Review
Pathophysiologic changes and effects of hypothermia on outcome in elective surgery and trauma patients

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Abstract

Generally, hypothermia is defined as a core temperature <35°C. In elective surgery, induced hypothermia has beneficial effects. It is recommended to diminish complications attributable to ischemia reperfusion injury. Experimental studies have shown that hypothermia during hemorrhagic shock has beneficial effects on outcome. In contrast, clinical experience with hypothermia in trauma patients has shown accidental hypothermia to be a cause of posttraumatic complications. The different etiology of hypothermia might be one reason for this disparity because induced therapeutic hypothermia, with induction of poikilothermia and shivering prevention, is quite different from accidental hypothermia, which results in physiological stress. Other studies have shown evidence that this contradictory effect is related to the plasma concentration of high-energy phosphates (e.g., adenosine triphosphate [ATP]). Induced hypothermia preserves ATP storage, whereas accidental hypothermia causes depletion. Hypothermia also has an impact on the immunologic response after trauma and elective surgery by decreasing the inflammatory response. This might have a beneficial effect on outcome. Nevertheless, posttraumatic infectious complications may be higher because of an immunosuppressive profile. Further studies are needed to investigate the impact of induced hypothermia on outcome in 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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