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Fisiopatologa y Atencin a
Pacientes
1308-05G
Hipotermia Teraputica
Indicaciones de uso:
El propsito de ARCTIC SUN Sistema de control de la temperatura
es monitorizar y controlar la temperatura del paciente. .
Contraindicaciones:
No se conocen contraindicaciones para el uso del sistema
termorregulador. No aplique los parches ARCTICGEL sobre la piel
con indicios de ulceraciones, quemaduras, urticaria o erupcin.
Tampoco deben colocarse sobre piel inmadura (no queratinizada)
o de bebs prematuros. No se conocen alergias a los
componentes del Hidrogel, pero debern extremarse las
precauciones ante cualquier paciente cuyo historial incluya
sensibilidad o alergia cutnea.
Fisiopatologa
Isquemia global
En la isquemia global, hay una completa o casi
completa falta de riego sanguneo.1,2
La interrupcin del flujo sanguneo produce
isquemia.1,2
Si el flujo sanguneo hacia el cerebro no se reanuda en 30
minutos, se produce necrosis generalizada y muerte
neuronal selectiva.2
1 Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009;37(suppl 7):S186S202.
2 Polderman, KH. Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1:
Indications and evidence. Int Care Med 2004;30:556-575
Isquemia focal
Oclusin u obstruccin de un nico vaso
sanguneo cerebral.1
La necrosis se producir en la zona cercana al vaso
ocluido u obstruido si no se reperfunde antes de
60 minutos.1
La zona circundante (penumbra) es recuperable si
se produce reperfusin y/o si se usan otras
intervenciones.1
1 Polderman, KH. Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and
evidence. Int Care Med 2004;30:556-575
Isquemia
... evitar el dao isqumico es crucial
para todos los mecanismos de
neuroproteccin.1
1 Polderman K. Induced hypothermia and fever control for prevention and treatment of neurologic injuries. Lancet 2008;371:p. 1956.
1 Polderman K. Induced hypothermia and fever control for prevention and treatment of neurologic injuries. Lancet 2008;371:p. 1956.
Cascada isqumica
Disfuncin mitocondrial1,3
Liberacin del neurotransmisor excitatorio
glutamato1,3
Liberacin en exceso de calcio1,3
Alteracin en las membranas celulares1,3
Produccin de radicales libres1,3
Disfuncin de la barrera hemato-enceflica1,2,3
1 Polderman K. Induced hypothermia and fever control for prevention and treatment of neurologic injuries. Lancet 2008;
371:p. 1955-1269
2 Lee, K (2012). The NeuroICU Book. New York: McGraw Hill Companies, Inc. p. 192
3 Malhotra, R. (2012). Cardiac arrest and anoxic brain injury. In N. Badjatia The Neuro ICU book (pp. 188-201).
New York, NY: McGraw Hill.
Hipotermia
Leve: 32-34C 3
Potenciales efectos secundarios conocidos manejables; rango
trmico ms utilizado en el campo de la hipotermia teraputica. 3
Moderada: 28-32C 1
Mayor riesgo de efectos secundarios, como arritmias leves,
taquicardias y fibrilacin auricular. 4
Severa:
<28C aumenta el riesgo de efectos secundarios tales como
prdida del conocimiento y coma; no es clnica. 4
1 Polderman K. Induced hypothermia and fever control for prevention and treatment of neurologic injuries. Lancet 2008; 371: p. 1955-1269
2 Patel, NC, Nanda, S., Unger, BT, & Mooney, M. (2010). Therapeutic hypothermia in cardiac arrest. In S. Mehta Textbook of STEMI
interventions (pp. 603-612). Malvern, PA: HMP Communications.
3 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006;
p.237-246.
4 Polderman, KH. Application of therapeutic hypothermia in the ICU: Opportunities and pitfalls of a promising treatment modality. Part 2:
Practicle aspects and side effects. Int Care Med 2004;30:757-769
Intervalo PR prolongado1,2
Ampliacin del complejo
QRS1,2
Incremento del intervalo
QR1,2
Onda J o de Osborn1
Hematolgicos:
Alteraciones en la cascada
de coagulacin1
Alteracin en la funcin
plaquetaria
( riesgo de sangrado)1
Descenso en el recuento
de glbulos blancos1
1 Mehta. S (2010). Textbook of STEMI Interventions. PA: HMP Communications. Chapter 29;p.603-612
2 Nunnally, ME (2010). Therapeutic Hypothermia in the ICU. Mount Prospect: SCCM. p.21-27
3 Tisherman, SA & Stertz, F (2010). Therapeutic Hypothermia. New York: Springer Science. p.235-246
Disminucin de la motilidad1
Hepato-pancreticos:
1 Mehta. S (2010). Textbook of STEMI Interventions. PA: HMP Communications. Chapter 29; p.603-612.
SaO2
% de saturacin de oxgeno
100
75
Normal
Inclinacin hacia la
derecha
40
80
50
25
20
60
PaO2
100
120
1 Mehta. S (2010). Textbook of STEMI Interventions. PA: HMP Communications. Chapter 29;603-612.
2 Bader, MK & Littlejohns, LR Eds. (2010). AANN Core Curriculum for Neuroscience Nursing, 5th Edition. Glenview: American Association of Neuroscience
Nurses, p. 534-549
3 Nunnally, ME (2010). Therapeutic Hypothermia in the ICU. Mount Prospect: SCCM. p21-27.
4 Tisherman, SA & Stertz, F (2010). Therapeutic Hypothermia. New York: Springer Science. P.235-246.
5 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006; p. 237-246
Sudoraci
n
Vasodilatacin
activa
Vasoconstriccin
36oC
1 Mayer SA & Sessler DI Eds. (2005). Therapeutic Hypothermia. Boca Raton: Taylor & Francis Group, p. 5
2 Sessler, D. I., & Mayer, S. A. (2005). Therapeutic hypothermia. Monticello, N.Y.: Marcel Dekker
Temblor
Temblor
Respuesta simptica involuntaria4
Vasoconstriccin4
Ereccin del vello de los brazos4
Temblor para producir calor1,4
1 Bader, MK & Littlejohns, LR Eds. (2010). AANN Core Curriculum for Neuroscience Nursing, 5th Edition. Glenview: American Association of Neuroscience
Nurses, p. 534-549
2 Lee, K (2012). The NeuroICU Book. New York: McGraw Hill Companies, Inc. p. 192
3 Nunnally, ME (2010). Therapeutic Hypothermia in the ICU. Mount Prospect: SCCM. p21-27.
4 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006; p. 237-246
Temblor (cont.)
Aumento de demanda metablica3
Posible duplicacin o triplicacin del consumo
de oxgeno y la produccin de dixido de
carbono (CO)1,4
1 Bader, MK & Littlejohns, LR Eds. (2010). AANN Core Curriculum for Neuroscience Nursing, 5th Edition. Glenview: American Association of Neuroscience
Nurses, p. 534-549
2 Lee, K (2012). The NeuroICU Book. New York: McGraw Hill Companies, Inc. p. 192
3 Nunnally, ME (2010). Therapeutic Hypothermia in the ICU. Mount Prospect: SCCM. p21-27.
4 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006; p. 237-246
1 Mehta. S (2010). Textbook of STEMI Interventions. PA: HMP Communications. Chapter 29;603-612.
2 Nunnally, ME (2010). Therapeutic Hypothermia in the ICU. Mount Prospect: SCCM. p21-27
3 Lee, K (2012). The NeuroICU Book. New York: McGraw Hill Companies, Inc. p. 343
1 Bader, MK & Littlejohns, LR Eds. (2010). AANN Core Curriculum for Neuroscience Nursing, 5th Edition. Glenview: American Association of
Neuroscience Nurses, p. 534-549.
2 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006; p. 237-246
1 Bader, MK & Littlejohns, LR Eds. (2010). AANN Core Curriculum for Neuroscience Nursing, 5th Edition. Glenview: American Association of
Neuroscience Nurses, p. 534-549.
2 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006; p. 237-246
1 Bader, MK & Littlejohns, LR Eds. (2010). AANN Core Curriculum for Neuroscience Nursing, 5th Edition. Glenview: American Association of
Neuroscience Nurses, p. 534-549.
2 Nunnally, ME (2010). Therapeutic Hypothermia in the ICU. Mount Prospect: SCCM. p21-27.
3 Mehta. S (2010). Textbook of STEMI Interventions. PA: HMP Communications. Chapter 29;603-612
4 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006; p. 237-246
Mantenimiento
Revisin de la piel
Examine con frecuencia la piel del paciente situada
bajo los parches ARCTICGEL, en particular si existe un
riesgo elevado de lesin cutnea. Puede presentarse
en pacientes con:
1 Bader, MK & Littlejohns, LR Eds. (2010). AANN Core Curriculum for Neuroscience Nursing, 5th Edition. Glenview: American Association of
Neuroscience Nurses, p. 534-549.
2 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006; p. 237-246
Pronostico neurolgico
La hipotermia teraputica altera la capacidad para realizar un
examen neurolgico clnico.2
La depuracin de los frmacos disminuye, los sedantes pueden
estar presentes durante 48-72 horas, dependiendo del tipo de
frmaco.2,3
La decisin de suspender cualquier cuidado deber esperar hasta
que se pueda realizar un examen clnico adecuado.1,2,3
1 Bader, MK & Littlejohns, LR Eds. (2010). AANN Core Curriculum for Neuroscience Nursing, 5th Edition. Glenview: American Association of
Neuroscience Nurses, p. 534-549.
2 Guanci, M. M., & Mathiesen, C. Temperature management of the neuroscience patient. In Foundations of neuroscience nursing 2006;
p. 237-246
3 Blondin, NA., & Greer, DM. (2011). Neurologic prognosis in cardiac arrest patients treated with therapeutic hypothermia. The neurologist,
2011; 17(5), 241-248.
Para Ms Informacin
Para ms informacin, consulte las siguientes
referencias:
ARCTIC SUn 5000 Manual de uso
Instrucciones para el uso de los parches de
ARCTICGEL
Pantallas de ayuda de ARCTIC SUN 5000
O pngase en contacto con su representante local de
Bard.
1308-05G