Effects of induced hypothermia in patients with septic adult respiratory distress syndrome.

OBJECTIVE

To test the hypothesis that treatment with hypothermia affects the course of overwhelming acute respiratory failure associated with sepsis.

DESIGN

Concurrent-controlled, prospective study.

SETTING

Adult multidisciplinary ICU in a teaching hospital.

PATIENTS

Nineteen consecutive patients with septic ARDS mechanically ventilated and a P(A-a)O2 > 500 Torr during 36 h on > or = 10 cm H2O of PEEP.

INTERVENTIONS

Patients were assigned to receive conventional treatment (n = 10) or conventional treatment plus mild hypothermia (32-35 degrees C) instituted as a last resort (n = 9).

RESULTS

Hypothermia (33.7 +/- 0.6 degrees C) was associated with a reduction in mortality rate (67% vs. 100%, P < 0.05), P(A-a)O2 (P < 0.001), heart rate (P < 0.001), cardiac index (P < 0.01), and QS/QT (P < 0.01). There were no significant differences in oxygen consumption (VO2) before (243 +/- 74 ml/min) and during treatment with hypothermia (246 +/- 87 ml/min) although O2 extraction increased during hypothermia (26 +/- 6 vs. 30 +/- 6%, P < 0.05).

CONCLUSIONS

This study suggests that hypothermia was effective in improving oxygenation and survival in patients with severe ARDS associated with sepsis, even though VO2 was unchanged.