Matt Harmon

16 Chapter one Figure 2. The relationship between peak body temperature in the first 24 hours of intensive care admission and adjusted odds ratio for in-hospital mortality patients with an infection. Adjusted Odds Ratio Peak Temperature (°C) <36 36 - 36.4 36.5 - 36.9 37.0 - 37.4 37.5 - 37.9 38.0 - 38.4 38.5 - 38.9 39.0 - 39.4 39.5 - 39..9 > 40 1 2 3 4 The figure was taken from Young et al. 44 model of experimental sepsis, hypothermia reduced proinflammatory cytokine levels. 45 Induced hypothermia also reduced bacterial dissemination in a rat model of pneumococcal pneumosepsis and improved mitochondrial respiration. 46 However, translation of these results to clinical practice has proven difficult. In a subsequent randomized clinical trial, cooling to hypothermia (32°C-34°C) failed to decrease mortality and even delayed recovery of several organ functions indicating an adverse effect of cooling. 7 A large clinical trial on treatment with induced normothermia to 36.5°C -37.0°C for 48 hours has shown potentially promising results. In patients with fever and septic shock, induced normothermia reduced the need for vasopressors and improved 14-day mortality. 6 These results are contrasted by two other trials that showed adverse hemodynamic effects and increased mortality due to induced