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Hypothermia may be harmful in patients with severe bacterial meningitis
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Hypothermia treatment was not beneficial for patients with severe bacterial meningitis and may actually be harmful, according to recent data.
“Clinical trials of patients with trauma have shown a decrease of intracranial pressure in those patients treated with hypothermia, stressing the potential benefit of this technique in bacterial meningitis,” researchers from Réanimation Médicale et Infectieuse, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude Bernard, wrote in JAMA.
The researchers conducted an open-label, randomized trial throughout 49 ICUs in France from February 2009 to November 2011. The study included 98 comatose patients with community-acquired bacterial meningitis who were randomly assigned to the hypothermia group or standard care group. In the hypothermia group, patients received a loading dose of 4°C cold saline, then 1,500 mL refrigerated fluids by infusion for 30 minutes. Patients who did not reach a body temperature of 33.5°C or lower continued to receive cold fluids, 500 mL for 10 minutes, until the temperature decreased.
The trial stopped early because of excess mortality in the hypothermia group: 25 of the 49 patients died (51%) compared with 15 of 49 patients (31%) in the control group (RR=1.99; 95% CI, 1.05-3.77). At 3 months, 42 of 49 patients in the hypothermia group (86%) and 36 of 49 patients in the control group (73%) had unfavorable events (RR=1.17; 95% CI, 0.95-1.43). Mortality remained higher in the hypothermia group after adjustment for age, Glasgow Coma Scale score at inclusion and septic shock in inclusion, although this was not significant.
“Our results may have important implications for future trials on hypothermia in patients presenting with septic shock or stroke,” the researchers wrote. “Careful evaluation of safety issues in these future and ongoing trials are needed.”
Disclosure: The researchers report no relevant financial disclosures.
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