{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T21:09:35Z","timestamp":1758056975492,"version":"3.44.0"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Aim of the study:<\/jats:title>\n            <jats:p>Hypothermia as the major clinical feature at emergency admission poses a low-frequency yet complex and life-threatening challenge. Limited knowledge about its morbidity, mortality, and influencing factors contributes to the absence of standardized guidelines for rewarming treatments. This retrospective study, the first of its kind in Portugal, aims to fill this gap by examining hypothermic patients in a temperate climate, exploring rewarming treatments, mortality factors, and complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Conducted at the Emergency Department of Centro Hospitalar Vila Nova de Gaia\/Espinho, the study spanned from January 2008 to December 2020. Sixty-two patients with body temperatures below 35\u00baC were included. Data collection focused on patient background, clinical presentation, hypothermia mechanism, reperfusion treatment, and laboratory results. Clinical infection was defined based on symptoms and imaging findings.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The study revealed a diverse cohort, with an average age of 82 and a mortality rate of 33.9%. Clinical infection was prevalent in 51.6% of patients, mostly respiratory (59.4%). Rewarming treatments varied, and no specific method showed significant advantage. Complications included rhabdomyolysis, and late deaths were primarily attributed to infectious diseases, particularly pneumonia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Taking into account its high mortality rate, accidental hypothermia, demands further research and multicenter data collection for evidence-based treatment strategies. Clinical infection emerged as a significant factor in mortality, prompting a call for increased attention to infectious disease identification and treatment during hypothermic episodes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/j.pbj.0000000000000300","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T11:00:45Z","timestamp":1757329245000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Infection\u2014key in treating hypothermia?"],"prefix":"10.1097","volume":"10","author":[{"given":"Tiago","family":"Beir\u00e3o","sequence":"first","affiliation":[{"name":"Rheumatology Department, Centro Hospitalar Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}]},{"given":"Guilherme","family":"Jesus","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}]},{"given":"In\u00eas Pinto","family":"Pereira","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Centro Hospitalar Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}]},{"given":"Milton","family":"Severo","sequence":"additional","affiliation":[{"name":"ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Portugal"}]},{"given":"Joana","family":"Cochicho","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}]}],"member":"276","published-online":{"date-parts":[[2025,9]]},"reference":[{"issue":"3","key":"R1-20250915","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/S0300-9572(03)00237-5","article-title":"Outcome from severe accidental hypothermia in Southern Finland-a 10-year review","volume":"59","author":"Silfvast","year":"2003","journal-title":"Resuscitation"},{"issue":"Suppl 1","key":"R2-20250915","doi-asserted-by":"crossref","first-page":"S135","DOI":"10.1016\/j.resuscitation.2005.10.004","article-title":"European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances","volume":"67","author":"Soar","year":"2005","journal-title":"Resuscitation"},{"key":"R3-20250915","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1111\/j.1440-172X.2006.00589.x","article-title":"Nursing and medical staff knowledge regarding the monitoring and management of accidental or exposure hypothermia in adult major trauma patients","volume":"12","author":"Ireland","year":"2006","journal-title":"Int J Nurs Pract"},{"key":"R4-20250915","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1089\/152702903321489031","article-title":"The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation","volume":"4","author":"Durrer","year":"2003","journal-title":"High Alt Med Biol"},{"key":"R5-20250915","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/00063110-199503000-00009","article-title":"Accidental hypothermia: incidence, risk factors and clinical course of patients admitted to hospital","volume":"2","author":"Bierens","year":"1995","journal-title":"Eur J Emerg Med"},{"key":"R6-20250915","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1378\/chest.120.6.1998","article-title":"Severe accidental hypothermia treated in an ICU: prognosis and outcome","volume":"120","author":"Vassal","year":"2001","journal-title":"Chest"},{"key":"R7-20250915","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/j.resuscitation.2010.05.023","article-title":"Accidental hypothermia: rewarming treatments, complications and outcomes from one university medical centre","volume":"81","author":"van der Ploeg","year":"2010","journal-title":"Resuscitation"},{"key":"R8-20250915","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1080\/00313020701716466","article-title":"Hypothermia fatalities in a temperate climate: Sydney, Australia","volume":"40","author":"Lim","year":"2008","journal-title":"Pathology"},{"key":"R9-20250915","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/0300-9572(96)00983-5","article-title":"Accidental hypothermia","volume":"32","author":"Lloyd","year":"1996","journal-title":"Resuscitation"},{"key":"R10-20250915","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/B978-0-444-63912-7.00010-2","article-title":"Shivering and nonshivering thermogenesis in skeletal muscles","volume":"156","author":"Blondin","year":"2018","journal-title":"Handb Clin Neurol"},{"key":"R11-20250915","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1152\/physrev.00038.2012","article-title":"Exercise, GLUT4, and skeletal muscle glucose uptake","volume":"93","author":"Richter","year":"2013","journal-title":"Physiol Rev"},{"key":"R12-20250915","doi-asserted-by":"crossref","first-page":"b2085","DOI":"10.1136\/bmj.b2085","article-title":"The management of accidental hypothermia","volume":"338","author":"Headdon","year":"2009","journal-title":"BMJ"},{"key":"R13-20250915","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/S0272-6386(98)70057-5","article-title":"Acute renal failure in accidental hypothermia of cold water immersion","volume":"31","author":"Yoshitomi","year":"1998","journal-title":"Am J Kidney Dis"},{"key":"R14-20250915","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s13049-019-0636-0","article-title":"An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature","volume":"27","author":"Pasquier","year":"2019","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"R15-20250915","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1161\/01.RES.10.2.148","article-title":"Mechanism of ventricular fibrillation in hypothermia","volume":"10","author":"Covino","year":"1962","journal-title":"Circ Res"},{"key":"R16-20250915","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.cryobiol.2008.09.006","article-title":"Changes in cardiovascular beta-adrenoceptor responses during hypothermia","volume":"57","author":"Han","year":"2008","journal-title":"Cryobiology"},{"key":"R17-20250915","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1136\/pgmj.2007.066050","article-title":"Multi-system complications of hypothermia: a case of recurrent episodic hypothermia with a review of the pathophysiology of hypothermia","volume":"84","author":"Alty","year":"2008","journal-title":"Postgrad Med J"},{"key":"R18-20250915","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s00101-007-1220-y","article-title":"Why 37 degrees C? Evolutionary fundamentals of thermoregulation","volume":"56","author":"Singer","year":"2007","journal-title":"Anaesthesist"},{"key":"R19-20250915","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/0300-9572(94)90021-3","article-title":"Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest","volume":"27","author":"Mair","year":"1994","journal-title":"Resuscitation"},{"key":"R20-20250915","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.resuscitation.2010.01.037","article-title":"Prognostic factors in avalanche resuscitation: a systematic review","volume":"81","author":"Boyd","year":"2010","journal-title":"Resuscitation"},{"key":"R21-20250915","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.amjsurg.2003.12.016","article-title":"Pathophysiologic changes and effects of hypothermia on outcome in elective surgery and trauma patients","volume":"187","author":"Hildebrand","year":"2004","journal-title":"Am J Surg"}],"container-title":["Porto Biomedical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/j.pbj.0000000000000300","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T19:00:27Z","timestamp":1757962827000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/j.pbj.0000000000000300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":21,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/j.pbj.0000000000000300","relation":{},"ISSN":["2444-8672"],"issn-type":[{"type":"electronic","value":"2444-8672"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2024-08-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}