Method of intensive care for accidental hypothermia

A.V. Tsarev

Abstract


Background. Accidental hypothermia is one of the most difficult problems of modern intensive care of critical states. The aim of the work was to study the efficiency of the developed method for the intensive care of accidental hypothermia, to assess its impact on the rate of the correction of pathophysiological changes and the level of mortality of patients in critical or terminal states. The aim of this study was to evaluate the effectiveness of the developed method for the intensive care of accidental hypothermia, the assessment of its impact on the speed of the correction of pathophysiological changes on the level of morta­lity of patients in critical states. Materials and methods. The study included 50 critically ill patients (mean age 43.00 ± 3.62 years) with accidental hypothermia, who were treated in the intensive care unit for polytrauma patients of I.I. Mechnikov Dnipro­petrovsk Regional Clinical Hospital. In all patients, the general classification of the stages of accidental hypothermia of the Swiss Society for Mountain Medicine has been used. Patients were divided into 2 groups. Group I (n = 25) — active warming using convection heating system WarmAir 135 (CSZ, USA) and infusion of crystalloid solutions (37 °C) in the following doses: for mild — 20–30 ml/kg; moderate and severe — 50–70 ml/kg. In patients with severe accidental hypothermia first 1–1.5 liters fell on colloidal plasma expanders (low molecular weight hydroxyethyl starch and gelatin). Group II (n = 25) — the passive war­ming and standard intensive care including crystalloid and colloid infusion solutions with indoor temperature at a dose of 20–30 ml/kg. We studied the esophageal (the core of the body — Tco (CSZ, USA)) and tympanic temperature (Tt (Omron, Japan)), hemodynamic parameters (blood pressure, heart rate, mean arterial pressure (MAP)), neurologic impairment according to the Glasgow Coma Scale, the rate of warming. Results. Initial Tco in group I was 29.03 ± 2.76 °C, in group II — 31.50 ± 1.97 °C. Minimum and maximum Tco: in group I — 24.3 and 33.6 °C, in group II — 27.2 and 34.5 °C, respectively. At the baseline, MAP in group I was 49.86 ± 20.71 mmHg, in group II — 70.45 ± 11.72 mmHg; after 48 hours — 76.65 ± 12.27 mmHg and 60.82 ± 36.39 mmHg, respectively. Rate of attaining normothermia (36.0 °C) in the first and second groups was: 6.48 ± 3.47 hours and 9.20 ± 6.52 hours, respectively. Mortality in group I was 12 %, in group II — 48 %, these differences were significant. More indicative mortality rates were in subgroups of patients with severe accidental hypothermia, since in group I it was 25 %, while in the group II — 100 %. It should be noted that the analysis of the three deceased patients in group I with a severe accidental hypothermia has shown that two of them had not acute hypothermia, but gradual cooling during a long time (from 12 to 24 h). The third patient had died with Tco 24.5 °C, and the death occurred in the first hours after admission to the hospital due to the significant hemodynamic instability, and failure of cardiopulmonary resuscitation. Conclusions. The most effective method of war­ming the patient with accidental hypothermia is active warming using convection hea­ting system. After securing the venous access, it is necessary to conduct infusion therapy with 37°C crystalloid solutions. In patients with mild accidental hypothermia, the total volume of infusion therapy should be 20–30 ml/kg; in patients with moderate to severe accidental hypothermia — 50–70 ml/kg. Thus, in patients with severe accidental hypothermia, the first 1–1.5 liters must account for colloidal plasma expanders (based on low molecular weight hydroxyethyl starch and/or ge­latin). Use of the method of intensive care is not indicated in the slow development of the accidental hypothermia du­ring a long time. Our preliminary data indicate that forced air rewarming and infusion of 37°C crystalloid solutions are efficient and safe met­hods of managing patients with accidental hypothermia and reduce mortality to 25 %.

Keywords


accidental hypothermia; hypothermia; convection heating system; intensive care

References


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DOI: https://doi.org/10.22141/2224-0586.2.81.2017.99707

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