Induced Hypothermia May Be Harmful in Severe Meningitis
Moderate hypothermia not found to improve outcomes in patients with severe bacterial meningitis
WEDNESDAY, Nov. 27, 2013 (HealthDay News) -- The use of induced hypothermia may be harmful to adults with severe meningitis, according to a study published in the Nov. 27 issue of the Journal of the American Medical Association.
Bruno Mourvillier, M.D., from Groupe Hospitalier Bichat-Claude Bernard in Paris, and colleagues conducted a multicenter trial in 49 French intensive care units (February 2009 to November 2011), in which 98 comatose adults (Glasgow Coma Scale [GCS] score of ≤8 for <12 hours) with community-acquired bacterial meningitis were randomized to induced hypothermia (with a loading dose of 4 degrees Celsius cold saline and were cooled to 32 to 34 degrees Celsius for 48 hours) or standard care.
The researchers stopped the trial early because of concerns over excess mortality in the hypothermia group (51 percent, versus 31 percent in the control group; relative risk, 1.99; P = 0.04). Twenty-four hours after randomization, mean temperatures achieved were 33.3 degrees Celsius in the hypothermia group and 37.0 degrees Celsius in the control group. Unfavorable outcomes at three months were seen in 86 percent of the hypothermia group and 74 percent of the control group (relative risk, 2.17; P = 0.13). Mortality remained higher, although not significantly, in the hypothermia group after adjustment for age, GCS score at inclusion, and baseline septic shock (hazard ratio, 1.76; P = 0.10).
"Moderate hypothermia did not improve outcome in patients with severe bacterial meningitis and may even be harmful," the authors write.
Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1748835#Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1748835 )