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Hipotermi gncel yaklam: Teoriden uygulamaya [Respir Case Rep]
Respir Case Rep. 2012; 1(2): 70-79 | DOI: 10.5505/respircase.2012.36844

Hipotermi gncel yaklam: Teoriden uygulamaya

Ersin Demirer1, Christian Ghattas2, Hossam Abdel Rahman3, Elamin Elamin4
1Gata Haydarpaa Eitim Hastanesi, Gs Hastalklar Servisi, stanbul, Trkiye
2Saint Elizabeth Salk Merkezi, Hastalklar Servisi, Ohio, ABD
3Uluslararas Tp Merkezi, Anestezi Servisi, Kahire, Msr
4South Florida niversitesi, Gs Hastalklar, Youn Bakm ve Uyku Servisi, Florida, ABD

Ama:
Kaza ile ortaya km olan hipoterminin kurbanlarna hastane ncesi ve hastane ortamndaki yaklam gncel bilgiler eliinde sistemli bir ekilde gzden geirmek.
Metodlar:
1 Ocak 1977 ile 31 Mays 2012 tarihleri arasnda yaynlanm olan almalar MEDLINE, EMBASE, CINAHL ve Ulusal Tp Ktphanesi veritabanlarn kullanarak aratrdk. Ek olarak ulalan makalelerin kaynakalar incelenerek de ek kaynaklara ulald. Balang arama kelimeleri olarak 'hipotermi tanm', 'hastane ncesi yaklam', 'hastane yaklam', ve 'yeniden stma teknikleri' olarak belirlendi. alma dizaynnn hiyerarisi, alma kalitesi, risk faktrleri ve laboratuar ngrcler ile ilgili verileri ortaya karmak iin standardize edilmi zet oluturma yntemleri kullandk.
Bulgular:
Kaza ile ortaya kan hipotermi kor ve perifer dokulardaki vcut ssnn yeniden dalm nedeni ile oluabilecei gibi s kayb ve retimi arasndaki dengesizlikten de kaynaklanr. Hipotermi, souk su ierisinde bulunduktan veya souk havaya maruz kalndktan birka dakika ierisinde geliebilir. Bununla birlikte akl sal bozuk kurbanlarda veya yallarda devaml olarak orta derecede scakla maruz kalndnda gnler ierisinde yavaca geliebilir. Kaza ile ortaya kan hipoterminin prognozu byk oranda hipoterminin derecesine ve sresine, hastalarn elik eden durumlarna, bitkinlik derecesine ve s kaybn telafi etmek iin fizyolojik giriimlerden dolay oluan metabolik bozukluklara baldr.
Yorumlar ve Etkiler:
Hipotermi kurbanlarnn iyilemesinin hastane ncesi ve hastane ii seviyelerde uygulanan iyi ynetim stratejisine bal olduu birok almada gsterilmitir. Derin hipotermiye yaklam vcut kor organlarnn desteklenmesi iin hzl internal yeniden stma gerektirmekte iken "yeniden stma oku" riskini azaltmak iin tm nlemler alnmaldr. Dier yandan daha dk iddetlerdeki hipotermi iin olgularn iyileebilmesi yeniden stma metodlarndan daha ok yaplan hastane destek tedavisinin yeterliliine baldr. Bu bakm, hipotermiye elik eden ve deiik tedavi strateji mekanizmalarn kullanabilen bir tbbi ekip gerektirmektedir.

Anahtar Kelimeler: hipotermi, hastane ncesi yaklam, hastane yaklam, yeniden stma teknikleri

Current Management of Hypothermia: From Theory to Application

Ersin Demirer1, Christian Ghattas2, Hossam Abdel Rahman3, Elamin Elamin4
1Department Of Pulmonary Diseases, Gata Haydarpasa Training Hospital, Istanbul, Turkey
2Department Of Internal Medicine, Saint Elizabeth Health Center, Ohio, United States Of America
3Department Of Anesthesiology, International Medical Center, Cairo, Egypt
4Department Of Pulmonary, Critical Care And Sleep Medicine, University Of South Florida, Florida, United States Of America

Objectives:
To systematically review the literature on the current data in managing accidental hypothermia victims in the pre-hospital and hospital settings.
Methods:
We identified studies published from 1 January 1977 through 31 May 2012 by searching the MEDLINE, EMBASE and CINAHL and database of the National Library of Medicine. In addition, hand search of the bibliographies of retrieved articles in order to find additional sources was also performed. Initial search terms were 'definition of hypothermia', 'prehospital management', 'hospital management', and 'rewarming techniques' ''. We used standardized abstraction instruments to extract data on study characteristics, hierarchy of research design, study quality, risk factors, and laboratory predictors.
Findings:
Accidental hypothermia occurs due to body heat redistribution between core and peripheral tissues as well as imbalance between heat loss and production. Hypothermia may develop within a few minutes after immersion in cold water or exposure to cold weather. However, in debilitated victims or in the elderly it can occur slowly over many days by continuous exposure to milder cold temperature. The prognosis in accidental hypothermia depends to great extent on the degree and duration of the hypothermia, patient's premorbid condition, and the degree of exhaustion and metabolic derangement that result from the physiologic attempts to compensate for the heat loss.
Interpretations and implications:
Several studies demonstrated that the rapid and adequate recovery of the hypothermia victims depends on a well orchestrated management strategy both at the pre- and in- hospital levels. Management of deep hypothermia require rapid internal rewarming in order to support body core organs but all possible precautions should be undertaken to minimize the risk of "rewarming shock". On the other hand, for lesser degrees of hypothermia, recoverability depends more on the adequacy of hospital supportive care than on the method of rewarming. Such care require a medical team with very well understanding of the pathophysiologic that accompanied hypothermia and the implications of various treatment strategies.

Keywords: hypothermia, prehospital management, hospital management, rewarming techniques

Ersin Demirer, Christian Ghattas, Hossam Abdel Rahman, Elamin Elamin. Current Management of Hypothermia: From Theory to Application. Respir Case Rep. 2012; 1(2): 70-79

Sorumlu Yazar: Ersin Demirer, Trkiye
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