Hypothermia in the sepsis syndrome and clinical outcome

T. P. Clemmer, C. J. Fisher, R. C. Bone, G. J. Slotman, C. A. Metz, F. O. Thomas, G. B. Goris, M. S. Hearron, J. N. Sheagren, R. A. Balk, Timothy E Albertson, G. E. Foulke, N. K. Mondragon, J. L. Smith, K. Nyman, K. W. Burchard, A. D'Arezzo, B. D. McLees, C. E. McCall

Research output: Contribution to journalArticle

169 Citations (Scopus)

Abstract

Objective: To evaluate the consequences of clinical hypothermia associated with sepsis syndrome and septic shock. Design: Analysis of data from a multi- institutional, randomized, placebo-controlled, prospective study with predetermined end-point analysis of development of shock, recovery from shock, hospital length of stay, and death. Setting: Multi-institutional medical and surgical ICUs. Patients: Patients meeting predetermined criteria for severe sepsis syndrome. Interventions: Appropriate sepsis and shock care with 50% of patients receiving methylprednisolone and 50% receiving placebo. Measurements and Main Results: The occurrence rate of hypothermia (<35.5°C) is 9% in this population. When compared with febrile patients, hypothermic patients had a higher frequency of central nervous system dysfunction (88% vs. 60%), increased serum bilirubin concentration (35% vs. 15%), prolonged prothrombin times (50% vs. 23%), shock (94% vs. 61%), failure to recover from shock (66% vs. 26%), and death (62% vs. 26%). The hypothermic patients were also more likely to be classified as having a rapidly or ultimately fatal disease upon study admission. Conclusions: This prospective study confirms that hypothermia associated with sepsis syndrome has a significant relationship to outcome manifest by increased frequency of shock and death from shock. This finding is in sharp contrast to the protective effects of induced hypothermia in septic animals and perhaps man.

Original languageEnglish (US)
Pages (from-to)1395-1401
Number of pages7
JournalCritical Care Medicine
Volume20
Issue number10
StatePublished - 1992
Externally publishedYes

Fingerprint

Systemic Inflammatory Response Syndrome
Hypothermia
Shock
Length of Stay
Sepsis
Placebos
Prospective Studies
Induced Hypothermia
Prothrombin Time
Methylprednisolone
Septic Shock
Bilirubin
Fever
Central Nervous System
Serum
Population

Keywords

  • adult respiratory distress syndrome
  • bacterial, infections
  • fever
  • hypothermia
  • multicenter study
  • multiple organ failure
  • septicemia
  • shock, septic
  • steroids
  • temperature

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Clemmer, T. P., Fisher, C. J., Bone, R. C., Slotman, G. J., Metz, C. A., Thomas, F. O., ... McCall, C. E. (1992). Hypothermia in the sepsis syndrome and clinical outcome. Critical Care Medicine, 20(10), 1395-1401.

Hypothermia in the sepsis syndrome and clinical outcome. / Clemmer, T. P.; Fisher, C. J.; Bone, R. C.; Slotman, G. J.; Metz, C. A.; Thomas, F. O.; Goris, G. B.; Hearron, M. S.; Sheagren, J. N.; Balk, R. A.; Albertson, Timothy E; Foulke, G. E.; Mondragon, N. K.; Smith, J. L.; Nyman, K.; Burchard, K. W.; D'Arezzo, A.; McLees, B. D.; McCall, C. E.

In: Critical Care Medicine, Vol. 20, No. 10, 1992, p. 1395-1401.

Research output: Contribution to journalArticle

Clemmer, TP, Fisher, CJ, Bone, RC, Slotman, GJ, Metz, CA, Thomas, FO, Goris, GB, Hearron, MS, Sheagren, JN, Balk, RA, Albertson, TE, Foulke, GE, Mondragon, NK, Smith, JL, Nyman, K, Burchard, KW, D'Arezzo, A, McLees, BD & McCall, CE 1992, 'Hypothermia in the sepsis syndrome and clinical outcome', Critical Care Medicine, vol. 20, no. 10, pp. 1395-1401.
Clemmer TP, Fisher CJ, Bone RC, Slotman GJ, Metz CA, Thomas FO et al. Hypothermia in the sepsis syndrome and clinical outcome. Critical Care Medicine. 1992;20(10):1395-1401.
Clemmer, T. P. ; Fisher, C. J. ; Bone, R. C. ; Slotman, G. J. ; Metz, C. A. ; Thomas, F. O. ; Goris, G. B. ; Hearron, M. S. ; Sheagren, J. N. ; Balk, R. A. ; Albertson, Timothy E ; Foulke, G. E. ; Mondragon, N. K. ; Smith, J. L. ; Nyman, K. ; Burchard, K. W. ; D'Arezzo, A. ; McLees, B. D. ; McCall, C. E. / Hypothermia in the sepsis syndrome and clinical outcome. In: Critical Care Medicine. 1992 ; Vol. 20, No. 10. pp. 1395-1401.
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T1 - Hypothermia in the sepsis syndrome and clinical outcome

AU - Clemmer, T. P.

AU - Fisher, C. J.

AU - Bone, R. C.

AU - Slotman, G. J.

AU - Metz, C. A.

AU - Thomas, F. O.

AU - Goris, G. B.

AU - Hearron, M. S.

AU - Sheagren, J. N.

AU - Balk, R. A.

AU - Albertson, Timothy E

AU - Foulke, G. E.

AU - Mondragon, N. K.

AU - Smith, J. L.

AU - Nyman, K.

AU - Burchard, K. W.

AU - D'Arezzo, A.

AU - McLees, B. D.

AU - McCall, C. E.

PY - 1992

Y1 - 1992

N2 - Objective: To evaluate the consequences of clinical hypothermia associated with sepsis syndrome and septic shock. Design: Analysis of data from a multi- institutional, randomized, placebo-controlled, prospective study with predetermined end-point analysis of development of shock, recovery from shock, hospital length of stay, and death. Setting: Multi-institutional medical and surgical ICUs. Patients: Patients meeting predetermined criteria for severe sepsis syndrome. Interventions: Appropriate sepsis and shock care with 50% of patients receiving methylprednisolone and 50% receiving placebo. Measurements and Main Results: The occurrence rate of hypothermia (<35.5°C) is 9% in this population. When compared with febrile patients, hypothermic patients had a higher frequency of central nervous system dysfunction (88% vs. 60%), increased serum bilirubin concentration (35% vs. 15%), prolonged prothrombin times (50% vs. 23%), shock (94% vs. 61%), failure to recover from shock (66% vs. 26%), and death (62% vs. 26%). The hypothermic patients were also more likely to be classified as having a rapidly or ultimately fatal disease upon study admission. Conclusions: This prospective study confirms that hypothermia associated with sepsis syndrome has a significant relationship to outcome manifest by increased frequency of shock and death from shock. This finding is in sharp contrast to the protective effects of induced hypothermia in septic animals and perhaps man.

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KW - adult respiratory distress syndrome

KW - bacterial, infections

KW - fever

KW - hypothermia

KW - multicenter study

KW - multiple organ failure

KW - septicemia

KW - shock, septic

KW - steroids

KW - temperature

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