THERAPEUTIC HYPOTHERMIA AND TEMPERATURE MANAGEMENT Volume 2, Number 4, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/ther.2012.1517
Editorial
New Therapeutic Strategies Emerge W. Dalton Dietrich, Ph.D.
Dear Colleagues:
I
n this current issue of Therapeutic Hypothermia and Temperature Management, expert panel discussions, an invited editorial comment, and original articles are provided to the readership of the journal. The journal continues to build momentum as we publish peer-reviewed publications as well as provocative roundtable discussions and clinical question-and-answer sessions that facilitate discussions on the clinical use of therapeutic hypothermia and temperature management in the experimental and clinical settings. The current issue highlights two expert panel discussions/roundtables held at a the 2nd Annual Therapeutic Hypothermia and Temperature Management conference held in Miami in 2012. One discussion looks at recent work in the area of the development of cooling strategies targeting the heart in both adults and children. Questions regarding how pediatric patients differ from adults and what strategies should be used to induce rapid hypothermia are discussed. In addition, new data indicating the usefulness of early cooling in acute myocardial infarction patients are also summarized. Based on the new findings, it appears that cooling prior to coronary artery angioplasty may be a powerful approach to limiting the detrimental effects of reperfusion injury. Cooling strategies targeting neurotrauma also continue to be a highly discussed concept that requires additional experimental and clinical information. Clinical topics are discussed targeting traumatic brain (TBI) and spinal cord injury. Several original articles targeting the various aspects of therapeutic hypothermia are also included in this current issue. Chatzipanteli et al. documented the effects of an induced period of secondary hypoxia on cerebral spinal fluid, plasma, and brain levels of Interleukin-6 (IL-6) after normothermic fluid percussion brain injury. Previous experimental and clinical studies have indicated that secondary hypoxia may be a clinically relevant secondary insult in patients with severe TBI. Thus demonstrating whether or not secondary hypoxia aggravates IL-6 levels was investigated in normothermic animals. These studies set the stage for future studies where hypothermic interventions targeting IL-6 elevations can be addressed. In another original study, Katz and Gordon used a novel pharmaceutical method of inducing therapeutic hypothermia after asphyxial cardiac arrest in swine. These investigators showed that a combination of drugs produced moderate hypo-
thermia in this large animal model of cardiac arrest. In future investigations, drug-induced hypothermia may be a strategy to consider, especially in the early injury setting where acute hypothermia is required. Finally, Madhavan et al. describe the use of hypothermia after iatrogenic spinal cord surgery. This study summarizes a safe strategy for producing mild hypothermia during invasive interoperative surgeries that could benefit the patient during spine procedures. Finally, the latest special edition of ‘‘The Arctic Challenge,’’ a section of the journal that addresses important questions regarding the use of therapeutic hypothermia, is included. Current topics center around the effects of cooling protocols on arterial blood gases and whether or not they should be temperature corrected. Another question is about the importance of monitoring QTc in patients receiving hypothermia and if abnormal readings should be reversed. A discussion regarding what key concepts the ICU personnel should be familiar with if they are involved in caring for patients with therapeutic hypothermia is included. Specific facts relate to understanding why hypothermia is being implemented, what happens if something goes wrong, being familiar with equipment, as well as appropriate individuals to call if questions are raised. Because of the effects of hypothermia on drug metabolism, another question is about evidence for rewarming a patient who codes during therapeutic hypothermia to improve resuscitation and drug performance. Mechanisms of shivering and various treatment strategies as well as recent experiences in skin breakdown under water blanket pads after hypothermia treatment are included in this session. In addition to these communications, an invited editorial comment by Dr. Yenari is provided on a previous publication by Meunier et al. (2012). In that original study, the effects of temperature on thrombolytic efficacy using rt-PA and the novel IIB/IIA inhibitor Eptifibatide were presented. Observations presented in this paper are consistent with other reports, but also emphasize the need for preclinical animal studies to determine the efficacy of such combination approaches targeting clot lysis at lower temperatures. Again, we thank our authors for their submissions of high-quality manuscripts and for contributing to the communications that are being published in this journal. We greatly appreciate the help of our international editorial board and reviewers for ensuring timely critiques that enhance the quality of our publication. We continue
155
156 to be committed to publishing manuscripts targeting a range of basic and clinical questions being addressed in the field of medical hypothermia research. We continue to request full-length original review articles and protocols as well as selective case reports for future publications. As Editor-in-Chief, I hope you are enjoying the journal and are telling your colleagues about this important publication. If you have any questions or would like to submit a Letter to the Editor specifically addressing points made in published articles, please contact me. I look
EDITORIAL forward to your participation and continued growth of our journal. —W. Dalton Dietrich, Ph.D. Editor-in-Chief Reference Meunier JM, Wan-Tsu W, Chang MD. Temperature affects thrombolytic efficacy using rt-PA and eptifibatide, an in vitro study. Ther Hypothermia Temperature Man 2012;2:112–118.
Editorial
New Therapeutic Strategies Emerge W. Dalton Dietrich, Ph.D.
Dear Colleagues:
I
n this current issue of Therapeutic Hypothermia and Temperature Management, expert panel discussions, an invited editorial comment, and original articles are provided to the readership of the journal. The journal continues to build momentum as we publish peer-reviewed publications as well as provocative roundtable discussions and clinical question-and-answer sessions that facilitate discussions on the clinical use of therapeutic hypothermia and temperature management in the experimental and clinical settings. The current issue highlights two expert panel discussions/roundtables held at a the 2nd Annual Therapeutic Hypothermia and Temperature Management conference held in Miami in 2012. One discussion looks at recent work in the area of the development of cooling strategies targeting the heart in both adults and children. Questions regarding how pediatric patients differ from adults and what strategies should be used to induce rapid hypothermia are discussed. In addition, new data indicating the usefulness of early cooling in acute myocardial infarction patients are also summarized. Based on the new findings, it appears that cooling prior to coronary artery angioplasty may be a powerful approach to limiting the detrimental effects of reperfusion injury. Cooling strategies targeting neurotrauma also continue to be a highly discussed concept that requires additional experimental and clinical information. Clinical topics are discussed targeting traumatic brain (TBI) and spinal cord injury. Several original articles targeting the various aspects of therapeutic hypothermia are also included in this current issue. Chatzipanteli et al. documented the effects of an induced period of secondary hypoxia on cerebral spinal fluid, plasma, and brain levels of Interleukin-6 (IL-6) after normothermic fluid percussion brain injury. Previous experimental and clinical studies have indicated that secondary hypoxia may be a clinically relevant secondary insult in patients with severe TBI. Thus demonstrating whether or not secondary hypoxia aggravates IL-6 levels was investigated in normothermic animals. These studies set the stage for future studies where hypothermic interventions targeting IL-6 elevations can be addressed. In another original study, Katz and Gordon used a novel pharmaceutical method of inducing therapeutic hypothermia after asphyxial cardiac arrest in swine. These investigators showed that a combination of drugs produced moderate hypo-
thermia in this large animal model of cardiac arrest. In future investigations, drug-induced hypothermia may be a strategy to consider, especially in the early injury setting where acute hypothermia is required. Finally, Madhavan et al. describe the use of hypothermia after iatrogenic spinal cord surgery. This study summarizes a safe strategy for producing mild hypothermia during invasive interoperative surgeries that could benefit the patient during spine procedures. Finally, the latest special edition of ‘‘The Arctic Challenge,’’ a section of the journal that addresses important questions regarding the use of therapeutic hypothermia, is included. Current topics center around the effects of cooling protocols on arterial blood gases and whether or not they should be temperature corrected. Another question is about the importance of monitoring QTc in patients receiving hypothermia and if abnormal readings should be reversed. A discussion regarding what key concepts the ICU personnel should be familiar with if they are involved in caring for patients with therapeutic hypothermia is included. Specific facts relate to understanding why hypothermia is being implemented, what happens if something goes wrong, being familiar with equipment, as well as appropriate individuals to call if questions are raised. Because of the effects of hypothermia on drug metabolism, another question is about evidence for rewarming a patient who codes during therapeutic hypothermia to improve resuscitation and drug performance. Mechanisms of shivering and various treatment strategies as well as recent experiences in skin breakdown under water blanket pads after hypothermia treatment are included in this session. In addition to these communications, an invited editorial comment by Dr. Yenari is provided on a previous publication by Meunier et al. (2012). In that original study, the effects of temperature on thrombolytic efficacy using rt-PA and the novel IIB/IIA inhibitor Eptifibatide were presented. Observations presented in this paper are consistent with other reports, but also emphasize the need for preclinical animal studies to determine the efficacy of such combination approaches targeting clot lysis at lower temperatures. Again, we thank our authors for their submissions of high-quality manuscripts and for contributing to the communications that are being published in this journal. We greatly appreciate the help of our international editorial board and reviewers for ensuring timely critiques that enhance the quality of our publication. We continue
155
156 to be committed to publishing manuscripts targeting a range of basic and clinical questions being addressed in the field of medical hypothermia research. We continue to request full-length original review articles and protocols as well as selective case reports for future publications. As Editor-in-Chief, I hope you are enjoying the journal and are telling your colleagues about this important publication. If you have any questions or would like to submit a Letter to the Editor specifically addressing points made in published articles, please contact me. I look
EDITORIAL forward to your participation and continued growth of our journal. —W. Dalton Dietrich, Ph.D. Editor-in-Chief Reference Meunier JM, Wan-Tsu W, Chang MD. Temperature affects thrombolytic efficacy using rt-PA and eptifibatide, an in vitro study. Ther Hypothermia Temperature Man 2012;2:112–118.
