The Use of Hypothermia in Septic Shock

Abstract

DiscussionUntil recently most studies of delayed recall of active tetanus immunization have dealt primarily with the concept that total body immunity is measured by the serum antitoxin levels. It has been shown, and is confirmed in our study, that there is a temporary drop in titer following injection of the toxoid. Ipsen recently has investigated this initial period in rabbits actively immunized against tetanus.5 He noticed an increased survival in rabbits challenged with tetanus toxin immediately following a toxoid booster injection even though an increase in circulating antitoxin could not be demonstrated until 2 days later. Thus it is possible that an individual, once actively immunized, may have protection before the circulating antibodies evoked by active recall are measurable. Since an adequate response can be demonstrated in nearly all previously immunized individuals regardless of the interval that has elapsed since the latest immunization, protection against the development of clinical tetanus possibly can be provided by a fluid toxoid booster alone. This might make it possible to avoid the administration of tetanus antitoxin under these circumstances and the risks inherent in its use. Summary and ConclusionsIt has been shown that there is a "significant response" to a booster injection of fluid tetanus toxoid in individuals 14 to 18 years after their most recent active immunization. A "significant response" occurred in 78% by the 7th day, 95% by the 10th day, and 98% by the 14th day. The longer the time interval the slower the response. This is borne out by comparison with 2 previously reported groups in which the interval was shorter.' ' If enough time is allowed to elapse all groups achieve a good response and are comparable. It has been shown experimentally that even during the lag period before a rise in serum titer occurs in actively immu-nized animals there is an increased survival rate when challenged with tetanus toxin. The total body immunity in a previously actively immunized patient may be sufficient to protect against clinical tetanus in spite of an initial low serum level and the lag in its rise after a booster.If confirmed by further investigation this will be of practical clinical importance, in that a person who has been actively immunized 18 or perhaps more years previously and who is now potentially exposed to tetanus may be protected by a booster dose of fluid toxoid. This would avoid the necessity and hazards of administering antitoxin either alone or in combination with toxoid. This should not be interpreted, however, as an endorsement for allowing such a long interval to pass without routine booster immunizations. On the contrary, more frequent injections would seem to offer a greater margin of safety and protection for the patient. In addition one must not forget the other adjuvants in the prevention of tetanus. Adequate local care of the wound is paramount to the elimination of the source of tetanus toxin.BACTEREMIA producing shock has been observed following both gram-positive ...

Relationship of Body Temperature to the Lethal Action of Bacterial Endotoxin*

“…If this is true, it may carry important therapeutic implications for the clinical management of systemic endotoxin producing infections, particularly in the earlier stages when high fever is commonly present before shock and spontaneous hypothermia supervene. Two reports have appeared in which moderate induced hypothermia has been used in the treatment of septic shock (36,37). In both of these, the authors reported that hypothermia was of some benefit, but the case series were too small to draw valid quantitative conclusions concerning differences in case salvage rate with hypothermia.…”

Effect of hypothermia on splenic leukocyte modulation and survival duration in severely septic rats

“…6 Since then, there have been multiple studies supporting and/or condemning the use of therapeutic hypothermia. 7–12 In experimental studies, therapeutic hypothermia is protective against inflammatory responses and improves survival in animals with severe septic shock.…”

Physiologic Characteristics of Cold Perfluorocarbon-Induced Hypothermia During Partial Liquid Ventilation in Normal Rabbits

“…The target core temperatures (Tcore) were 39°Ϯ 1°C for normothermia and 35°Ϯ 1°C for hypothermia, a 4°C difference, which is comparable to the strategy of mild hypothermia in humans (4,5). Body temperature was determined simultaneously from the PA (Tcore) by a thermistor at the distal end of the PA catheter, and from 5-cm deep in the rectum by a rectal probe (intermediate or shell temperature, Tshell) (14).…”

“…I nduced hypothermia is used in various fields of medicine, e.g., cardiac surgery, ex vivo organ/ tissue preservation, brain injury, sepsis/acute respiratory distress syndrome, with the purpose of preserving tissue integrity in the setting of compromised blood supply or exaggerated inflammation (1)(2)(3)(4)(5). Among various methods of induced hypothermia, body surface cooling is the one most commonly used at the bedside.…”