Systemic Temperature and Paralysis After Thoracoabdominal and Descending Aortic Operations
HYPOTHESIS Systemic temperature influences the development of neurologic deficits after aortic surgery. DESIGN Retrospective case-comparison study of prospectively collected data. SETTING Tertiary referral center. PATIENTS AND INTERVENTIONS We examined spinal cord injury according to mild passive hy...
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| Veröffentlicht in: | Archives of surgery (Chicago. 1960) 2003-02, Vol.138 (2), p.175-179 |
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| container_title | Archives of surgery (Chicago. 1960) |
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| creator | Svensson, Lars G Khitin, Lev Nadolny, Edward M Kimmel, Wendy A |
| description | HYPOTHESIS Systemic temperature influences the development of neurologic deficits after aortic surgery. DESIGN Retrospective case-comparison study of prospectively collected data. SETTING Tertiary referral center. PATIENTS AND INTERVENTIONS We examined spinal cord injury according to mild passive hypothermia (mean temperature, 36.5°C; n = 25), moderate active hypothermia (temperature range, 29°C-32°C; n = 76), or profound hypothermia (temperature, |
| doi_str_mv | 10.1001/archsurg.138.2.175 |
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DESIGN Retrospective case-comparison study of prospectively collected data. SETTING Tertiary referral center. PATIENTS AND INTERVENTIONS We examined spinal cord injury according to mild passive hypothermia (mean temperature, 36.5°C; n = 25), moderate active hypothermia (temperature range, 29°C-32°C; n = 76), or profound hypothermia (temperature, <20°C; n = 31) for complex repairs in 132 patients. Aortic dissection was present in 67 patients (51%), 41 (31%) had leaks or rupture, 39 (30%) were reoperations on the descending thoracic aorta, and 27 (20%) had concurrent arch and/or ascending thoracic aortic repairs. MAIN OUTCOME MEASURE Occurrence of permanent and transient deficits. RESULTS Five patients (3.8%) had permanent deficits. One (4.0%) of the 25 patients underwent mild hypothermia, 3 (3.9%) of the 76 patients who underwent moderate hypothermia, and 1 (3.2%) of the 31 patients who underwent profound hypothermia (P = .70). Reversible deficits occurred in 7 patients (total 32%) who underwent mild hypothermia, 2 patients (total 6.6%) underwent moderate hypothermia, and 1 (total 6.5%) underwent profound hypothermia (P = .004). Six were delayed neurologic deficits. Independent predictors were intercostal ischemic time (P = .02), mild hypothermia (P = .004), and no cerebrospinal fluid drainage (P = .05). The total 30-day survival was 92.4% (122 of 132 patients). The only multivariable predictor of death was acuity of surgery (namely, emergent, urgent, or elective) (P = .06). CONCLUSIONS Moderate or profound hypothermia resulted in fewer transient neurologic deficits. Thus, we recommend active cooling and cerebrospinal fluid drainage for most patients, and profound hypothermia for patients undergoing complex repairs and reoperations.Arch Surg. 2003;138:175-179--></description><identifier>ISSN: 0004-0010</identifier><identifier>EISSN: 1538-3644</identifier><identifier>DOI: 10.1001/archsurg.138.2.175</identifier><identifier>PMID: 12578415</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aorta, Abdominal - surgery ; Aorta, Thoracic - surgery ; Case-Control Studies ; Comorbidity ; Female ; Humans ; Hypothermia - physiopathology ; Logistic Models ; Male ; Paraplegia - etiology ; Paraplegia - mortality ; Prospective Studies ; Spinal Cord Injuries - mortality ; Spinal Cord Injuries - physiopathology</subject><ispartof>Archives of surgery (Chicago. 1960), 2003-02, Vol.138 (2), p.175-179</ispartof><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a383t-a36c614a80c3e23a821a145ca1c7418ebb8ab4ff933cc1c9f282fd5ec0397d6a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/archsurg.138.2.175$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.138.2.175$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3338,27923,27924,76260,76263</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12578415$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Svensson, Lars G</creatorcontrib><creatorcontrib>Khitin, Lev</creatorcontrib><creatorcontrib>Nadolny, Edward M</creatorcontrib><creatorcontrib>Kimmel, Wendy A</creatorcontrib><title>Systemic Temperature and Paralysis After Thoracoabdominal and Descending Aortic Operations</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>Arch Surg</addtitle><description>HYPOTHESIS Systemic temperature influences the development of neurologic deficits after aortic surgery. DESIGN Retrospective case-comparison study of prospectively collected data. SETTING Tertiary referral center. PATIENTS AND INTERVENTIONS We examined spinal cord injury according to mild passive hypothermia (mean temperature, 36.5°C; n = 25), moderate active hypothermia (temperature range, 29°C-32°C; n = 76), or profound hypothermia (temperature, <20°C; n = 31) for complex repairs in 132 patients. Aortic dissection was present in 67 patients (51%), 41 (31%) had leaks or rupture, 39 (30%) were reoperations on the descending thoracic aorta, and 27 (20%) had concurrent arch and/or ascending thoracic aortic repairs. MAIN OUTCOME MEASURE Occurrence of permanent and transient deficits. RESULTS Five patients (3.8%) had permanent deficits. One (4.0%) of the 25 patients underwent mild hypothermia, 3 (3.9%) of the 76 patients who underwent moderate hypothermia, and 1 (3.2%) of the 31 patients who underwent profound hypothermia (P = .70). Reversible deficits occurred in 7 patients (total 32%) who underwent mild hypothermia, 2 patients (total 6.6%) underwent moderate hypothermia, and 1 (total 6.5%) underwent profound hypothermia (P = .004). Six were delayed neurologic deficits. Independent predictors were intercostal ischemic time (P = .02), mild hypothermia (P = .004), and no cerebrospinal fluid drainage (P = .05). The total 30-day survival was 92.4% (122 of 132 patients). The only multivariable predictor of death was acuity of surgery (namely, emergent, urgent, or elective) (P = .06). CONCLUSIONS Moderate or profound hypothermia resulted in fewer transient neurologic deficits. Thus, we recommend active cooling and cerebrospinal fluid drainage for most patients, and profound hypothermia for patients undergoing complex repairs and reoperations.Arch Surg. 2003;138:175-179--></description><subject>Aorta, Abdominal - surgery</subject><subject>Aorta, Thoracic - surgery</subject><subject>Case-Control Studies</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Humans</subject><subject>Hypothermia - physiopathology</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Paraplegia - etiology</subject><subject>Paraplegia - mortality</subject><subject>Prospective Studies</subject><subject>Spinal Cord Injuries - mortality</subject><subject>Spinal Cord Injuries - physiopathology</subject><issn>0004-0010</issn><issn>1538-3644</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1PwzAMhiMEYmPwA-CAeuLWESdpmx4nvqVJQ2JcuERumm5FbTOS9rB_T9gGXGxLfvzKegi5AjoFSuEWnV77wa2mwOWUTSFLjsgYEi5jngpxTMaUUhEHko7ImfefYWIyZ6dkBCzJpIBkTD7etr43ba2jpWk3xmE_OBNhV0av6LDZ-tpHs6o3LlqurUNtsShtW3fY7KB747XpyrpbRTPr-hCz2IXUtvPn5KTCxpuLQ5-Q98eH5d1zPF88vdzN5jFyyftQU52CQEk1N4yjZIAgEo2gMwHSFIXEQlRVzrnWoPOKSVaVidGU51mZIp-Qm33uxtmvwfhetXX4qmmwM3bwKuMUMsFoANke1M5670ylNq5u0W0VUPVjVP0aVcGoYioYDUfXh_ShaE35f3JQGIDLPYAt_m15Ljik_BunRH27</recordid><startdate>20030201</startdate><enddate>20030201</enddate><creator>Svensson, Lars G</creator><creator>Khitin, Lev</creator><creator>Nadolny, Edward M</creator><creator>Kimmel, Wendy A</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20030201</creationdate><title>Systemic Temperature and Paralysis After Thoracoabdominal and Descending Aortic Operations</title><author>Svensson, Lars G ; Khitin, Lev ; Nadolny, Edward M ; Kimmel, Wendy A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a383t-a36c614a80c3e23a821a145ca1c7418ebb8ab4ff933cc1c9f282fd5ec0397d6a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Aorta, Abdominal - surgery</topic><topic>Aorta, Thoracic - surgery</topic><topic>Case-Control Studies</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Humans</topic><topic>Hypothermia - physiopathology</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Paraplegia - etiology</topic><topic>Paraplegia - mortality</topic><topic>Prospective Studies</topic><topic>Spinal Cord Injuries - mortality</topic><topic>Spinal Cord Injuries - physiopathology</topic><toplevel>online_resources</toplevel><creatorcontrib>Svensson, Lars G</creatorcontrib><creatorcontrib>Khitin, Lev</creatorcontrib><creatorcontrib>Nadolny, Edward M</creatorcontrib><creatorcontrib>Kimmel, Wendy A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of surgery (Chicago. 1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Svensson, Lars G</au><au>Khitin, Lev</au><au>Nadolny, Edward M</au><au>Kimmel, Wendy A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Systemic Temperature and Paralysis After Thoracoabdominal and Descending Aortic Operations</atitle><jtitle>Archives of surgery (Chicago. 1960)</jtitle><addtitle>Arch Surg</addtitle><date>2003-02-01</date><risdate>2003</risdate><volume>138</volume><issue>2</issue><spage>175</spage><epage>179</epage><pages>175-179</pages><issn>0004-0010</issn><eissn>1538-3644</eissn><abstract>HYPOTHESIS Systemic temperature influences the development of neurologic deficits after aortic surgery. DESIGN Retrospective case-comparison study of prospectively collected data. SETTING Tertiary referral center. PATIENTS AND INTERVENTIONS We examined spinal cord injury according to mild passive hypothermia (mean temperature, 36.5°C; n = 25), moderate active hypothermia (temperature range, 29°C-32°C; n = 76), or profound hypothermia (temperature, <20°C; n = 31) for complex repairs in 132 patients. Aortic dissection was present in 67 patients (51%), 41 (31%) had leaks or rupture, 39 (30%) were reoperations on the descending thoracic aorta, and 27 (20%) had concurrent arch and/or ascending thoracic aortic repairs. MAIN OUTCOME MEASURE Occurrence of permanent and transient deficits. RESULTS Five patients (3.8%) had permanent deficits. One (4.0%) of the 25 patients underwent mild hypothermia, 3 (3.9%) of the 76 patients who underwent moderate hypothermia, and 1 (3.2%) of the 31 patients who underwent profound hypothermia (P = .70). Reversible deficits occurred in 7 patients (total 32%) who underwent mild hypothermia, 2 patients (total 6.6%) underwent moderate hypothermia, and 1 (total 6.5%) underwent profound hypothermia (P = .004). Six were delayed neurologic deficits. Independent predictors were intercostal ischemic time (P = .02), mild hypothermia (P = .004), and no cerebrospinal fluid drainage (P = .05). The total 30-day survival was 92.4% (122 of 132 patients). The only multivariable predictor of death was acuity of surgery (namely, emergent, urgent, or elective) (P = .06). CONCLUSIONS Moderate or profound hypothermia resulted in fewer transient neurologic deficits. Thus, we recommend active cooling and cerebrospinal fluid drainage for most patients, and profound hypothermia for patients undergoing complex repairs and reoperations.Arch Surg. 2003;138:175-179--></abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>12578415</pmid><doi>10.1001/archsurg.138.2.175</doi><tpages>5</tpages></addata></record> |
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| subjects | Aorta, Abdominal - surgery Aorta, Thoracic - surgery Case-Control Studies Comorbidity Female Humans Hypothermia - physiopathology Logistic Models Male Paraplegia - etiology Paraplegia - mortality Prospective Studies Spinal Cord Injuries - mortality Spinal Cord Injuries - physiopathology |
| title | Systemic Temperature and Paralysis After Thoracoabdominal and Descending Aortic Operations |
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