by Kim, Jun Hyun; Nagy, Ádám; Putzu, Alessandro; Belletti,
Alessandro; Biondi-Zoccai, Giuseppe; Likhvantsev, Valery V.; Yavorovskiy,
Andrey G.; Landoni, Giovanni
Critical Care
Medicine: July 2020 -
Volume 48 - Issue 7 - p 1047-1054
Objectives: To
investigate the effect of the application of therapeutic hypothermia (32–35°C)
on survival and major clinical endpoints in critically ill patients.
Data Sources: We
searched online database and clinical trial registries dated up to April 30,
2019, and references of relevant studies. Study Selection: Low risk of bias
randomized trials which compared hypothermia applied for at least 24 hours and
conventional therapy in critically ill patients were included. We excluded
trials investigating therapeutic hypothermia in indications already supported
by international guidelines (adult cardiac arrest and hypoxic-ischemic
encephalopathy of newborns) or intraoperative hypothermia.
Data Extraction:
Titles and abstracts were reviewed independently by two authors. If the
articles seemed eligible, full-text articles were reviewed, and data were
abstracted using a structured template.
Data Synthesis:
Our search retained 14 low risk of bias randomized trials (2,670 patients)
performed in three different settings: traumatic brain injury, serious
infections, and stroke. Therapeutic hypothermia was associated with an increase
in mortality at longest follow-up available (432/1,375 [31%] vs 330/1,295
[25%]; risk ratio, 1.24; 95% CI, 1.10–1.39; p = 0.0004; I2 = 0%). Pooled
results showed no difference of good neurologic outcome among survivors between
the two treatment arms (493/1,142 [43%] vs 486/1,067 [46%]; risk ratio, 1.04;
95% CI, 0.97–1.12; p = 0.27; I2 = 1%). Arrhythmias were significantly increased
among patients undergoing therapeutic hypothermia. We found no difference
between groups in pneumonia, serious infections, any infection, hemorrhage,
renal failure, deep vein thrombosis, and uncontrollable intracranial
hypertension.
Conclusions:
High-quality randomized evidence indicates that therapeutic hypothermia is
associated with higher mortality and no difference in good neurologic outcome
compared with normothermia in critically ill patients. Although there still
might be a possibility that therapeutic hypothermia is beneficial in a specific
setting, routine application of therapeutic hypothermia would better be avoided
outside the settings indicated by international guidelines (adult cardiac
arrest and hypoxic-ischemic encephalopathy of newborns).
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