N. Yahagi et al., VALUE OF MILD HYPOTHERMIA IN PATIENTS WHO HAVE SEVERE CIRCULATORY INSUFFICIENCY EVEN AFTER INTRAAORTIC BALLOON PUMP, Journal of clinical anesthesia, 10(2), 1998, pp. 120-125
Study Objective: To evaluate the effectiveness of mild hypothermia in
postcardiac surgical patients with severe heart failure in spite of co
nventional medical therapy and the use of intra-aortic balloon pumping
(IABP). Design: Prospective, clinical study. Setting: Teaching hospit
al. Patients: 10 postcardiac surgical patients with severe heart failu
re despite the use of IABP with massive doses of catecholamine. Interv
entions: Patients underwent mild hyperthermia produced by surface cool
ing (to approximately 34.5 degrees C). Hemodynamic criteria for the in
duction of hyperthermia included a cardiac index (CI) of less than 2.2
L/min/m(2) with a pulmonary capillary wedge pressure (PCWP) of up to
18 mmHg despite the use of IABP with massive doses of catecholamine. M
easurements and Main Results: After control measurements had been take
n at normal core body temperature (37 degrees C), patients were cooled
to approximately 34.5 degrees C (using a cooling blanket and gastric
lavage with cold water) to decrease tissue oxygen (O-2) demand. Patien
ts showed significant improvements in CI (1.9 +/- 0.3 to 2.2 +/- 0.3 L
/min/m(2)), mixed venous O-2 saturation, (SvO(2); 55 +/- 7 to 64 +/- 6
%), and urine output (2.1 +/- 1.1 to 3.4 +/- 2.2 ml/kg/hr). Patients w
ere rewarmed while SvO(2) was being monitored. The duration of the hyp
othermia was 38 +/- 41 hours, Oxygen delivery increased in 8 of the 10
patients, the mean value (+/- SD) for the group rising from 309 +/- 6
5 ml/min/m(2) to 358 +/- 57 ml/min/m(2) as temperature was reduced fro
m 36.7 +/- 0.4 degrees C to 34.7 +/- 0.3 degrees 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 surgica
l patients with severe heart failure despite the use of IABP. (C) 1998
by Elsevier Science Inc.