umu.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Field torso-warming modalities: a comparative study using a human model
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
Laboratory for Exercise and Environmental Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Laboratory for Exercise and Environmental Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Visa övriga samt affilieringar
2009 (Engelska)Ingår i: Prehospital Emergency Care, ISSN 1090-3127, E-ISSN 1545-0066, Vol. 13, nr 3, s. 371-378Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To compare four field-appropriate torso warming modalities, that do not require AC electrical power, using a human model of non-shivering hypothermia.

Methods: Five subjects, serving as their own controls, were cooled four times in 8ºC water, for 10-30 minutes. Shivering was inhibited by Buspirone (30 mg) taken orally prior to cooling and IV Meperidine (1.25 mg/kg) at the end of immersion. Subjects were hoisted out of the water, dried, insulated and then underwent 120 min of either: spontaneous warming only; a charcoal heater on the chest; two flexible hot water bags (total4 liters of water at55°C, replenished every 20 minutes) applied to the chest and upper back; or two chemical heat pads applied to the chest and upper back. Supplemental meperidine (maximum cumulative dose of 3.5 mg/kg) was administered as required to inhibit shivering.

Results:  Post-cooling afterdrop was compared to spontaneous warming (2.2°C) less for chemical heat pads (1.5°C) and hot water bags (1.6°C, p < 0.05), and was1.8°C with the charcoal heater.  Subsequent core rewarming rates, the hot water bags (0.7°C/h) and the charcoal heater (0.6°C/h), tended to be higher than chemical heat pads (0.2°C/h, p = 0.055) and was significantly greater than spontaneous warming (0.1°C/h, p < 0.05).

Conclusion: In subjects with shivering suppressed, greater sources of external heat were effective in attenuating core temperature afterdrop whereas sustained sources of external heat effectively established core rewarming. Depending on scenario and available resources, we advice to use charcoal heaters, chemical heat pads or hot water bags as effective means for treating cold patients in the field or during transport to definitive care.

Ort, förlag, år, upplaga, sidor
Informa Healthcare, 2009. Vol. 13, nr 3, s. 371-378
Nyckelord [en]
Hypothermia
Nationell ämneskategori
Kirurgi
Forskningsämne
kirurgi
Identifikatorer
URN: urn:nbn:se:umu:diva-54277DOI: 10.1080/10903120902935348OAI: oai:DiVA.org:umu-54277DiVA, id: diva2:517560
Tillgänglig från: 2012-04-24 Skapad: 2012-04-23 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Protection and treatment of hypothermia in prehospital trauma care: with emphasis on active warming
Öppna denna publikation i ny flik eller fönster >>Protection and treatment of hypothermia in prehospital trauma care: with emphasis on active warming
2012 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: In prehospital trauma care active warming is recommended to aid in protection from further cooling. However, scientific evidence of the effectiveness of active warming in a clinical setting is scarce. Also, evaluating the effectiveness of active warming, especially in harsh ambient conditions, by objective measures, is difficult.

Objective: To evaluate the effectiveness of field applicabe heat sources (I) and to evaluate active warming intervention in a prehospital clinical setting (II and III).

To evaluate reliability and validity of the Cold Discomfort Scale (CDS), a subjective judgement scale for assessment of the thermal state of patients in a cold environment (IV).

Methods: In a laboratory trial, non-shivering hypothermic subjects (n=5), were cooled in 8 ºC water followed by spontaneous warming, a charcoal heater, two flexible hot-water bags or two chemical heat pads, all applied to the chest and upper back (I). Oesophageal temperature, skin temperature, heat flux, oxygen consumption, respiratory rate and, heart rate were measured.

In two clinical randomized trials, shivering patients during road and air ambulance transport (II) and during field treatment (III) were randomized to either passive warming alone (n=22 and n=9) or to passive warming with the addition of a chemical heat pad (n=26 and n=11). Body core temperature, respiratory rate, heart rate, blood pressure (II) and the patients’ subjective sensation of thermal comfort (II and III) were measured.

In a laboratory trial, shivering subjects were exposed to – 20 ºC (n=22). The CDS was evaluated regarding reliability, defined as test-retest stability, and criterion validity, defined as the ability to detect changes in cold discomfort due to changes in cumulative cold stress (IV).

Results: In non-shivering hypothermic subjects postcooling afterdrop was significantly less for the chemical heat pads, but not for the hot water bags and the charcoal heater, compared to spontaneous warming (I). Temperature drop during the entire warming phase was significantly less for all the heat sources respectively, compared to spontaneous warming (I).

During road and air ambulance transport, ear canal temperature was significantly increased and cold discomfort significantly decreased, both in patients assigned to passive warming only, and in patients assigned to additional active warming (II). During field treatment, cold discomfort was significantly reduced in patients assigned to additional active warming, but remained the same in patients assigned to passive warming only (III).

Weighted kappa coefficient, describing test-retest stability, was 0.84 (IV). CDS ratings were significantly increased during each 30 minutes interval (IV).

Conclusion: In non-shivering hypothermic subjects, heat sources were effective to attenuate afterdrop, when providing high heat content over a large surface area and effective to continue to increase body core temperature when providing sustained high heat content. In shivering trauma patients, adequate passive warming were sufficient treatment to prevent afterdrop, to slowly increase body core temperature, and to reduce cold discomfort. If inadequate passive warming, additional active warming was required to reduce cold discomfort. The CDS, a subjective judgement scale for assessment of the thermal state of patients in a cold environment seemed to be reliable regarding test-retest stability and valid regarding ability to detect change in cumulative cold stress.

Ort, förlag, år, upplaga, sidor
Umeå universitet, 2012. s. 51
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1502
Nyckelord
Hypothermia
Nationell ämneskategori
Kirurgi
Forskningsämne
kirurgi
Identifikatorer
urn:nbn:se:umu:diva-54304 (URN)978-91-7459-424-9 (ISBN)
Disputation
2012-05-16, Tandläkarhögskolan sal B, byggnad 1D, 9 tr, 08:30 (Engelska)
Opponent
Handledare
Tillgänglig från: 2012-04-24 Skapad: 2012-04-24 Senast uppdaterad: 2018-06-08Bibliografiskt granskad

Open Access i DiVA

fulltext(208 kB)408 nedladdningar
Filinformation
Filnamn FULLTEXT02.pdfFilstorlek 208 kBChecksumma SHA-512
c490bceafc29ba804c074d87b996fea73535a775b117e9cec67e3df83f5de26976dca48bf36d1f3d1d7ac5d1decd88827fc16b9e84a9edd6260640b0d6a41011
Typ fulltextMimetyp application/pdf

Övriga länkar

Förlagets fulltext

Personposter BETA

Lundgren, PeterHenriksson, OttoBjörnstig, Ulf

Sök vidare i DiVA

Av författaren/redaktören
Lundgren, PeterHenriksson, OttoBjörnstig, Ulf
Av organisationen
Kirurgi
I samma tidskrift
Prehospital Emergency Care
Kirurgi

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 408 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

doi
urn-nbn

Altmetricpoäng

doi
urn-nbn
Totalt: 243 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf