Sepsis why hypothermia

Author s : Adith Sekaran, MD. Infectious Diseases Critical Care. Quality Geographic cohorting increased direct care time and interruptions Publish date: October 20, Practice Management What does it mean to be a trustworthy male ally? Publish date: November 10, From the Society Mean leadership Publish date: September 23, Matt Aldrich Publish date: March 30, Sepsis is the systemic inflammatory response to infection.

Like coagulation, the systemic response relies on the complex interaction of multiple proteins. Fever is a characteristic sign of infection, but sepsis may also present as hypothermia, as emphasized in the International Sepsis Definitions Conference Washington, D. Fever, clearly, is an important adaptive response that should be preserved.

For example, it has long been clinical practice to treat fever in patients with infection. This practice is now being questioned. Active external cooling of healthy volunteers with fever does not reduce core temperature, but it increases metabolic rate and activates the autonomic nervous system. What are the mechanisms for an abnormal immune response in the setting of hypothermia? Both humoral and cellular immunity are adversely affected with lower temperature.

In bacterial infections, neutrophil chemotaxis is an essential component of host defense. Hypothermia inhibits both neutrophil chemotaxis and killing via the respiratory burst, and delays induction of pro-inflammatory cytokine production by macrophages.

Although the mortality data are robust, it is premature to speculate on mechanisms. It is tempting to conclude that the harmful effects of hypothermia were reversed via G-CSF's stimulation of neutrophil function, but close examination of the data suggests caution. For example, although neutrophil counts were increased by both hypothermia and G-CSF, functional phagocytic activity was not different in any of the groups.

Cytokine and chemokine levels were decreased by normothermia and G-CSF, but little is known about what levels of these proteins are appropriate. It may be that G-CSF's salutary effects were on other leukocytes or on other aspects of neutrophil function. Cytokine concentrations are difficult to interpret in any study; recent data suggest that cytokine levels must be interpreted in the context of time and space, with high levels of pro-inflammatory cytokines advantageous early in infection and harmful later.

How, then, should we proceed in patients in whom induced hypothermia is contemplated and who are at risk for systemic infection? Hypothermia alone clearly results in an increased rate of wound infection, coagulopathy, and other postoperative complications 5 ; therefore, it should be used sparingly.

More promising therapies using focal cooling, especially for the brain, are on the horizon. The data to date do not support this practice. However, enough provocative animal and human data now exist to justify a large, randomized trial. Sign In or Create an Account. Advanced Search. Sign In. Skip Nav Destination Article Navigation. Close mobile search navigation Article navigation. Hypothermia in the sepsis syndrome and clinical outcome.

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The authors acknowledge all members of the MARS consortium for the participation in data collection and especially acknowledge: Friso M. Glas, MD, Roosmarijn T. The datasets supporting the results of this article are available on request, which may be addressed to m. All authors critically reviewed the manuscript. All authors read and approved the final version of this manuscript. Maryse A. Wiewel, Lonneke A. Scicluna, Arie J. Joost Wiersinga. Matthew B. Harmon, Janneke Horn, Marcus J.

You can also search for this author in PubMed Google Scholar. Correspondence to Matthew B. Selection of study patients. Table S1. Causative pathogens. Table S2. Multivariable logistic regression analysis to identify risk factors for hypothermia. Table S3. Outcomes of sepsis patients with and without hypothermia during the first 24 h of admission. Table S4. Association between hypothermia and day mortality in patients with sepsis, adjusted for confounders.

Table S5. Clinical characteristics of sepsis patients included in ex vivo whole blood stimulation analysis. Table S6. DOC kb. Reprints and Permissions. Wiewel, M. Risk factors, host response and outcome of hypothermic sepsis.

Crit Care 20, Download citation. Received : 31 May Accepted : 26 September Published : 14 October Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Wiewel 1 , Matthew B. Harmon 2 , Lonneke A. Scicluna 1 , Arie J. Hoogendijk 1 , Janneke Horn 2 , Aeilko H. Zwinderman 3 , Olaf L.