Management of Hypothermia in Septic Patients

Understanding Hypothermia in Sepsis

Hypothermia in sepsis is classified as mild (34-36°C), moderate (32-34°C), or severe (<32°C) and is associated with increased mortality, particularly when temperature falls below 32°C 1, 3

Temperature should be monitored continuously using core temperature measurements (esophageal thermometer, bladder catheter in non-anuric patients, or pulmonary artery catheter) 4
Axillary and oral temperatures are inadequate for accurate core temperature monitoring, especially during active temperature manipulation 4
Consider using a secondary source of temperature measurement if using a closed feedback cooling system 4

For mild hypothermia (34-36°C), remove wet clothing immediately, cover with at least two warm blankets, increase ambient room temperature, and apply forced-air warming devices 1, 3
For moderate hypothermia (32-34°C), continue all measures for mild hypothermia, administer warmed intravenous fluids, provide humidified, warmed oxygen, and consider more aggressive external warming methods 1, 2
For severe hypothermia (<32°C), continue all previous measures, consider active internal rewarming methods, and consider peritoneal lavage with warmed fluids in extreme cases 1, 2

Keep patients euvolemic to maintain normal hemodynamic parameters 5
Use crystalloids as the initial fluid of choice for resuscitation 5
Consider albumin in patients with persistent hypotensive shock despite corrective measures 5
Target a mean arterial pressure (MAP) of ≥65 mmHg, though this may need to be individualized based on patient characteristics 5
Use norepinephrine as the initial vasopressor for hypotension after euvolemia is restored 5
Consider hydrocortisone (200 mg once daily) in patients with persisting hypotensive shock 5

Fluid restriction to reduce cerebral edema is not recommended in septic patients 5
Monitor for complications during rewarming, including coagulopathy, cardiac arrhythmias, and increased risk of infection 1, 2, 3, 4
Cease rewarming after reaching 37°C as higher temperatures are also associated with poor outcomes 2, 3
Patients with severe sepsis should be managed in a critical care setting in accordance with surviving sepsis guidelines 5

For patients with traumatic brain injury alongside sepsis, controlled hypothermia (33-35°C) may be beneficial only after bleeding from other sources has been controlled 3