Hypothermia and Sepsis

Discussion in 'Critical Care' started by waterski232002, Apr 21, 2007.

  1. waterski232002

    waterski232002 Senior Member
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    Anyone read any articles on using therapeutic hypothermia and sepsis? Has this been studied? The only articles I could find were from the 1950's and 1960's.
     
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  3. Hernandez

    Hernandez Paranoid and Crotchety...
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    Effects of mild induced hypothermia during experimental sepsis *
    [Laboratory Investigations]

    L'Her, Erwan MD, PhD; Amerand, Aline; Vettier, Aurélie PhD; Sebert, Philippe PhD
    From Medical Intensive Care Unit, University Hospital, Brest Cedex, France (EL); and Unité de Physiologie Comparée et Intégrative EA 3879, Université de Bretagne, Occidentale, Brest, France (EL, AA, AV, PS).
    The authors have not disclosed any potential conflicts of interest.
    Abstract

    Objectives: The potential advantages of lowering core temperature during sepsis are to lower energy requirement and to activate various cell-protecting pathways. We experimentally investigated whether postconditioning temperature modifications influence survival duration during experimental sepsis.

    Design: A prospective, randomized, experimental animal study.

    Setting: University laboratory.

    Subjects: Eighteen male Sprague-Dawley rats (median 326 g, range 310–347 g).

    Interventions: After anesthesia, experimental sepsis was induced by cecal ligation and perforation. The animals were subsequently assigned a core temperature range: normothermia (37°C), hyperthermia (42°C), and mild hypothermia (32°C). Anesthesia and analgesia were continuously maintained until death.

    Measurements and Main Results: Plasma lactate and pyruvate concentrations were measured at sepsis induction (H0), 4 hrs later (H4), and/or at the time of death. A significant increase in lactate concentration was observed at the time of death in the 42&#176;C group (p = .04). Lactate-to-pyruvate ratio increased in the 32&#176;C (at H4) and 42&#176;C (at the time of death) groups (p = .04). A linear correlation between a longer survival duration and a lower assigned core temperature was observed (from 61 &#177; 10 mins at 42&#176;C to 289 &#177; 17 mins at 37&#176;C and to 533 &#177; 69 mins at 32&#176;C; R2 = .959, p < .0001).

    Conclusions: The current results demonstrate that postconditioning hypothermia was associated with increased survival duration during experimental sepsis. Whether the observed benefits on survival duration are due to potential impacts on energy metabolism or to an anti-inflammatory effect of hypothermia requires further investigation.
     
  4. Hernandez

    Hernandez Paranoid and Crotchety...
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    Fever control in septic shock: beneficial or harmful?.
    Shock. 23(6):516-20, 2005 Jun.

    Abstract The beneficial effects of interventions to control fever in sepsis are controversial. We investigated whether the use of acetaminophen and external cooling is beneficial to control fever in septic shock. We studied 24 fasted, anesthetized, invasively monitored, mechanically ventilated female sheep (27.0 +/- 4.6 kg) that received 0.5 g/kg body weight of feces into the abdominal cavity to induce sepsis. Ringer's lactate (RL) was titrated to maintain pulmonary artery occlusion pressure (PAOP) at baseline levels throughout the experimental period. During the 2 h after the surgical operation, animals were placed in the hypothermia group if their temperature fell below 36.0 degrees C; the other animals were randomized to three groups: high fever (T > 39.0 degrees C), mild fever (37.5 degrees C < T < 38.5 degrees C), and normothermia (36.0 degrees C < T < 37.0 degrees C). The administration of 25 mg/kg acetaminophen every 4 to 6 h combined with external cooling (ice pad) was used to control core temperature in these three groups. The PaO2/FiO2 ratio was higher and blood lactate concentration was lower in the high fever than in the other groups (P < 0.01 and 0.05, respectively). Survival time was longer in the high fever group (25.2 +/- 3.0 h) than in the mild fever (17.7 +/- 3.5 h), normothermia (16.0 +/- 1.9 h), and hypothermia (18.5 +/- 2.5 h) groups (P < 0.05 for all). Plasma heat shock protein (HSP) 70 levels were higher in the two fever groups than in the other groups (P < 0.05). In this clinically relevant septic shock model, the febrile response thus resulted in better respiratory function, lower blood lactate concentration, and prolonged survival time. Antipyretic interventions including acetaminophen and external cooling were associated with lower circulating HSP70 levels. These data challenge the temperature control practices often used routinely in acutely ill patients.
     
  5. Hernandez

    Hernandez Paranoid and Crotchety...
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    and another one about temp control, although not what you're looking for

    Correction of perioperative hypothermia decreases experimental sepsis mortality by modulating the inflammatory response
    [Laboratory Investigations]

    Xiao, Hongyan MD; Remick, Daniel G. MD
    From the Department of Pathology, University of Michigan, Ann Arbor, Michigan.
    This project was supported by grant GM 44918.
    Address requests for reprints to: Daniel Remick, MD, 2210 Medical Science I Building, 1301 Catherine Road, Ann Arbor, MI 48109-0602. E-mail: [email protected]
    Abstract

    Objective: The objective of this study was to investigate if the correction of perioperative hypothermia improves sepsis survival.

    Design: Mice with anesthesia-induced perioperative hypothermia had sepsis induced by cecal ligation and puncture and were treated with fluid resuscitation and antibiotics. The mice were either warmed (35&#176;C) or kept at room temperature for 1 hr in the immediate postoperative period.

    Setting: This study was conducted at a university research laboratory.

    Subjects: This study included adult, female outbred mice.

    Interventions: Immediately after surgery, mice were randomized to 1 hr of warming or maintained at room temperature. Warming was accomplished by placing the mice in a cage preheated to 35&#176;C.

    Measurement and Main Results: The anesthesia-induced hypothermia resolved within 10 hrs, and perioperative warming reestablished normothermia within 1 hr. Restoring normothermia improved sepsis survival from 42% to 60% (p < .02). Warming also significantly corrected the changes in body weight, reflecting improved overall physiological status. To examine the mechanism of this beneficial response, plasma levels of interleukin-6 were assessed. Warming was associated with a decrease in interleukin-6 levels in both those mice that died as well as survivors, reflecting a blunting but not complete inhibition of the inflammatory response. Among surviving mice, warming also significantly increased the peripheral blood cell count, including the neutrophils, an indication that warming augmented innate immunity.

    Conclusions: Correction of perioperative hypothermia improves survival after sepsis by appropriately modulating the early inflammatory response.
     
  6. fedes

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    Hi! Just had the same thought, and came across this long lost post. Has there been any new evidence in the last years? Isnt it a compelling theory?
    Thanks,
    F
     
  7. musikmonk

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    Rivers in Detroit was randomizing pts in theraputic hypothermia study for sepsis around 4 yrs back when i rotated in his SICU.. Don't know if he published his findings tho..
     
  8. DrDawg

    DrDawg Member
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    I recently read a review of fever in Critical Care Medicine from 2009. Vol 37 S273. Very poor lit on this in general. Many studies would say that in human septic patients hypothermia is associated with worse outcomes.
     
  9. turkeyjerky

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    I would assume that you're referring to patients who are hypothermic on presentation, and not to induced hypothermia, right?
     

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