Hypothermia and surgery: immunologic mechanisms for current practice.
OBJECTIVE
To examine cellular and immunologic mechanisms by which intraoperative hypothermia affects surgical patients.


BACKGROUND
Avoidance of perioperative hypothermia has recently become a focus of attention as an important quality performance measure, aimed at optimizing the care of surgical patients. Anesthetized surgical patients are particularly at risk for hypothermia, which has been directly linked to the development of sequelae, such as coagulopathy, infection, morbid myocardial events, and death after surgery. However, many of the underlying immunologic mechanisms remain unclear.


METHODS
Venous blood samples from healthy volunteers were exposed for up to 4 hours to various temperatures following the addition of a 1 ng/mL lipopolysaccharide challenge. Innate immune function, assessed by the ability of monocytes to present antigen and coordinate cytokine release, was determined by qualitative and quantitative measurements of HLA-DR surface expression 2 hours following incubation, and proinflammatory tumor necrosis factor-alpha (TNF-alpha) and anti-inflammatory (IL-10) cytokine release in the first 4 hours.


RESULTS
Monocyte incubation at hypothermic temperatures (34 degrees C) reduced HLA-DR surface expression, delayed TNF-alpha clearance, and increased IL-10 release. Conversely, hyperthermia (40 degrees C) increased monocyte antigen presentation and resulted in rapid decay of TNF-alpha. However, IL-10 release was also increased. Normothermia (37 degrees C) attenuated IL-10 release following the initial proinflammatory surge.


CONCLUSIONS
Hypothermia exerts multiple effects at the cellular level, which impair innate immune function, and are associated with increased septic complications and mortality. These findings provide a physiological basis for perioperative temperature monitoring, which is a valid surgical performance measure that can be used to reduce surgical complications associated with avoidable hypothermia.
Qadan
Motaz
M
Price Institute of Surgical Research, University of Louisville School of Medicine, Medical-Dental Research Building (3rd Floor), 511 South Floyd St, Louisville, Kentucky 40202, USA. m0qada01@louisville.edu
Gardner
Sarah A
SA
Vitale
David S
DS
Lominadze
David
D
Joshua
Irving G
IG
Polk
Hiram C
HC
D001769:Blood / Q000276:immunology*; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000276:immunology*; D007113:Immunity, Innate; D007432:Intraoperative Period; D008070:Lipopolysaccharides / Q000276:immunology; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013696:Temperature
D008070:Lipopolysaccharides