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LETTER TO THE EDITOR

Hypothermia in Acute Lung Injury: Reduction of Barotrauma or Biotrauma?

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

1. Chin JY, Koh Y, Kim MJ, Kim HS, Kim WS, Kim DS, Kim WD, Lim CM. The effects of hypothermia on endotoxin-primed lung. Anesth Analg 2007;104: 1171–8[Abstract/Free Full Text]
2. Hong SB, Koh Y, Lee IC, Kim MJ, Kim WS, Kim DS, Kim WD, Lim CM. Induced hypothermia as a new approach to lung rest for the acutely injured lung. Crit Care Med 2005;33:2049–55[Web of Science][Medline]
3. Chu SJ, Perng WC, Hung CM, Chang DM, Lin SH, Huang KL. Effects of various body temperatures after lipopolysaccharide-induced lung injury in rats. Chest 2005;128: 327–36[Web of Science][Medline]

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