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Cheap and simple, could it get even cooler? Mild hypothermia and COVID-19.
Dos Reis Ururahy, Raul; Park, Marcelo.
  • Dos Reis Ururahy R; Universidade de São Paulo (USP) Medical School, Internal Medicine Department, Dr. Enéas Carvalho de Aguiar Ave. 255, CEP 05403-000 São Paulo, SP, Brazil. Electronic address: rreisururahy@gmail.com.
  • Park M; Universidade de São Paulo (USP) Medical School, Emergency Department, Intensive Care Unit, Dr. Enéas Carvalho de Aguiar Ave. 255, CEP 05403-000 São Paulo, SP, Brazil.
J Crit Care ; 63: 264-268, 2021 06.
Article in English | MEDLINE | ID: covidwho-1060792
ABSTRACT

PURPOSE:

The pathophysiology theories of COVID-19 attach the injury of target organs to faulty immune responses and occasionally hyper-inflammation. The damage frequently extends beyond the respiratory system, accompanying cardiovascular, renal, central nervous system, and/or coagulation derangements. Tumor necrosis factor-α (TNF-α) and interleukins (IL)-1 and - 6 suppression may improve outcomes, as experimentally shown. Targeted therapies have been proposed, but mild therapeutic hypothermia-a more multifaceted approach-could be suitable.

FINDINGS:

According to evidence derived from previous applications, therapeutic hypothermia diminishes the release of IL-1, IL-6, and TNF-α in serum and at the tissue level. PaCO2 is reduced and the PaO2/FiO2 ratio is increased, possibly lasting after rewarming. Cooling might mitigate both ventilator and infectious-induced lung injury, and suppress microthrombi development, enhancing V/Q mismatch. Improvements in microhemodynamics and tissue O2 diffusion, along with the ischemia-tolerance heightening of tissues, could be reached. Arrhythmia incidence diminishes. Moreover, hypothermia may address the coagulopathy, promoting normalization of both hypo- and hyper-coagulability patterns, which are apparently sustained after a return to normothermia.

CONCLUSIONS:

As per prior therapeutic hypothermia literature, the benefits regarding inflammatory response and organic damage might be seen. Following the safety-cornerstones of the technique, the overall infection rate and infection-related mortality are not expected to rise, and increased viral replication does not seem to be a concern. Therefore, the possibility of a low cost and widely available therapy being capable of improving COVID-19 outcomes deserves further study.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cytokine Release Syndrome / SARS-CoV-2 / COVID-19 / Hypothermia, Induced Type of study: Observational study Limits: Humans Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cytokine Release Syndrome / SARS-CoV-2 / COVID-19 / Hypothermia, Induced Type of study: Observational study Limits: Humans Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2021 Document Type: Article