SESSION TITLE: Therapeutic Hypothermia
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM
PURPOSE: There is limited data on burden of non-therapeutic hypothermia among critically ill patients and its impact on their outcome.
METHODS: This study is part of an ongoing registry study involving all patients admitted to the medical intensive care unit (MICU, a 53-bed closed unit) at the Cleveland Clinic Foundation. We reviewed all the patient encounters between April 2011 and September 2012 for development of hypothermia during the MICU stay. Among these, those encounters with ICU length of stay <72 hours and those whose hypothermia developed as a pre-terminal event were excluded. We reviewed the incidence and severity of hypothermia and compared demographics, clinical and laboratory profile at presentation, MICU course and outcome among patients with and without hypothermia.
RESULTS: A total of 1696 encounters with complete data (mean age 60.9±15.9 years, range 18-99, Males 52%) were available for analysis. Hypothermia was seen among nearly a quarter of the encounters (overall 24.1%; mild: 20.4%; moderate: 1.3%; severe: 2.4%). On univariate analysis, hypothermia was associated with history of chronic liver disease (37.8% vs 21.6%, OR 2.2, 95% CI 1.3-3.6, p=0.003), low pH (7.32±0.11 vs 7.36±0.1, p<0.001), low albumin (2.58±0.7 vs 2.69±0.7, p=0.04), high bilirubin (3.2±6 vs 2.2±5, p=0.02), high blood urea nitrogen (50±38 vs 41±32, p=0.001), high APS (77±29 vs 67±26, p<0.001) and APACHE III scores (91±31 vs 80±28, p<0.001). On multivariate analysis, high BUN (adjusted OR, 95% CI: 1.005, 1.001-1.009, p=0.048) and APAPCHE III (adjusted OR, 95% CI: 1.012, 1.006-1.017, p<0.001) score were independently associated with hypothermia. Hypothermia was associated with increased ICU (11.4 vs 8.6 days, p<0.001) and hospital stay (22.9 vs 19.8 days, p<0.001) and hospital mortality (38.6% vs 26.4%, unadjusted OR 1.75, 95% CI: 1.38-2.21; p<0.001).
CONCLUSIONS: Hypothermia is common among patients admitted to MICU. Worse blood urea nitrogen levels and high APACHE III score at admission are independently associated with development of hypothermia during the ICU stay. Patients with hypothermia during the MICU stay have increased morbidity and mortality.
CLINICAL IMPLICATIONS: Hypothermia is associated with worse outcomes among MICU patients. Abnormal renal functions and high APAPCHE III score at admission should prompt close monitoring for development of hypothermia.
DISCLOSURE: The following authors have nothing to disclose: Chirag Choudhary, Shruti Gadre, Amit Banga, Madhu Sasidhar
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