Core Warming of Coronavirus Disease 2019 Patients Undergoing Mechanical Ventilation: A Pilot Study
MD Nathaniel P Bonfanti, MD, MS Nicholas M Mohr, MD David C Willms, MD, MS Roger J Bedimo, MD Emily Gundert, MD Kristina L Goff, MD Erik B Kulstad, MD Anne M Drewry
Therapeutic Hypothermia and Temperature Management, doi:10.1089/ther.2023.0030
Fever is a recognized protective factor in patients with sepsis, and growing data suggest beneficial effects on outcomes in sepsis with elevated temperature, with a recent pilot randomized controlled trial (RCT) showing lower mortality by warming afebrile sepsis patients in the intensive care unit (ICU). The objective of this prospective single-site RCT was to determine if core warming improves respiratory physiology of mechanically ventilated patients with coronavirus disease 2019 (COVID-19), allowing earlier weaning from ventilation, and greater overall survival. A total of 19 patients with mean age of 60.5 (-12.5) years, 37% female, mean weight 95.1 (-18.6) kg, and mean body mass index 34.5 (-5.9) kg/m 2 with COVID-19 requiring mechanical ventilation were enrolled from September 2020 to February 2022. Patients were randomized 1:1 to standard of care or to receive core warming for 72 hours through an esophageal heat exchanger commonly utilized in critical care and surgical patients. The maximum target temperature was 39.8°C. A total of 10 patients received usual care and 9 patients received esophageal core warming. After 72 hours of warming, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratios were 197 (-32) and 134 (-13.4), cycle thresholds were 30.8 (-6.4) and 31.4 (-3.2), ICU mortalities were 40% and 44%, 30-day mortalities were 30% and 22%, and mean 30-day ventilator-free days were 11.9 (-12.6) and 6.8 (-10.2) for standard of care and warmed patients, respectively ( p = NS). This pilot study suggests that core warming of patients with COVID-19 undergoing mechanical ventilation is feasible and appears safe. Optimizing time to achieve febrile-range temperature may require a multimodal temperature management strategy to further evaluate effects on outcome. ClinicalTrials.
Authors' Contributions Writing-original draft, review, and editing by N.P.B. Methodology, data curation, and formal analysis by N.M.M.
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