DOI: 10.1097/01.CCM.0000208152.58639.5E
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PMID: 16550094
Issn Print: 0090-3493
Publication Date: 2006/04/01
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Excerpt
Induced hypothermia has long been used in medicine. The main rationale for systemic body cooling is to protect the organs highly sensitive to compromised oxygen supply, such as the brain, heart, and kidneys during extreme conditions including cardiac surgery, cardiac arrest, or various forms of trauma. Moderate hypothermia has been shown to be beneficial in many human and animal studies. However, there are controversial reports that raise a significant question about the effectiveness and safety of therapeutic systemic hypothermia. Recently, it was reported that normothermic cardiopulmonary bypass resulted in less organ dysfunction and improved outcome in adults (2, 3) and less oxidative stress in children compared with hypothermic cardiopulmonary bypass (4). Hall et al. (5) demonstrated that hypothermia-induced platelet aggregation might be associated with an added risk of cognitive decline following coronary artery bypass grafts. Knappe et al. (6) suggested that systemic hypothermia may aggravate soft-tissue trauma-associated microcirculatory dysfunction. Takasu et al. (7) reported that hypothermia failed to prolong survival after hemorrhagic shock in rats. There are few human or animal studies that report long-term effects of hypothermia. The article by Dr. Huang and colleagues (1) is one of the first reports documenting systemic hypothermia that reduced pathophysiology of smoke inhalation injury. However, the salutary effects of cooling are limited to only a 5-hr time period.
It is well known that systemic hypothermia is frequently complicated by pneumonia (8). The incidence of pneumonia following hypothermia is double that of normothermic patients (9). It is also well documented that pneumonia is a detrimental complication of smoke inhalation that may lead to development of acute respiratory distress syndrome and/or sepsis. About 38% of patients with inhalation injury develop subsequent pneumonia with standard care (10). Therefore, there is an enhanced demand for longitudinal outcome studies that reveal the effect of systemic hypothermia on multiple organ function following smoke inhalation. Future studies should consider the possible negative effects of rewarming after hypothermia. Future studies should also carefully weigh both beneficial and detrimental effects of systemic hypothermia.
