Hypothermia as a predictor for mortality in trauma patients at admittance to the intensive care unit

Abstract

Aims:To study the impact of hypothermia upon admission to the Intensive Care Unit (ICU) on early and late mortality and to develop a prediction model for late mortality in severely injured trauma patients.Materials and Methods:A multicenter retrospective cohort study was performed in adult trauma patients admitted to the ICU of two Level-1 trauma centers between 2007 and 2012. Hypothermia was defined as a core body temperature of ≤35° Celsius. Logistic regression analyses were performed to quantify the effect of hypothermia on 24-hour and 28-day mortality and to develop a prediction model.Results:A total of 953 patients were included, of which 354 patients had hypothermia (37%) upon ICU admission. Patients were divided into a normothermic or hypothermic group. Hypothermia was associated with a significantly increased mortality at 24 hours and 28 days (OR 2.72 (1.18-6.29 and OR 2.82 (1.83-4.35) resp.). The variables included in the final prediction model were hypothermia, age, APACHE II score (corrected for temperature), INR, platelet count, traumatic brain injury and Injury Severity Score. The final prediction model discriminated between survivors and non-survivors with high accuracy (AUC = 0.871, 95% CI 0.844-0.898).Conclusions:Hypothermia, defined as a temperature ≤35° Celsius, is common in critically ill trauma patients and is one of the most important physiological predictors for early and late mortality in trauma patients. Trauma patients admitted to the ICU may be at high risk for late mortality if the patient is hypothermic, coagulopathic, severely injured and has traumatic brain injury or an advanced age.

A Novel Cooling Method and Comparison of Active Rewarming of Mildly Hypothermic Subjects

“…19 A recommended prehospital rewarming treatment used by search and rescue teams, emergency medical services, and the military is administration of warmed intravenous fluids (IVF). 3,[19][20][21][22][23] Prior to administration, IVF should be warmed to 38 to 421C, [1][2][3] as 211C (room temperature) IVF decreases normothermic core temperatures by 0.31C/L. 24 A liter of 401C IVF provides 8 kcal of heat directly into circulating normothermic blood.…”

Hipotermia pourazowa jako wyzwanie dla personelu zespołów ratownictwa medycznego

“…obliczyli, że hipotermia była związana z istotnie większą śmiertelnością w 1. i 2. dobie po urazie, kolejno: OR = 2,72 (1,18-6,29) i OR = 2,82 (1,35). Wykazano także częstsze występowanie zespołu ostrej niewydolności oddechowej dorosłych [18,19]. Z kolei Martin i wsp.…”

Therapeutic Whole-Body Hypothermia Reduces Death in Severe Traumatic Brain Injury if the Cooling Index Is Sufficiently High: Meta-Analyses of the Effect of Single Cooling Parameters and Their Integrated Measure

“…13 Over the last 25 years, numerous clinical trials have been conducted to assess the effects of induced hypothermia in severe TBI. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Cooling of patients with severe TBI improved the outcome in several of these studies, 14,17,5 Journal of Neurotrauma Therapeutic whole-body hypothermia reduces mortality in severe traumatic brain injury if the cooling index is sufficiently high: meta-analyses of the effect of single cooling parameters and their integrated measure (DOI: 10.1089(DOI: 10. /neu.2018 This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction.…”