Reason #10 Focusing on depth of hypothermia may distract from the importance of duration of temperature management.
Reason #9 Therapeutic hypothermia increases the risk of infection.
Reason #8 Therapeutic hypothermia may aggravate Torsade de Pointes.
Reason #7 Therapeutic hypothermia may compromise hemodynamics.
Recently a post hoc analysis of the Nielsen trial by Annborn et al. showed a trend towards increased mortality among patients who were cooled to 33C in the presence of shock (figure below). In summary, hypothermia worsens hemodynamics and this could lead to worse outcomes, particularly among patients with shock.
Reason #6 Therapeutic Hypothermia delays accurate neuroprognostication.
Reason #5 Withdrawal of care following induced hypothermia can be ethically problematic.
Reason #4 Cognitive Offloading: Reducing focus on therapeutic hypothermia may allow us to focus more on other aspects of patient care.
Reason #3 We don't fully understand what happens to the body at 33C.
Reason #2 Therapeutic hypothermia to 33C may be less effective in real-world settings than in clinical trials.
Reason #1 The main reason that 33C is still being used may be status quo bias.
Conflicts of interest: None.
- IBCC chapter:Guide to APRV for COVID-19 - April 8, 2020
- PulmCrit Theoretical Post – The COVID Severity Index (CSI 1.0) - April 2, 2020
- PulmCrit wee – Why the SCCM/AARC/ASA/APSF/AACN/CHEST joint statement on split ventilators is wrong. - March 29, 2020