Terapijska hipotermija u intenzivnoj kardiološkoj skrbi

master's thesis

• Title (english): Therapeutic hypothermia in cardiovascular intensive care
• Author: Sara Gregurić
• Mentor: Zdravko Babić (mentor)
• Committee member: Diana Delić-Brkljačić (predsjednik povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Committee member: Zdravko Babić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Kardiovaskularna bolest predstavlja glavni uzrok smrti i invaliditeta u svijetu, a najčešće je posljedica aterosklerotskih promjena na krvnim žilama. Promjene na epikardnim krvnim žilama povećavaju rizik od nastanka ishemijske srčane bolesti koja je odgovorna za skoro polovicu datog mortaliteta. Budući da je moguće reducirati i do 80% kardiovaskularnih incidenata nužna je
promocija zdravlja i usvajanje zdravih životnih navika. Iznenadni srčani zastoj je neočekivani i nagli prestanak srčane akcije koji dovodi do hemodinamskog kolapsa, a najčešće je posljedica ishemijske bolesti srca. Kardiopulmonalna resuscitacija predstavlja niz postupaka koji se poduzimaju sa svrhom ponovne uspostave srčane funkcije i disanja kako bi se minimizirala ishemija mozga i vitalnih organa. Rano prepoznavanje stanja u kojima je indicirana te njena primjena osnova je pozitivnog krajnjeg ishoda ovih pacijenata. Terapijska hipotermija je dokazana neuroprotektivna metoda koja se koristi u stanjima globalne ishemije mozga. Podrazumijeva kontrolirano sniženje tjelesne temperature stoga razlikujemo blagu (34-35.9°C), umjerenu (32-34.9°C), umjereno duboku (30-31.9°C) te duboku (<30°C) hipotermiju. Provodi se nizom neinvazivnih i invazivnih metoda kojima se smanjuje ishemijska ozljeda mozga i vitalnih organa te poboljšava krajnji neurološki ishod i preživljenje. Zbog mnogih komplikacija, indicirana je u pomno odabranih bolesnika odnosno bolesnika bez svijesti uz spontanu cirkulaciju nakon srčanog zastoja, asfiktične novorođenčadi, traumatske ozljede mozga te u stanjima gdje je potreban cirkulacijski zastoj kao što su kardiokirurške i neurokirurške operacije. Veliki izazov predstavljaju optimalna kombinacija duljine hipotermije, temperature te brzine zagrijavanja, a kao standard u kliničkoj praksi koriste se umjerena hipotermija uz sporije zagrijavanje.

Abstract (english)

Cardiovascular disease represents the main cause of death and disability globally, with atherosclerosis as the most common underlying condition. Changes in the epicardial coronary vessels significantly increase the risk of ischemic heart disease which is responsible for almost a half of the cardiovascular mortality. Since nearly 80 % of these incidents are preventable, promotion of health and healthy lifestyle are necessary. Sudden cardiac arrest stands for abrupt and unexpected loss of heart function that leads to hemodynamic collapse and is most likely the result of ischemic heart disease. Cardiopulmonary resuscitation represents a series of measures set to re-establish hearth action and breathing with a goal of minimizing cerebral and vital organ ischemia. Early recognition of where it is indicated and its application makes a foundation for positive ultimate outcome of these patients. Therapeutic hypothermia is a neuroprotective method used in states of global ischemia. It implies controlled reduction of body temperature so we differentiate mild (34-35.9°C), moderate (32-34.9°C), moderately deep (30-31.9°C) and deep (<30°C) hypothermia. It is implemented by a series of non-invasive and invasive methods which reduce cerebral and vital organs ischemia and improve final neurological outcome and survival. Due to many complications, it is indicated in selected patients such as unconscious patients with spontaneous circulation after cardiac arrest, perinatal asphyxia, traumatic brain injury and where circulation stagnation is needed, that is
cardiac and brain surgery. The optimal combination of the length of hypothermia, targeted temperature and warm up velocity represents a big clinical practice challenge, but the best results are achieved by mild hypothermia with slower rewarming.

• Keywords: kardiovaskularna bolest; iznenadni srčani zastoj; kardiopulmonalna resuscitacija; terapijska hipotermija
• Keywords (english): cardiovascular disease; sudden cardiac arrest; cardiopulmonary resuscitation; therapeutic hypothermia
• Language: croatian
• URN:NBN: urn:nbn:hr:105:909482
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-03 12:53:18