SESSION TYPE: New Insights into ARDS/Lung Injury
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: In recent years, therapeutic hypothermia (TH) has become an integral part of the treatment of victims of sudden cardiac arrest with return of spontaneous circulation and decreased level of consciousness. TH has been utilized experimentally in other clinical conditions. The use of TH in the treatment of the acute respiratory distress syndrome (ARDS) has not been fully studied. This study aimed to evaluate the effects of TH as an adjuvant treatment in the context of ARDS.
METHODS: Systematic review of patients that underwent TH in our clinical service for patients with ARDS. Inclusion criteria included the presence of ARDS and failure of conventional treatment to provide adequate oxygenation and oxygen delivery. All patients underwent a standard protocol for hypothermia consisting of a 24-hour hypothermia phase with a goal temperature of 32°C, followed by a rewarming phase at a rate of 0.6°C per hour. TH was provided with a non-invasive targeted temperature system (Artic Sun 5000; Medivance, Inc; Louisville, CO). In addition to clinical criteria, daily portable chest radiographs, arterial blood gas analysis, as well as dynamic compliance calculations were used to evaluate patient progress.
RESULTS: From June 2010 to March 2012, 4 patients met criteria for enrollment. The mean Alveolar-arterial gradient (A-aDO2) prior to TH was 543.625 Torr. Dynamic compliance (Cdyn) prior to TH was 26.145 dyn/cm-5. The mean chest radiography ARDS score was 7.25 prior to TH. Following implementation of TH the mean A-aDO2 was 198.75 Torr, the mean Cdyn and the mean chest radiography ARDS score was 21.68 dyn/cm-5, and 5.5 respectively. Three of the patients survived and were discharged from the hospital. On follow up 2 of these patients were found to have normal spirometry measurements and the third one was lost for followup. The fourth patient had significant physiological improvement but, due to his oncological pre-existing condition, expired after the family decision to withdraw care.
CONCLUSIONS: Clinical and physiological data shown in our patients suggest that TH in ARDS have a positive impact in the progression of the disease, improving pulmonary function, all patients showed an improvement radiographically and physiologically in all parameters measured.
CLINICAL IMPLICATIONS: TH is feasible and proved useful physiologically and radiographically in our patients with ARDS. Further large clinical trials are necessary to establish clinical guidelines to justify its use in this clinical setting.
DISCLOSURE: The following authors have nothing to disclose: Joseph Varon, Eduardo Fastag, Ilse Espina, Jorge Sanchez
Application of therapeutic hypothermia in the context of ARDS is not approved by the FDA for this purpose. These are reports of 4 extraordinary cases in which oxygenation was remarkably improved and the lived saved for patients with severe ARDS.University General Hospital, Houston, TX