PMID- 33622611
OWN - NLM
STAT- MEDLINE
DCOM- 20210504
LR  - 20221221
IS  - 1557-8615 (Electronic)
IS  - 0883-9441 (Print)
IS  - 0883-9441 (Linking)
VI  - 63
DP  - 2021 Jun
TI  - Cheap and simple, could it get even cooler? Mild hypothermia and COVID-19.
PG  - 264-268
LID - S0883-9441(21)00008-3 [pii]
LID - 10.1016/j.jcrc.2021.01.009 [doi]
AB  - PURPOSE: The pathophysiology theories of COVID-19 attach the injury of target 
      organs to faulty immune responses and occasionally hyper-inflammation. The damage 
      frequently extends beyond the respiratory system, accompanying cardiovascular, 
      renal, central nervous system, and/or coagulation derangements. Tumor necrosis 
      factor-alpha (TNF-alpha) and interleukins (IL)-1 and - 6 suppression may improve 
      outcomes, as experimentally shown. Targeted therapies have been proposed, but 
      mild therapeutic hypothermia-a more multifaceted approach-could be suitable. 
      FINDINGS: According to evidence derived from previous applications, therapeutic 
      hypothermia diminishes the release of IL-1, IL-6, and TNF-alpha in serum and at the 
      tissue level. PaCO2 is reduced and the PaO2/FiO2 ratio is increased, possibly 
      lasting after rewarming. Cooling might mitigate both ventilator and 
      infectious-induced lung injury, and suppress microthrombi development, enhancing 
      V/Q mismatch. Improvements in microhemodynamics and tissue O2 diffusion, along 
      with the ischemia-tolerance heightening of tissues, could be reached. Arrhythmia 
      incidence diminishes. Moreover, hypothermia may address the coagulopathy, 
      promoting normalization of both hypo- and hyper-coagulability patterns, which are 
      apparently sustained after a return to normothermia. CONCLUSIONS: As per prior 
      therapeutic hypothermia literature, the benefits regarding inflammatory response 
      and organic damage might be seen. Following the safety-cornerstones of the 
      technique, the overall infection rate and infection-related mortality are not 
      expected to rise, and increased viral replication does not seem to be a concern. 
      Therefore, the possibility of a low cost and widely available therapy being 
      capable of improving COVID-19 outcomes deserves further study.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Dos Reis Ururahy, Raul
AU  - Dos Reis Ururahy R
AD  - Universidade de Sao Paulo (USP) Medical School, Internal Medicine Department, Dr. 
      Eneas Carvalho de Aguiar Ave. 255, CEP 05403-000 Sao Paulo, SP, Brazil. 
      Electronic address: rreisururahy@gmail.com.
FAU - Park, Marcelo
AU  - Park M
AD  - Universidade de Sao Paulo (USP) Medical School, Emergency Department, Intensive 
      Care Unit, Dr. Eneas Carvalho de Aguiar Ave. 255, CEP 05403-000 Sao Paulo, SP, 
      Brazil.
LA  - eng
PT  - Letter
DEP - 20210130
PL  - United States
TA  - J Crit Care
JT  - Journal of critical care
JID - 8610642
RN  - 0 (IL6 protein, human)
RN  - 0 (Interleukin-1)
RN  - 0 (Interleukin-6)
RN  - 0 (TNF protein, human)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - COVID-19/blood/*therapy/virology
MH  - Cytokine Release Syndrome/*therapy
MH  - Humans
MH  - Hypothermia, Induced/*methods
MH  - Interleukin-1/blood
MH  - Interleukin-6/blood
MH  - *SARS-CoV-2
MH  - Tumor Necrosis Factor-alpha/blood
PMC - PMC7847287
OTO - NOTNLM
OT  - COVID-19
OT  - Cooling
OT  - Cytokine storm
OT  - Mild therapeutic hypothermia
OT  - SARS CoV2
COIS- None.
EDAT- 2021/02/25 06:00
MHDA- 2021/05/05 06:00
PMCR- 2021/01/30
CRDT- 2021/02/24 05:35
PHST- 2020/09/20 00:00 [received]
PHST- 2020/12/28 00:00 [revised]
PHST- 2021/01/18 00:00 [accepted]
PHST- 2021/02/25 06:00 [pubmed]
PHST- 2021/05/05 06:00 [medline]
PHST- 2021/02/24 05:35 [entrez]
PHST- 2021/01/30 00:00 [pmc-release]
AID - S0883-9441(21)00008-3 [pii]
AID - 10.1016/j.jcrc.2021.01.009 [doi]
PST - ppublish
SO  - J Crit Care. 2021 Jun;63:264-268. doi: 10.1016/j.jcrc.2021.01.009. Epub 2021 Jan 
      30.