ReviewPathophysiologic changes and effects of hypothermia on outcome in elective surgery and trauma patients
Section snippets
Pathophysiology and clinical findings
Depending on the severity, hypothermia induces pathophysiologic changes in different body organ systems as follows.
Therapeutic effects of hypothermia in elective surgery
The effect of hypothermia as a therapeutic modality is as old as the earliest written record. The most ancient medical text of all, the Edwin Smith Papyrus (3500 bce), recommends local cold applications for wounds of the head and for infected or ulcerated breast [26]. Physicians in the Hippocratic school on Cos in 5 bce used local treatment with cold water for sprains, fractures, and swellings. Ice was also used to suppress hemorrhage and to treat skin infections and head injuries. General body
Hypothermia in multiple trauma
Hypothermia is a frequent event in trauma patients. The incidence of hypothermia in trauma patients arriving at the emergency room varied in different clinical studies between 12% and 66% [45], [46], [47]. The cause of hypothermia in the trauma victim is thought to be multifactorial. The thermoneutral zone of humans (25 to 30°C) is defined as the ambient temperature at which the basal rate of thermogenesis is sufficient to offset ongoing heat losses. Maintaining euthermia when ambient
The impact of hypothermia on immunologic response after trauma and elective surgery
The recent development of precise molecular tools for identifying and measuring inflammatory mediators has led to rapid accumulation of data implicating biologic autocoids in the pathophysiology of remote organ injury. It is this complex network of cytokines, complement degradation products, eicosanoids, platelet activators, leukocytes, endothelial cells, and numerous other chemicals that “police” the normally controlled inflammatory response.
The major cytokines involved in the response to
Conclusion
Induced hypothermia in elective surgery and in experimental studies with hemorrhagic shock has been shown to have beneficial effects. Clinical experience with accidental hypothermia in multiple traumas, however, shows adverse outcome. In case of accidental hypothermia, homeostatic mechanisms counter forced decreases in body temperature, which results in physiologic stress and decreased efficacy of the hypothermic treatment. In addition and depending on the severity of injury as well as
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