Mild induced hypothermia and coagulation and platelet function in patients with septic shock: Secondary outcome of a randomized trial

Itenov, TS; Kromann, ME; Ostrowski, SR; Bestle, MH; Mohr, T; Gyldensted, L; Lindhardt, A; Thormar, K; Sessler, DI; Juffermans, NP; Lundgren, JD; Jensen, JU

doi:10.1111/aas.14254

Sepsis & infection

Mild induced hypothermia and coagulation and platelet function in patients with septic shock: Secondary outcome of a randomized trial

Acta Anaesthesiol ScandPublished 2 May 2023Secondary analysis of a randomised controlled trial

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Authors' conclusion

In patients with septic shock, mild induced hypothermia slightly impaired clot initiation, but did not change clot strength.

Study context

Population: Adults with septic shock requiring mechanical ventilation, 8 ICUs in Denmarkrandomized
Participants: 326 adults

Comparison: Mild induced hypothermia for 24 h vs routine thermal management
Mild induced hypothermian = 163
Routine thermal managementn = 163reference
Primary endpoint: Coagulation (viscoelastography) and platelet aggregation
Follow-up: At inclusion, after 12 h of thermal management, and 24 h after inclusion

Methodological detailsmulticentre

Multicentre

Primary result

As reported in the abstract

Thrombus initiation time (R time)

Mild induced hypothermia8.0IQR 6.6–11.1 · min

Routine thermal management7.2IQR 5.8–9.2 · min

P = 0.004

Further findings

Thrombus propagation (angle)

P = 0.014

Mild induced hypothermia68 °IQR 59–73

Routine thermal management71 °IQR 63–75

Clot strength (MA)

P = 0.9

Mild induced hypothermia71 mmIQR 66–76

Routine thermal management72 mmIQR 65–77

Hyperfibrinolysis

P = 0.19

Mild induced hypothermia0.7%

Routine thermal management3.3%

No fibrinolysis

P < 0.001

Mild induced hypothermia8.8%

Routine thermal management40.4%

Platelet aggregation (ASPI)

P < 0.001

Mild induced hypothermia85 UIQR 50–113

Routine thermal management109 UIQR 74–148

Platelet aggregation (ADP)

P < 0.001

Mild induced hypothermia61 UIQR 40–83

Routine thermal management79 UIQR 54–101

Platelet aggregation (COL)

P < 0.001

Mild induced hypothermia50 UIQR 34–66

Routine thermal management67 UIQR 46–92

Outcome	Mild induced hypothermia	Routine thermal management	P value
Platelet aggregation (TRAP)	108 (IQR 83–154)	119 (IQR 94–146)	P = 0.042

Original publication

Mild induced hypothermia and coagulation and platelet function in patients with septic shock: Secondary outcome of a randomized trial. Acta Anaesthesiol Scand. Published 2 May 2023. doi:10.1111/aas.14254

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