COLD THERAPY IN BACTEREMIC SHOCK 



then, is to modify the metabolic environment of the host with likely 

 no specific action at any given site or enzyme system. In instances 

 such as bacteremic shock, hypothermia would place the metabolic 

 community at a physiologic level more commensurate with the ex- 

 isting attenuated blood flow. Hypothermia as a "therapeutic" tool is 

 quite ancient (Currie, 1798). In recent years a number of reports 

 have attested to the value of hypothermia in septic problems (Blair 

 et al., 1961;Cockett and Goodwin, 1961;Martin, 19 58; Drescher, 1960), 



This report consists of a description of clinical experiences and 

 some aspects of experimental studies. Evaluation of the influence of 

 hypothermia rested on refractoriness to standard therapy. The pa- 

 tients continued to receive intensive drug and antibiotic treatment 

 while under hypothermia. In order to evaluate the effects of hypo- 

 thermia per se, bacteremic shock was induced in dogs, one series 

 of which received no treatment other than hypothermia. 



CLINICAL STUDY 



Criteria for Cooling 



The sequence of progressive deterioration from an acute infection 

 to septicemia, hypotension, and shock does not adhere to a specific 

 clinical pattern. Too many important factors influence the probabil- 

 ities of shock in septicemia. Some of these are host resistance, in- 

 cluding age and nutrition; type and virulence of offending micro- 

 organism; and type, intensity, and timing of treatment. The criteria 

 for the development of shock secondary to sepsis are largely based 

 upon hypotension, tachycardia, hyperpnea, and oliguria. All patients 

 in septic shock were begun on the accepted regimen as enumerated 

 previously. Only those who subsequently became unresponsive and 

 seemed about to die were selected as candidates for hypothermia. 



Characteristics of a typical clinical picture are listed in Figure 1. 

 The patient who appeared tobedoingfairly well was usually elderly. 

 The temperature dropped slightly,ventilationbecame irregular, and 



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