Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Michigan State University College of Human Medicine, Grand Rapids, MI.
Crit Care Med. 2018 Jul;46(7):1133-1138. doi: 10.1097/CCM.0000000000003154.
Assess if amount of heat generated by postcardiac arrest patients to reach target temperature (Ttarget) during targeted temperature management is associated with outcomes by serving as a proxy for thermoregulatory ability, and whether it modifies the relationship between time to Ttarget and outcomes.
Retrospective cohort study.
Urban tertiary-care hospital.
Successfully resuscitated targeted temperature management-treated adult postarrest patients between 2008 and 2015 with serial temperature data and Ttarget less than or equal to 34°C.
None.
Time to Ttarget was defined as time from targeted temperature management initiation to first recorded patient temperature less than or equal to 34°C. Patient heat generation ("heat units") was calculated as inverse of average water temperature × hours between initiation and Ttarget × 100. Primary outcome was neurologic status measured by Cerebral Performance Category score; secondary outcome was survival, both at hospital discharge. Univariate analyses were performed using Wilcoxon rank-sum tests; multivariate analyses used logistic regression. Of 203 patients included, those with Cerebral Performance Category score 3-5 generated less heat before reaching Ttarget (median, 8.1 heat units [interquartile range, 3.6-21.6 heat units] vs median, 20.0 heat units [interquartile range, 9.0-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.3 hr [interquartile range, 1.5-4.0 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01) than patients with Cerebral Performance Category score 1-2. Nonsurvivors generated less heat than survivors (median, 8.1 heat units [interquartile range, 3.6-20.8 heat units] vs median, 19.0 heat units [interquartile range, 6.5-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.2 hr [interquartile range, 1.5-3.8 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01). Controlling for average water temperature between initiation and Ttarget, the relationship between outcomes and time to Ttarget was no longer significant. Controlling for location, witnessed arrest, age, initial rhythm, and neuromuscular blockade use, increased heat generation was associated with better neurologic (adjusted odds ratio, 1.01 [95% CI, 1.00-1.03]; p = 0.039) and survival (adjusted odds ratio, 1.01 [95% CI, 1.00-1.03]; p = 0.045) outcomes.
Increased heat generation during targeted temperature management initiation is associated with better outcomes at hospital discharge and may affect the relationship between time to Ttarget and outcomes.
评估心脏骤停后患者在达到目标温度（Ttarget）期间产生的热量是否与体温调节能力有关，因为这可以作为体温调节能力的替代指标，以及热量产生是否会改变达到 Ttarget 时间与结果之间的关系。
回顾性队列研究。
城市三级保健医院。
2008 年至 2015 年间，成功复苏并接受目标温度管理治疗的心脏骤停后成年患者，有连续的体温数据和 Ttarget 小于或等于 34°C。
无。
达到 Ttarget 的时间定义为从目标温度管理开始到首次记录的患者体温小于或等于 34°C 的时间。患者产热量（“热量单位”）的计算方法为平均水温的倒数×从开始到 Ttarget 的时间×100。主要结局是通过脑功能分类评分衡量的神经功能状态；次要结局是在出院时的生存情况。使用 Wilcoxon 秩和检验进行单变量分析；使用逻辑回归进行多变量分析。在 203 名患者中，Cerebral Performance Category 评分 3-5 的患者在达到 Ttarget 之前产生的热量较少（中位数，8.1 热量单位[四分位距，3.6-21.6 热量单位]vs 中位数，20.0 热量单位[四分位距，9.0-33.5 热量单位]；p=0.001），达到 Ttarget 的时间更快（中位数，2.3 小时[四分位距，1.5-4.0 小时]vs 中位数，3.6 小时[四分位距，2.0-5.0 小时]；p=0.01）。非幸存者比幸存者产生的热量更少（中位数，8.1 热量单位[四分位距，3.6-20.8 热量单位]vs 中位数，19.0 热量单位[四分位距，6.5-33.5 热量单位]；p=0.001），达到 Ttarget 的时间也更快（中位数，2.2 小时[四分位距，1.5-3.8 小时]vs 中位数，3.6 小时[四分位距，2.0-5.0 小时]；p=0.01）。在控制了 Ttarget 开始和结束之间的平均水温后，结果和达到 Ttarget 时间之间的关系不再显著。在控制了位置、目击性、初始节律和神经肌肉阻滞的使用后，产热量的增加与更好的神经功能（调整后的优势比，1.01[95%CI，1.00-1.03]；p=0.039）和生存（调整后的优势比，1.01[95%CI，1.00-1.03]；p=0.045）结局有关。
在目标温度管理开始时产生的热量增加与出院时的更好结果有关，并且可能会影响达到 Ttarget 时间与结果之间的关系。
