Department of Emergency Medicine, University of Texas at Southwestern Medical Center, Dallas, Texas, USA.
Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Ther Hypothermia Temp Manag. 2023 Dec;13(4):225-229. doi: 10.1089/ther.2023.0030. Epub 2023 Aug 2.
Fever is a recognized protective factor in patients with sepsis, and growing data suggest beneficial effects on outcomes in sepsis with elevated temperature, with a recent pilot randomized controlled trial (RCT) showing lower mortality by warming afebrile sepsis patients in the intensive care unit (ICU). The objective of this prospective single-site RCT was to determine if core warming improves respiratory physiology of mechanically ventilated patients with coronavirus disease 2019 (COVID-19), allowing earlier weaning from ventilation, and greater overall survival. A total of 19 patients with mean age of 60.5 (±12.5) years, 37% female, mean weight 95.1 (±18.6) kg, and mean body mass index 34.5 (±5.9) kg/m with COVID-19 requiring mechanical ventilation were enrolled from September 2020 to February 2022. Patients were randomized 1:1 to standard of care or to receive core warming for 72 hours through an esophageal heat exchanger commonly utilized in critical care and surgical patients. The maximum target temperature was 39.8°C. A total of 10 patients received usual care and 9 patients received esophageal core warming. After 72 hours of warming, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratios were 197 (±32) and 134 (±13.4), cycle thresholds were 30.8 (±6.4) and 31.4 (±3.2), ICU mortalities were 40% and 44%, 30-day mortalities were 30% and 22%, and mean 30-day ventilator-free days were 11.9 (±12.6) and 6.8 (±10.2) for standard of care and warmed patients, respectively ( = NS). This pilot study suggests that core warming of patients with COVID-19 undergoing mechanical ventilation is feasible and appears safe. Optimizing time to achieve febrile-range temperature may require a multimodal temperature management strategy to further evaluate effects on outcome. ClinicalTrials.gov Identifier: NCT04494867.
发热是脓毒症患者公认的保护因素，越来越多的数据表明，发热对脓毒症患者的结局有有益影响，最近一项前瞻性单中心随机对照试验（RCT）显示，在重症监护病房（ICU）中对无热脓毒症患者进行体温升高的加温可降低死亡率。这项前瞻性单中心 RCT 的目的是确定核心加温是否能改善 COVID-19 机械通气患者的呼吸生理，使患者更早脱机，并提高总体生存率。共有 19 名平均年龄为 60.5（±12.5）岁、女性占 37%、平均体重 95.1（±18.6）kg、平均 BMI 为 34.5（±5.9）kg/m2 的 COVID-19 患者需要机械通气，他们于 2020 年 9 月至 2022 年 2 月期间在本研究中心纳入。患者按 1:1 随机分配至标准治疗组或接受 72 小时食管热交换器核心加温治疗，该热交换器常用于重症监护和外科患者。最大目标温度为 39.8°C。共有 10 名患者接受常规治疗，9 名患者接受食管核心加温。加温 72 小时后，动脉血氧分压与吸入氧分数比值（PaO2/FiO2）分别为 197（±32）和 134（±13.4），循环阈值分别为 30.8（±6.4）和 31.4（±3.2），ICU 死亡率分别为 40%和 44%，30 天死亡率分别为 30%和 22%，常规治疗和加温治疗患者的 30 天无呼吸机天数分别为 11.9（±12.6）和 6.8（±10.2）（无统计学差异）。这项初步研究表明，对 COVID-19 机械通气患者进行核心加温是可行的，而且似乎是安全的。优化达到发热范围温度的时间可能需要采用多模式体温管理策略来进一步评估对结局的影响。临床试验.gov 标识符：NCT04494867。
