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Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.); Department of Intensive Care Medicine; Academic Medical Center; Amsterdam, The Netherlands; n.p.juffermans{at}amc.uva.nl
To the Editor:
Recently, Chin et al. (1) showed that hypothermia attenuates inflammation in an experimental model of acute lung injury, which was associated with a decrease in pulmonary neutrophil-mediated inflammation, suggesting that hypothermia inhibits a cellular-mediated inflammatory response.
However, induced hypothermia also allows for a lower minute ventilation to ensure gas exchange, thereby potentially reducing ventilator-induced injury. In addition, hypothermia resulted in a markedly reduced CO2 production during experimental lung injury, as evidenced by decreased Pco2 and respiratory alkalosis (2) and increase in oxygenation (2,3).
In their (unventilated) model, Chin et al. (1) did not test these effects. Induced hypothermia may be a promising new therapy for acute lung injury and the authors should be congratulated on their work. Whether the protective effect of hypothermia in acute lung injury occurs via attenuation of inflammation, a decrease in CO2 production resulting in a reduction of minute ventilation and barotrauma or a decrease in O2 demand remains to be established. As patients with lung injury often require ventilatory support, the effect of hypothermia on both inflammation and respiratory mechanics and gas exchange should be studied in models of ventilated acute lung injury.
REFERENCES
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