Restoration of Body Temperature to Normothermia During Resuscitation Following Trauma-Hemorrhage Improves the Depressed Cardiovascular and Hepatocellular Functions

Abstract

Hypothesis: Rewarming the body to 37°C during resuscitation following trauma-hemorrhage has salutary effects on cardiovascular and hepatocellular functions. Design, Interventions, and Main Outcome Measures: Male rats underwent laparotomy (trauma induced) and were then bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the maximum shed blood volume was returned in the form of Ringer lactate solution. Rats were exposed to ambient temperature and allowed to become hypothermic during hemorrhage. The animals were then resuscitated with 4 times the volume of shed blood with Ringer lactate solution for 60 minutes. In 1 group, the body temperature was rewarmed to 37°C during resuscitation. In another group, the body temperature was maintained at hypothermia (32°C) for 4 hours after resuscitation. In an additional group, the body temperature was kept at 37°C during hemorrhage and resuscitation. At 4 hours after resuscitation, the rats were returned to a room with ambient temperature. Various in vivo heart performance variables (maximal rate of pressure increase and decrease), cardiac output, hepatocellular function, and plasma IL-6 level were determined at 24 hours after resuscitation. Results: Either maintenance of normothermia during hemorrhage or prolonged hypothermia following resuscitation had deleterious effects on cardiovascular variables and hepatocellular function and up-regulated plasma IL-6 levels. In contrast, rewarming the body to 37°C during resuscitation improved cardiac contractility, cardiac output, and hepatocellular function and reduced plasma IL-6 level. Conclusion: Since rewarming the body temperature to normothermia during resuscitation improved depressed cardiovascular and hepatocellular functions, this should be considered as a useful adjunct to fluid resuscitation after trauma-hemorrhage.

Effects of environmental hypothermia on hemodynamics and oxygen dynamics in a conscious swine model of hemorrhagic shock

“…Clinical retrospective analysis has suggested that hypothermia is associated with poor outcome in trauma patients. [1][2][3] This supports the recommendations that hypothermia should be avoided in trauma patients. [4,5] The US Emergency War Surgery guidelines require early recognition, aggressive prevention, and treatment of hypothermia (including heat lamps, warmed fluids, forced air heating, and warm water immersion).…”

Pulmonary artery blood temperature at admission to the intensive care unit is predictive of outcome after on‐pump coronary artery bypass surgery

“…However, some recent studies failed to confirm the beneficial effects of hypothermia in patients with traumatic brain injury (24,25). Indeed, hypothermia has been demonstrated to be associated also with several deleterious effects such as acidosis (3), coagulopathy (26), hemodynamic instability (3,16,(27)(28)(29), cardiac arrhythmias (16,27,28,30), ventilatory instability (31-33), reduction of leukocytes and neutrophils (3,34), thrombocytopenia (16,27,34), endotoxemia (35), infectious complications (16,27,28,34,36), and increase of lipase and amylase levels (16,34,37). Most of these adverse effects have been reported only in association with prolonged mild hypothermia.…”

Die Behandlung des hämorrhagischen Schocks

“…In klinischen Studien scheint die Hypothermie mit einer höheren Mortalität assoziiert. Die Gründe hierfür sind wahrscheinlich eine Einschränkung der linksventrikulären Funktion und des HZV sowie eine regionale, hepatische Perfusionsstörung unter Hypothermie [76,77]. Ein weiterer Aspekt ist der negative Effekt der Hypothermie auf das Gerinnungssystem; eine hypotherme Koagulopathie ist mit einem schlechten Outcome korreliert [48].…”