COLD THERAPY IN BACTEREMIC SHOCK 



The salvage rate was 50 per cent (Fig. 3). Only one- half of 

 the deaths were due to unremitting septic shock. At the time 

 of all fatalities antibiosis was specifically bacterio- sensitive. 

 The elderly debilitated patient tolerated septic shock most poorly. 

 Survival rate was 73 per cent in those under 50 years of age 

 and only 44 per cent in those over 50. Two deaths were associ- 

 ated with deeper cooling (28° C and 27° C) and were in individuals 

 over 50 years of age. Response to cooling was uniformly favor- 

 able, attesting to the augmenting influence of the level of cooling 

 employed (Fig. 4). However, this response proved no indicator 

 of the outcome. Most of the deaths occurred within 72 hours of 

 cooling. Therefore, survival beyond this time increased prob- 

 abilities of recovery, unless a complication unrelated to the 

 sepsis intervened. Complications of hjrpothermia proved to be 

 of little or no consequence where adherence to 32° C was ob- 

 served (Fig. 5). Four patients developed hypoglycemia, which 

 was adequately managed by glucose infusion. 



The criteria for rewarming were based entirely on the sub- 

 jective course of the hj^othermic patient and did not bear neces- 

 sarily any relationship to the state of the sepsis or host anti- 

 bacterial response. The primary indication for rewarming was 

 the patient's vocal and muscular objection to the cold state. The 

 sensorium was clear, the arterial blood pressure and pulse sta- 

 bilized, and ventilation was normal. Elevation in temperature 

 occurred in all patients after rewarming. Hypothermia was re- 

 instituted only when this was accompanied by evidences of shock. 



An example of a survivor cooled for eight days is illustrated 

 in Figure 6, This was an 18 year old white female, who devel- 

 oped peritonitis following an appendectomy. Septicemia was evi- 

 denced by an elevated temperature of 39° C to 40° C, tachy- 

 cardia, hyperpnea, and leucopenia. Bacteroides was cultured 

 from the blood stream. Surgical exploration was followed by 

 shock. Failure of response to therapy highlighted by lethargy 

 and coma prompted resort to hypothermia. Within 72 hours there 

 ^\as considerable improvement in the patient's status. Blood cul- 

 tures remained positive during the hypothermic state and be- 

 came negative 12 days after hypothermia was discontinued. Re- 

 warming was started on the fourth day, but a convulsive seizure 



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