1Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands. 2Center for Clinical Brain Sciences, Department of Clinical Neurosciences, University of Edinburgh, Scotland, UK. 3Klinik für Neurologie und Neurogeriatrie, Klinikum Darmstadt, Darmstadt, Germany.
Crit Care Med. 2014 Feb;42(2):231-42. doi: 10.1097/CCM.0b013e3182a276e8.
Observational studies suggest that infections are a common complication of therapeutic hypothermia. We performed a systematic review and meta-analysis of randomized trials to examine the risk of infections in patients treated with hypothermia.
PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched for eligible studies up to October 1, 2012.
We included randomized controlled clinical trials of therapeutic hypothermia induced in adults for any indication, which reported the prevalence of infection in each treatment group.
For each study, we collected information about the baseline characteristics of patients, cooling strategy, and infections.
Twenty-three studies were identified, which included 2,820 patients, of whom 1,398 (49.6%) were randomized to hypothermia. Data from another 31 randomized trials, involving 4,004 patients, could not be included because the occurrence of infection was not reported with sufficient detail or not at all. The risk of bias in the included studies was high because information on the method of randomization and definitions of infections lacked in most cases, and assessment of infections was not blinded. In patients treated with hypothermia, the prevalence of all infections was not increased (rate ratio, 1.21 [95% CI, 0.95-1.54]), but there was an increased risk of pneumonia and sepsis (risk ratios, 1.44 [95% CI, 1.10-1.90]; 1.80 [95% CI, 1.04-3.10], respectively).
The available evidence, subject to its limitations, strongly suggests an association between therapeutic hypothermia and the risk of pneumonia and sepsis, whereas no increase in the overall risk of infection was observed. All future randomized trials of hypothermia should report on this important complication.
观察性研究表明，感染是治疗性低温治疗的常见并发症。我们进行了一项系统评价和荟萃分析，以研究接受低温治疗的患者感染的风险。
系统地检索了 PubMed、Embase 和 Cochrane 对照试验中心注册库，以获取截至 2012 年 10 月 1 日的合格研究。
我们纳入了成人任何适应证的治疗性低温诱导的随机对照临床试验，这些试验报告了每个治疗组的感染发生率。
对于每项研究，我们收集了有关患者基线特征、冷却策略和感染的信息。
确定了 23 项研究，共纳入 2820 例患者，其中 1398 例（49.6%）被随机分配至低温组。由于未详细报告或根本未报告感染的发生情况，无法纳入另外 31 项随机试验的数据，这些试验涉及 4004 例患者。纳入研究的偏倚风险较高，因为在大多数情况下，缺乏关于随机分组方法和感染定义的信息，并且对感染的评估未设盲。在接受低温治疗的患者中，所有感染的发生率并未增加（率比 1.21[95%CI，0.95-1.54]），但肺炎和败血症的风险增加（风险比分别为 1.44[95%CI，1.10-1.90]；1.80[95%CI，1.04-3.10]）。
在受其局限性影响的情况下，现有证据强烈提示治疗性低温与肺炎和败血症风险之间存在关联，而未观察到感染总风险增加。所有未来的低温治疗随机试验都应报告这一重要并发症。
