Journal article
Therapeutic Hyperthermia Is Associated With Improved Survival in Afebrile Critically Ill Patients With Sepsis: A Pilot Randomized Trial
Critical care medicine, Vol.50(6), pp.924-934
06/01/2022
DOI: 10.1097/CCM.0000000000005470
PMCID: PMC9133030
PMID: 35120040
Abstract
To test the hypothesis that forced-air warming of critically ill afebrile sepsis patients improves immune function compared to standard temperature management.
Single-center, prospective, open-label, randomized controlled trial.
One thousand two hundred-bed academic medical center.
Eligible patients were mechanically ventilated septic adults with: 1) a diagnosis of sepsis within 48 hours of enrollment; 2) anticipated need for mechanical ventilation of greater than 48 hours; and 3) a maximum temperature less than 38.3°C within the 24 hours prior to enrollment. Primary exclusion criteria included: immunologic diseases, immune-suppressing medications, and any existing condition sensitive to therapeutic hyperthermia (e.g., brain injury). The primary outcome was monocyte human leukocyte antigen (HLA)-DR expression, with secondary outcomes of CD3/CD28-induced interferon gamma (IFN-γ) production, mortality, and 28-day hospital-free days.
External warming using a forced-air warming blanket for 48 hours, with a goal temperature 1.5°C above the lowest temperature documented in the previous 24 hours.
We enrolled 56 participants in the study. No differences were observed between the groups in HLA-DR expression (692 vs 2,002; p = 0.396) or IFN-γ production (31 vs 69; p = 0.678). Participants allocated to external warming had lower 28-day mortality (18% vs 43%; absolute risk reduction, 25%; 95% CI, 2-48%) and more 28-day hospital-free days (difference, 2.6 d; 95% CI, 0-11.6).
Participants randomized to external forced-air warming did not have a difference in HLA-DR expression or IFN-γ production. In this pilot study, however, 28-day mortality was lower in the intervention group. Future research should seek to better elucidate the impact of temperature modulation on immune and nonimmune organ failure pathways in sepsis.
Details
- Title: Subtitle
- Therapeutic Hyperthermia Is Associated With Improved Survival in Afebrile Critically Ill Patients With Sepsis: A Pilot Randomized Trial
- Creators
- Anne M Drewry - Roy J. and Lucille A. Carver College of MedicineNicholas M Mohr - Department of Medicine, Washington University School of Medicine, St. Louis, MOEnyo A Ablordeppey - Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MOCatherine M Dalton - Department of Anesthesiology, Washington University School of Medicine, St. Louis, MORebecca J Doctor - Department of Anesthesiology, Washington University School of Medicine, St. Louis, MOBrian M Fuller - Department of Anesthesiology, Washington University School of Medicine, St. Louis, MOMarin H Kollef - Department of Medicine, Washington University School of Medicine, St. Louis, MORichard S Hotchkiss - Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.50(6), pp.924-934
- DOI
- 10.1097/CCM.0000000000005470
- PMID
- 35120040
- PMCID
- PMC9133030
- NLM abbreviation
- Crit Care Med
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Language
- English
- Date published
- 06/01/2022
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984295947102771
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