Is Therapeutic Hypothermia for Acute Respiratory Distress Syndrome the Future?
BACKGROUND
Severe acute respiratory distress syndrome (ARDS) has a high mortality, and there is limited knowledge about management of severe ARDS refractory to standard therapy. Early evidence suggests that therapeutic hypothermia (TH) could be a viable treatment for acute respiratory failure. We present 2 cases where TH was successfully used to manage refractory ARDS on extracorporeal membrane oxygenation (ECMO) and a review of the literature around TH and acute respiratory failure.


RESULTS
We present 2 cases of ARDS secondary to H1N1 influenza and human metapneumovirus. Both patients were treated with the current evidence-based therapy for ARDS. Venovenous ECMO was used in both patients for refractory hypoxemia. Therapeutic hypothermia was applied for 24 hours with improved oxygenation. We did a review of the literature summarizing 38 patients in 10 publications where TH was successfully utilized in the treatment of acute respiratory failure.


CONCLUSIONS
Therapeutic hypothermia may be a viable salvage therapy for ARDS refractory to the current evidence-based therapy but needs further evaluation.
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, USA.
Adam J
AJ
Hayek
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, USA.
Heath D
HD
White
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, USA.
Shekhar
S
Ghamande
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, USA.
Christopher
C
Spradley
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, USA.
Alejandro C
AC
Arroliga
D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications* / Q000821:virology; D008297:Male; D029121:Metapneumovirus; D008875:Middle Aged; D018184:Paramyxoviridae Infections / Q000150:complications* / Q000821:virology; D012128:Respiratory Distress Syndrome / Q000628:therapy* / Q000821:virology; D016896:Treatment Outcome; D055815:Young Adult
acute respiratory distress syndrome; extracorporeal membrane oxygenation; refractory hypoxemia; therapeutic hypothermia