Kim Se Heon, Sul Younghoon, Ye Jin Bong, Lee Jin Young, Lee Jin Suk
Department of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.
Department of Trauma Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Medicine (Baltimore). 2025 Jan 17;104(3):e41349. doi: 10.1097/MD.0000000000041349.
Hypothermia, defined as a core body temperature below 35°C, is a common and serious complication in severe trauma patients, often worsened by hemorrhage and medical interventions. Dexmedetomidine, an α2-adrenergic agonist used for sedation in intensive care units, has known thermoregulatory effects; however, its association with hypothermia in trauma patients remains insufficiently explored.
A 40-year-old male with severe polytrauma from a motor vehicle accident presented in distress, with hypotension, tachycardia, and a baseline temperature of 35.8°C. Despite effective management, he developed profound hypothermia, with a recorded temperature dropping below 34.0°C after switching from midazolam to dexmedetomidine for sedation.
The patient had multiple bilateral rib fractures, a right-sided pneumothorax, and grade 3 liver and grade 5 splenic injuries, along with orthopedic fractures. His Injury Severity Score signified critical trauma, increasing the risk of complications like hypothermia.
Following stabilization, dexmedetomidine was administered for sedation. Continuous warming interventions were initiated to address hypothermia; however, the temperature continued to decline. Suspecting dexmedetomidine's contribution, its administration was discontinued.
After stopping dexmedetomidine, the patient's temperature gradually recovered to 36.8°C within 5 hours. He demonstrated improved consciousness and stable vital signs, subsequently undergoing 2 successful orthopedic surgeries and discharging without further hypothermia-related issues.
This case highlights dexmedetomidine's potential to induce hypothermia in critically ill trauma patients. It stresses the importance of careful temperature monitoring and proactive thermoregulation during sedative administration in intensive care. Further research is needed to explore the prevalence and mechanisms of dexmedetomidine-associated hypothermia in trauma populations.
体温过低定义为核心体温低于35°C，是严重创伤患者常见且严重的并发症，常因出血和医疗干预而加重。右美托咪定是一种用于重症监护病房镇静的α2肾上腺素能激动剂，已知具有体温调节作用；然而，其与创伤患者体温过低的关联仍未得到充分研究。
一名40岁男性因机动车事故导致严重多发伤，出现痛苦面容，伴有低血压、心动过速，基线体温为35.8°C。尽管进行了有效治疗，但在从咪达唑仑换用右美托咪定进行镇静后，他出现了严重体温过低，记录体温降至34.0°C以下。
患者有多发性双侧肋骨骨折、右侧气胸、3级肝损伤和5级脾损伤，以及骨科骨折。他的损伤严重程度评分表明为严重创伤，增加了体温过低等并发症的风险。
在病情稳定后，给予右美托咪定进行镇静。启动持续升温干预措施以应对体温过低；然而，体温仍持续下降。怀疑是右美托咪定的作用，遂停止使用。
停用右美托咪定后，患者体温在5小时内逐渐恢复至36.8°C。他的意识有所改善，生命体征稳定，随后成功接受了2次骨科手术，出院时未出现与体温过低相关的进一步问题。
该病例突出了右美托咪定在重症创伤患者中诱发体温过低的可能性。强调了在重症监护中镇静给药期间仔细监测体温和积极进行体温调节的重要性。需要进一步研究以探讨右美托咪定相关体温过低在创伤人群中的发生率和机制。
