects and side effects.

Polderman KH.

Intensive Care Med. 2004 May;30(5):757-69. Epub 2004 Feb 6. Review.

PMID: 14767590 [PubMed - indexed for MEDLINE]

20:

Induced hypothermia in traumatic brain injury: effective if properly employed.

Polderman KH, van Zanten AR, Nipshagen MD, Girbes AR.

Crit Care Med. 2004 Jan;32(1):313-4. No abstract available.

PMID: 14707614 [PubMed - indexed for MEDLINE]

Effects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury.

Polderman KH, Tjong Tjin Joe R, Peerdeman SM, Vandertop WP, Girbes AR.

Intensive Care Med. 2002 Nov;28(11):1563-73. Epub 2002 Oct 4.

PMID: 12415442 [PubMed - indexed for MEDLINE]

22:

Potential mechanisms of hypothermia-induced electrolyte depletion.

Polderman KH, Girbes AR.

Crit Care Med. 2002 Aug;30(8):1932; author reply 1932-3. No abstract available.

PMID: 12163833 [PubMed - indexed for MEDLINE]

23:

Therapeutic hypothermia after cardiac arrest.

Polderman KH, Girbes AR.

N Engl J Med. 2002 Jul 4;347(1):63-5; author reply 63-5. No abstract available.

PMID: 12102061 [PubMed - indexed for MEDLINE]

24:

Hypothermia.

Polderman KH, Girbes AR, Peerdeman SM, Vandertop WP.

J Neurosurg. 2001 May;94(5):853-8. Review. No abstract available.

PMID: 11354424 [PubMed - indexed for MEDLINE]

25:

Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury.

Polderman KH, Peerdeman SM, Girbes AR.

J Neurosurg. 2001 May;94(5):697-705.

PMID: 11354399 [PubMed - indexed for MEDLINE]

26:

Agenesis of the corpus callosum associated with paroxysmal hypothermia: Shapiro's syndrome.

Segeren CM, Polderman KH, Lips P.

Neth J Med. 1997 Jan;50(1):29-35.

PMID: 9038041 [PubMed - indexed for MEDLINE]

順便在這裡安插上週NEJM發表於Neonal ischemic hypoxic encephalopathy 使用 hypothermia的RCT結果。

Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy NEJM Volume 361:1349-1358 October 1, 2009

此研究顯示，低溫療法對嚴重患者（首要指標-死亡，腦損傷）無助益，但對次要指標，存活者的腦神經功能是有好處的。這也合乎一般腦細胞損傷的印象，亦即primary insult即決定腦細胞損傷的程度，就好像你無法對已經壞死（necrosis）的心臟組織有何reperfusion的幫助一樣！

重點，33.5 °C for 72 hrs, follow-up 18 months.

歲月麻醉

急救加護年會-sepsis, hypothermia

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急救加護年會-sepsis, hypothermia

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