The purpose of this integrated review of the literature was to determine the relationship between therapeutic hypothermia and cardiac arrhythmias. The reviewed literatures were English based articles from year 2003-2013. Relevant information from the American Heart Association and the International Liaison Committee on Resuscitation was used to further enhance research results. The results of this literature review showed hypothermia treatment propensity to prolong QT interval without precipitating life-threatening arrhythmias. Although arrhythmias can be potentially increased under induced hypothermia, it has been shown that treatment is easier while under hypothermic conditions. The reviewed research also shows that hypothermia treatment should be expanded to include more circumstance besides ventricular cardiac arrest. It was suggested that the reason for lack of use of hypothermia treatment under the suggested conditions was due to the restricted circumstances in which it is suggested to be used. Other recommendations include increased monitoring for cardiac rhythms during cardiac arrhythmias and protocols for arrhythmia treatment.

O presente estudo é resultado de uma pesquisa de revisão integrativa, cujo objetivo geral é sintetizar a contribuição de pesquisas nacionais e internacionais referentes à hipotermia não induzida em pacientes graves e as possíveis complicações desencadeadas no período pós-operatório. O material do estudo foi constituído de artigos publicados nos periódicos nacionais e internacionais, no período de 2001 a 2011 e indexados nas seguintes bases de dados: CINAHL, EMBASE, LILACS, PUBMED e SCIELO e por Teses catalogadas no sistema DEDALUS no mesmo período. Os artigos selecionados totalizam 17 Artigos e 02 Teses. Estes artigos e Teses foram catalogados e chamados de A e T respectivamente. Foram elaborados três formulários: o formulário A, composto pelos seguintes itens: identificação dos artigos, autores, título da pesquisa, fonte e origem, já o formulário B, contém itens que detalham os artigos encontrados, isto é, tipo de estudo, finalidades/objetivos, descrição do estudo, resultados obtidos e conclusões, e o formulário C, que contém a identificação das teses, autor, título da pesquisa, ano de publicação e local. Realizadas as análises, foram encontradas as seguintes complicações mais frequentes causadas pela hipotermia não induzida: cardiovascular (vasoconstrição periférica, isquemia miocárdica, hipertensão arterial, taquicardia e trombose venosa profunda); coagulopatia (diminuição da coagulação em 10% e ativação plaquetária); infecção da ferida operatória (diminuição da circulação sanguínea nos tecidos); imunológica (aumento da incidência de infecção no local cirúrgico); alterações hidroeletrolíticas (hipocalemia, hipomagnesemia e hipofosfatemia); alteração na eliminação dos medicamentos (diminuição da circulação sanguínea e dificuldade de eliminação dos fármacos); tremor; úlcera por pressão (diminuição da circulação sanguínea e diminuição da perfusão periférica); dificuldade respiratória; alterações endócrino-metabólicas (diminuição de corticoides e da insulina, aumento da resistência periférica a insulina e do hormônio tireotrófico, hiperglicemia e hipoglicemia); aumento do tempo de recuperação. Apesar do conhecimento teórico sobre a hipotermia e suas complicações, surge um questionamento: o que nos leva a subestimar a hipotermia não induzida? / The present study is the result of an integrative research review whose objective is to summarize the contributions of national and international research related to non-induced hypothermia in critically ill patients and the possible complications triggered in the postoperative period. The study material consists of articles published in national and international journals indexed in the following databases: CINAHL, EMBASE, LILACS, PUBMED and SCIELO in the period between 2001 and 2011 and of theses cataloged in the DEDALUS database in the same period. The selected material totaled 17 articles and 02 theses. They were cataloged and named A and T respectively. Three forms were created: A, B and C. Form A contains items which detail the identification of the article, its authors, title, source and origin; Form B details the study type, its purposes/objectives, description, results and conclusions; and Form C contains the identification of the thesis, its author, title, publication year and location. Having performed the analyzes, we found the following most frequent postoperative complications caused by non-induced hypothermia: cardiovascular problems (peripheral vasoconstriction, myocardial ischemia, hypertension, tachycardia and deep vein thrombosis); coagulopathy (10% decrease in coagulation and platelet activation); wound infections (decrease in blood flow to tissues); immunological complications (increase in incidence of surgical site infections); electrolyte changes (hypokalemia, hypomagnesaemia and hypophosphatemia); changes in the elimination of drugs (decrease in blood flow and difficulty of removing drugs); trembling; pressure ulcers (decrease in blood flow and decrease in peripheral perfusion); breathing difficulty; endocrine-metabolic changes (decrease of corticosteroids and of insulin, increase of peripheral resistance to insulin and thyroid stimulating hormone, hyperglycemia and hypoglycemia); and increase in recovery time. Despite the theoretical knowledge of hypothermia and its complications, a question arises: what makes us underestimate the non-induced hypothermia?

O presente estudo é resultado de uma pesquisa de revisão integrativa, cujo objetivo geral é sintetizar a contribuição de pesquisas nacionais e internacionais referentes à hipotermia não induzida em pacientes graves e as possíveis complicações desencadeadas no período pós-operatório. O material do estudo foi constituído de artigos publicados nos periódicos nacionais e internacionais, no período de 2001 a 2011 e indexados nas seguintes bases de dados: CINAHL, EMBASE, LILACS, PUBMED e SCIELO e por Teses catalogadas no sistema DEDALUS no mesmo período. Os artigos selecionados totalizam 17 Artigos e 02 Teses. Estes artigos e Teses foram catalogados e chamados de A e T respectivamente. Foram elaborados três formulários: o formulário A, composto pelos seguintes itens: identificação dos artigos, autores, título da pesquisa, fonte e origem, já o formulário B, contém itens que detalham os artigos encontrados, isto é, tipo de estudo, finalidades/objetivos, descrição do estudo, resultados obtidos e conclusões, e o formulário C, que contém a identificação das teses, autor, título da pesquisa, ano de publicação e local. Realizadas as análises, foram encontradas as seguintes complicações mais frequentes causadas pela hipotermia não induzida: cardiovascular (vasoconstrição periférica, isquemia miocárdica, hipertensão arterial, taquicardia e trombose venosa profunda); coagulopatia (diminuição da coagulação em 10% e ativação plaquetária); infecção da ferida operatória (diminuição da circulação sanguínea nos tecidos); imunológica (aumento da incidência de infecção no local cirúrgico); alterações hidroeletrolíticas (hipocalemia, hipomagnesemia e hipofosfatemia); alteração na eliminação dos medicamentos (diminuição da circulação sanguínea e dificuldade de eliminação dos fármacos); tremor; úlcera por pressão (diminuição da circulação sanguínea e diminuição da perfusão periférica); dificuldade respiratória; alterações endócrino-metabólicas (diminuição de corticoides e da insulina, aumento da resistência periférica a insulina e do hormônio tireotrófico, hiperglicemia e hipoglicemia); aumento do tempo de recuperação. Apesar do conhecimento teórico sobre a hipotermia e suas complicações, surge um questionamento: o que nos leva a subestimar a hipotermia não induzida? / The present study is the result of an integrative research review whose objective is to summarize the contributions of national and international research related to non-induced hypothermia in critically ill patients and the possible complications triggered in the postoperative period. The study material consists of articles published in national and international journals indexed in the following databases: CINAHL, EMBASE, LILACS, PUBMED and SCIELO in the period between 2001 and 2011 and of theses cataloged in the DEDALUS database in the same period. The selected material totaled 17 articles and 02 theses. They were cataloged and named A and T respectively. Three forms were created: A, B and C. Form A contains items which detail the identification of the article, its authors, title, source and origin; Form B details the study type, its purposes/objectives, description, results and conclusions; and Form C contains the identification of the thesis, its author, title, publication year and location. Having performed the analyzes, we found the following most frequent postoperative complications caused by non-induced hypothermia: cardiovascular problems (peripheral vasoconstriction, myocardial ischemia, hypertension, tachycardia and deep vein thrombosis); coagulopathy (10% decrease in coagulation and platelet activation); wound infections (decrease in blood flow to tissues); immunological complications (increase in incidence of surgical site infections); electrolyte changes (hypokalemia, hypomagnesaemia and hypophosphatemia); changes in the elimination of drugs (decrease in blood flow and difficulty of removing drugs); trembling; pressure ulcers (decrease in blood flow and decrease in peripheral perfusion); breathing difficulty; endocrine-metabolic changes (decrease of corticosteroids and of insulin, increase of peripheral resistance to insulin and thyroid stimulating hormone, hyperglycemia and hypoglycemia); and increase in recovery time. Despite the theoretical knowledge of hypothermia and its complications, a question arises: what makes us underestimate the non-induced hypothermia?

Background: Ongoing educational development is essential to ensure the effectiveness of professional nurses’ learning experiences. Understanding the ways in which workplace learning occurs is fundamental to enabling nurse educators to deliver that knowledge. Induced hypothermia was introduced as a new treatment modality in 2005 and education surrounding the care of the hypothermia patient is lacking in the literature. Purpose: The purpose of this study is to illuminate how nurses learn new knowledge in the clinical setting. Theoretical Framework: The learning theory chosen for this study is the three dimensions of learning by Illeris (2004). Methods: Semistructured interviews were conducted with each participant in one individual, face-to-face session to examine the lived experiences of nurses providing care to induced hypothermia patients. A hermeneutic phenomenology method was chosen based on the work of van Manen. Hycner’s methodological approach was utilized to analyze data. Results: In this study, four learning areas emerged which corresponded to Illeris’ (2003b) three dimensions of learning, including cognitive, emotional, and environmental-social dimensions. The main theme described by every nurse interviewed was the necessity to have hands-on experience to feel competent in their care for induced hypothermia patients. The unit had a special identity because of their unique work of providing hypothermia care and one nurse explained, “We are making history.” Conclusions: Nurses preferred hands-on learning or experiential learning and they helped construct their learning environment. Nurse educators and nurse leaders fueled this synergetic learning process.

The modified Fiala model from Westin was implemented with conditions for circulatory shock and hypothermia. The purpose is to model Emergency Preservation and Resuscitation (EPR), a procedure for inducing hypothermia in patients. Cold tissue temperatures reduce metabolism exponentially, greatly extending the window of anaerobic metabolic activity before permanent deoxygenation damage. EPR in patients undergoing hypovolemic shock can preserve the patient until primary surgical care and blood transfusions are attainable., thereby increasing survival rates. The main applications of EPR are military in-situ stabilization for transit to clinical care and extending the survivability of patients requiring prolonged surgery before blood transfusion. The model explored in this paper seeks to model the tissue temperatures of the body while enduring circulatory shock and various options of cooling devices. Calibrating this model with already available data enables its use for getting preliminary results and design parameters for prototype cooling devices. The final objective of this research is to support the design of a cooling device that can induce sustained hypothermia in a field setting, while still being mobile enough for military and ambulance use.

Use of induced hypothermia for the purpose of lowering intracranial pressure and preserving neuronal function has increased as research data reveals a trend of positive outcomes in patients treated with this therapy. Recently induced hypothermia following cardiac arrest due to ventricular fibrillation has been deemed successful. Current research has expanded to evaluate the effectiveness of induced hypothermia as a treatment modality for severe stroke and head trauma. In spite of its efficacy, complications exist with this treatment modality. The purpose of this literature review is to examine potential complications secondary to induced hypothermia and highlight the nurse's role in managing patient care. At the present, patient protocols for induced hypothermia are lacking. The success of treatment is largely dependent on the skill of the healthcare team to prevent further harm and enhance therapeutic outcomes by providing astute assessment and management of complications in patients undergoing induced hypothermia. The desired outcome of this review is to promote integration of research in the development of evidence-based protocols for induced hypothermia.

Sepsis-induced organ failure is associated with high morbidity and mortality rates. The onset of an exaggerated host response to microbial invasion and/or trauma, is believed to be the primary cause of excessive inflammation and the subsequent tissue hypoperfusion observed in patients with severe sepsis. In our mouse model of sepsis induced by cecal ligation and perforation (CLP), symptoms indicative of the disease, including diarrhea, increased ventilation and persistent hypothermia, are present at six hours after the surgery (T6). In the untreated CLP mice, mortality occurs starting at T15. As induced hypothermia has shown to exert immunomodulatory effects, this study is aimed at assessing its potential in attenuating inflammation and improving survival in experimental sepsis. Our data has shown that deep hypothermia initiated at T6, by means of cold chamber-induced cooling, prolongs survival. Plasma cytokine quantification by enzyme-linked immunosorbent assays (ELISA) also reveals that induced deep hypothermia reduces tumour necrosis factor(TNF)-α and interleukin (IL)-6 production in untreated CLP mice. In contrast, induced moderate hypothermia does not have such effect. Antibiotic (cefotaxime) and saline resuscitation initiated immediately following CLP ensures survival. However, when these supportive treatments are initiated at T6, >50% mortality is observed in the CLP mice with or without induced hypothermia. In summary, this preliminary study provides proof for a downregulated inflammatory response mediated by external cooling. However, to achieve a survival benefit, treatment strategies in addition to cooling and antibiotics may be required.

Sepsis-induced organ failure is associated with high morbidity and mortality rates. The onset of an exaggerated host response to microbial invasion and/or trauma, is believed to be the primary cause of excessive inflammation and the subsequent tissue hypoperfusion observed in patients with severe sepsis. In our mouse model of sepsis induced by cecal ligation and perforation (CLP), symptoms indicative of the disease, including diarrhea, increased ventilation and persistent hypothermia, are present at six hours after the surgery (T6). In the untreated CLP mice, mortality occurs starting at T15. As induced hypothermia has shown to exert immunomodulatory effects, this study is aimed at assessing its potential in attenuating inflammation and improving survival in experimental sepsis. Our data has shown that deep hypothermia initiated at T6, by means of cold chamber-induced cooling, prolongs survival. Plasma cytokine quantification by enzyme-linked immunosorbent assays (ELISA) also reveals that induced deep hypothermia reduces tumour necrosis factor(TNF)-α and interleukin (IL)-6 production in untreated CLP mice. In contrast, induced moderate hypothermia does not have such effect. Antibiotic (cefotaxime) and saline resuscitation initiated immediately following CLP ensures survival. However, when these supportive treatments are initiated at T6, >50% mortality is observed in the CLP mice with or without induced hypothermia. In summary, this preliminary study provides proof for a downregulated inflammatory response mediated by external cooling. However, to achieve a survival benefit, treatment strategies in addition to cooling and antibiotics may be required.

Sepsis-induced organ failure is associated with high morbidity and mortality rates. The onset of an exaggerated host response to microbial invasion and/or trauma, is believed to be the primary cause of excessive inflammation and the subsequent tissue hypoperfusion observed in patients with severe sepsis. In our mouse model of sepsis induced by cecal ligation and perforation (CLP), symptoms indicative of the disease, including diarrhea, increased ventilation and persistent hypothermia, are present at six hours after the surgery (T6). In the untreated CLP mice, mortality occurs starting at T15. As induced hypothermia has shown to exert immunomodulatory effects, this study is aimed at assessing its potential in attenuating inflammation and improving survival in experimental sepsis. Our data has shown that deep hypothermia initiated at T6, by means of cold chamber-induced cooling, prolongs survival. Plasma cytokine quantification by enzyme-linked immunosorbent assays (ELISA) also reveals that induced deep hypothermia reduces tumour necrosis factor(TNF)-α and interleukin (IL)-6 production in untreated CLP mice. In contrast, induced moderate hypothermia does not have such effect. Antibiotic (cefotaxime) and saline resuscitation initiated immediately following CLP ensures survival. However, when these supportive treatments are initiated at T6, >50% mortality is observed in the CLP mice with or without induced hypothermia. In summary, this preliminary study provides proof for a downregulated inflammatory response mediated by external cooling. However, to achieve a survival benefit, treatment strategies in addition to cooling and antibiotics may be required.

Sepsis-induced organ failure is associated with high morbidity and mortality rates. The onset of an exaggerated host response to microbial invasion and/or trauma, is believed to be the primary cause of excessive inflammation and the subsequent tissue hypoperfusion observed in patients with severe sepsis. In our mouse model of sepsis induced by cecal ligation and perforation (CLP), symptoms indicative of the disease, including diarrhea, increased ventilation and persistent hypothermia, are present at six hours after the surgery (T6). In the untreated CLP mice, mortality occurs starting at T15. As induced hypothermia has shown to exert immunomodulatory effects, this study is aimed at assessing its potential in attenuating inflammation and improving survival in experimental sepsis. Our data has shown that deep hypothermia initiated at T6, by means of cold chamber-induced cooling, prolongs survival. Plasma cytokine quantification by enzyme-linked immunosorbent assays (ELISA) also reveals that induced deep hypothermia reduces tumour necrosis factor(TNF)-α and interleukin (IL)-6 production in untreated CLP mice. In contrast, induced moderate hypothermia does not have such effect. Antibiotic (cefotaxime) and saline resuscitation initiated immediately following CLP ensures survival. However, when these supportive treatments are initiated at T6, >50% mortality is observed in the CLP mice with or without induced hypothermia. In summary, this preliminary study provides proof for a downregulated inflammatory response mediated by external cooling. However, to achieve a survival benefit, treatment strategies in addition to cooling and antibiotics may be required.