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Value of Mild Hypothermia in Patients Who Have Severe Circulatory Insufficiency Even After Intra-Aortic Balloon Pump

1998; Elsevier BV; Volume: 10; Issue: 2 Linguagem: Inglês

10.1016/s0952-8180(97)00255-9

1873-4529

Staff Naoki Yahagi, Director Keiji Kumon, Staff Yasuhiko Watanabe, Staff Hironobu Tanigami, Staff Masaki Haruna, Staff Hideaki Hayashi, S Imanaka, Staff Muneyuki Takeuchi, Staff Yoko Ohashi, Director Chairman Shinichi Takamoto,

Respiratory Support and Mechanisms

Study Objective: To evaluate the effectiveness of mild hypothermia in postcardiac surgical patients with severe heart failure in spite of conventional medical therapy and the use of intra-aortic balloon pumping (IABP). Design: Prospective, clinical study. Setting: Teaching hospital. Patients: 10 postcardiac surgical patients with severe heart failure despite the use of IABP with massive doses of catecholamine. Interventions: Patients underwent mild hypothermia produced by surface cooling (to approximately 34.5°C). Hemodynamic criteria for the induction of hypothermia included a cardiac index (CI) of less than 2.2 L/min/m2 with a pulmonary capillary wedge pressure (PCWP) of up to 18 mmHg despite the use of IABP with massive doses of catecholamine. Measurements and Main Results: After control measurements had been taken at normal core body temperature (37°C), patients were cooled to approximately 34.5°C (using a cooling blanket and gastric lavage with cold water) to decrease tissue oxygen (O2) demand. Patients showed significant improvements in CI (1.9 ± 0.3 to 2.2 ± 0.3 L/min/m2), mixed venous O2 saturation, (SvO2; 55 ± 7 to 64 ± 6%), and urine output (2.1 ± 1.1 to 3.4 ± 2.2 ml/kg/hr). Patients were rewarmed while SvO2 was being monitored. The duration of the hypothermia was 38 ± 41 hours. Oxygen delivery increased in 8 of the 10 patients, the mean value (±SD) for the group rising from 309 ± 65 ml/min/m2 to 358 ± 57 ml/min/m2 as temperature was reduced from 36.7 ± 0.4°C to 34.7 ± 0.3°C. All patients were successfully weaned from IABP at 140 ± 107 hours after admission to the intensive care unit. Conclusions: Mild hypothermia is a simple and useful procedure for improving the circulation of postcardiac surgical patients with severe heart failure despite the use of IABP.