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

Abstract

To test the hypothesis that treatment with hypothermia affects the course of overwhelming acute respiratory failure associated with sepsis. Concurrent-controlled, prospective study. Adult multidisciplinary ICU in a teaching hospital. 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. 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). 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). 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.