Therapeutic Hypothermia and Risk for Pneumonia and Sepsis

Therapeutic Hypothermia and Risk for Pneumonia and Sepsis

Kristi L. Koenig, MD, FACEP, FIFEM reviewing Geurts M et al. Crit Care Med 2013 Aug 28.

In this meta-analysis, patients treated with hypothermia were more likely to develop pneumonia and sepsis, despite no increased prevalence of all infections.

Therapeutic hypothermia is purported to reduce mortality and improve neurological outcomes after cardiac arrest, but at what cost? Researchers performed a systematic review and meta-analysis of 23 randomized controlled trials that involved adult patients treated with therapeutic hypothermia for any indication (e.g., cardiac arrest, traumatic brain injury, invasive procedures) and that reported infections. Duration of cooling ranged from several hours to several days.

Among the 2820 patients, there were 579 infections, including 296 cases of pneumonia and 50 of sepsis. While overall infection rates were similar in the hypothermia and control groups, rates of pneumonia and sepsis were higher in the hypothermia group (risk ratios, 1.44 and 1.80, respectively).

COMMENT

Therapeutic hypothermia is a standard postresuscitation treatment; however, there are associated risks, such as bleeding, cardiac instability, electrolyte imbalances, and infection. Overall, though, this analysis showed no increased risk for infection with therapeutic hypothermia. The subgroup analysis does not prove a causal link between therapeutic hypothermia and pneumonia or sepsis, and the authors rightly call for infection to be part of reporting for future randomized trials of hypothermia.

 Editor Disclosures at Time of Publication

CITATION(S):

1. Geurts M et al. Therapeutic hypothermia and the risk of infection: A systematic review and meta-analysis. Crit Care Med 2013 Aug 28; [e-pub ahead of print]. (http://dx.doi.org/10.1097/CCM.0b013e3182a276e8) 

   
   

- See more at: http://www.jwatch.org/na32169/2013/09/16/therapeutic-hypothermia-and-risk-pneumonia-and-sepsis?query=etoc_jwem#sthash.xvd2Hjfu.dpuf