Hypoxic Brain Injury & Elective Hypothermia... Who's doing it?

  1. Hi all,

    We're getting ready to start trialing a new whole-body cooling system for hypoxic-brain injury term infants. I need to start researching protocols, etc for our new program. Is anyone using a system like this? Any info would be appreciated.

    Stevern21
    •  
  2. 30 Comments

  3. by   Zippedodah
    I've been reading about it....it will be interesting to see if we trial it where I work. Keep us updated@
  4. by   grlgid
    I think Duke up in Durham, NC has was doing that or at least doing a trial
  5. by   augigi
    I googled "hypoxic infant hypothermia protocol" and got several literature articles and some hospital protocols.

    http://content.nejm.org/cgi/content/...15/1574?ck=nck
    (free registration)
  6. by   2curlygirls
    We're doing it. Just got an HIE kiddo Tues. morning. I think it has to be initiated within 5 hours of birth. Certain apgars, cord blood pH less than 7.1. They use an esophageal probe to monitor temp. It's been ages since I've read the protocol. Not very helpful am I.

    A coworker said she did it at her last hospital where they just cooled the head.
  7. by   dawngloves
    We were going to do it last year. I forget what happened. We have to send kids out for it still.I really haven't heard feedback either.
  8. by   preemieRNkate
    There is a hospital close by to me that does head cooling. There is a list of criteria before we can transport them there. They have to be >36 weeks, have certain blood gas pH, it has to be initiated within 6 hours of birth. If I remember when I go back to work, I will post the list. I go back next Wed. night.
  9. by   Sweeper933
    We just got inserviced on it a couple of months ago. We have yet to have a situation where we need to use it though. Without copying our entire protocol... here's some of the basics:

    A. Term infants (greater than 36 weeks) diagnosed with moderate to severe Hypoxic-Ischemic Encephalopathy (HIE) are treated with total body cooling to a core temperature of 33-34 degrees Celsius (91.4 -93.2 degrees Fahrenheit) as a neuroprotective therapy.
    B. Initiation of the cooling should occur at or before 6 hours of age.
    C. The cool body temperature is maintained for 72 hours and then the infant is re-warmed over a 4-6 hour period.

    There's an esophageal temp probe that measures core temperature. It takes about 45 min to reach the desired cool temperature. When the infant's temp goes below the desired temperature, the blanket automatically warms up to warm the baby back to the desired "cool temp". We have to monitor skin condition frequently, record temps every 30-60 min during the cooling/warming phase.
    For more info let me know and I'll get it to you. We used this reference to help us make up our protocol:
    Shankaran, S. (2005) Whole-Body Hypothermia for neonates with Hypoxic-Ischemic Encephalopathy. New England Journal of Medicine, 353;15
  10. by   sadlady
    Hi, I need to know if any of you professionals can tell me this- have ANY of you seen recovery EVER in an anoxic brain injury necrosis case? The PT is male, 50, had massive MI 11/26/06, and went w/o oyxgen 20 min. causing this. His pupils are fixed & dialated, he has been on a mech. vent. machine and set at 6-but reads 6-10 per min. He was a 4 ppd smoker, and an alcoholic, and his arteries were all severely blocked. He has only myoclonic movements, and an abnormal babinski sign, where he moves his upper r. body with stimuli of his L. foot. He had seizures that were difficult to control after the MD's stented him. He is totally unresponsive. I ask this because my ex-husband is the man I am speaking of here, but I want to have input from you ALL so that I can show this to my ex's fiance and family, who all need to realize that "IF they love him that much- then love him enough, to let him go." Turn off the ventilator, and let GOD. If he is meant to be here, he will be...I look into his eyes and see that the light is on, but nobody's home. Now they are going to go ahead with a tracheostomy and stomach tube for feeding- and probably move him to a nursing facility where he will lie needlessly. He always said "Promise me you'll pull the plug if I ever have anything happen and become a vegetable". Please show this to anyone it may help too- tell them to LEARN CPR. (C=call 911 P=push & Pray R=rush to get air IN!) And lastly, if you don't have a living will , GET ONE!!! THIS could happen to YOU!!! Thank You all for any help here.
  11. by   Gompers
    Quote from sadlady
    Hi, I need to know if any of you professionals can tell me this- have ANY of you seen recovery EVER in an anoxic brain injury necrosis case? The PT is male, 50, had massive MI 11/26/06, and went w/o oyxgen 20 min. causing this. His pupils are fixed & dialated, he has been on a mech. vent. machine and set at 6-but reads 6-10 per min. He was a 4 ppd smoker, and an alcoholic, and his arteries were all severely blocked. He has only myoclonic movements, and an abnormal babinski sign, where he moves his upper r. body with stimuli of his L. foot. He had seizures that were difficult to control after the MD's stented him. He is totally unresponsive. I ask this because my ex-husband is the man I am speaking of here, but I want to have input from you ALL so that I can show this to my ex's fiance and family, who all need to realize that "IF they love him that much- then love him enough, to let him go." Turn off the ventilator, and let GOD. If he is meant to be here, he will be...I look into his eyes and see that the light is on, but nobody's home. Now they are going to go ahead with a tracheostomy and stomach tube for feeding- and probably move him to a nursing facility where he will lie needlessly. He always said "Promise me you'll pull the plug if I ever have anything happen and become a vegetable". Please show this to anyone it may help too- tell them to LEARN CPR. (C=call 911 P=push & Pray R=rush to get air IN!) And lastly, if you don't have a living will , GET ONE!!! THIS could happen to YOU!!! Thank You all for any help here.

    I'm so sorry to hear about your ex-husband and you have given us much to think about. However, it's against this website's Terms of Service to give out medical or legal advice. You take care, okay?
  12. by   sadlady
    Thank you for your replies, I guess what I just really wanted to ask and recieve an answer about was this-
    Have ANY of you ever heard of anyone ever recovering from this type of injury to the brain? I just wanted to know if anyone who is a NURSE has heard of someone even opening their eyes SPECIFICALLY with Anoxic Brain Injury Necrosis.? I'm not asking for legal, or medical advice, just wanted to know IF anyone ever saw recovery occur in a pt with this diagnosis.
    Thank You also for your Kindness. I have encouraged his family members to talk about him to the social workers, and psych workers there, but they only believe a miracle will occur against all odds- and that we are the enemy...
    Good Luck with your New Baby, what a Christmas Gift, My oldest son Alan is celebrating this Saturday, the 23rd. He will be 21! (And YES, I did feel blessed and that I had received the best gift of all when he was born!!!)
  13. by   Gompers
    Quote from sadlady
    Thank you for your replies, I guess what I just really wanted to ask and recieve an answer about was this-
    Have ANY of you ever heard of anyone ever recovering from this type of injury to the brain? I just wanted to know if anyone who is a NURSE has heard of someone even opening their eyes SPECIFICALLY with Anoxic Brain Injury Necrosis.? I'm not asking for legal, or medical advice, just wanted to know IF anyone ever saw recovery occur in a pt with this diagnosis.
    Thank You also for your Kindness. I have encouraged his family members to talk about him to the social workers, and psych workers there, but they only believe a miracle will occur against all odds- and that we are the enemy...
    Good Luck with your New Baby, what a Christmas Gift, My oldest son Alan is celebrating this Saturday, the 23rd. He will be 21! (And YES, I did feel blessed and that I had received the best gift of all when he was born!!!)
    This is the Neonatal ICU forum - we are nurses that take care of sick newborn and premature babies. The Neuro ICU forum would be a better place for these kinds of questions, as those nurses deal with adults who have brian injuries. Again, they also won't be able to provide much advice because these kinds of questions coming from non-nurses often borders on medical and legal advice. I hope everything works out with your ex-husband and the decisions his family has to make at this point. You are doing everything you can to educate them, you can only hope that the medical personnel taking care of him will fill in the blanks and help them make the appropriate decision, whatever that may be. Another thing you can do is make sure everyone you love has a living will in place, like you mentioned in your last post, so that situations like this can be avoided. I wish you luck and peace.

    Thank you for the well-baby wishes, and I hope your son has a great day! You take care.
    Last edit by Gompers on Dec 19, '06
  14. by   SteveNNP
    On an interesting note, I had a pt last week that we transferred out to another facility that does elective hypothermia. He had been born after being found to have a HR in the 50's at mom's latest US appt. The doc wheeled mom as fast as he could to the OR, intubated and sectioned her, and we got the kid with apgars of 0-1-2-4. He was intubated and brought back to the unit, went into Vtach with a pulse, got Adenocard, converted, and got lines and a quick ride to another facility. (He was a 37 wkr) They paralyzed/sedated him, cooled him to 33c for 72 hours and warmed him up by 1c/hr until normal body temp. He came off the vent, was backtransported, and just went home, a normal-acting newborn. It was quite interesting! I'm wondering what his developmental outcomes will be, but from what I've been reading, they have had much success with this type program.

close