Matt Harmon

31 Chapter two Introduction An altered core body temperature is a hallmark of sepsis. Although fever is most commonly associated with sepsis, hypothermia occurs spontaneously in 10–35% of septic patients at the time of admission 1 and in an additional 30% of the patients during the intensive care unit (ICU) stay. 2 Development of hypothermia is associated with a twofold increase in mortality compared to patients presenting with fever. 1 This association has led to the hypothesis that hypothermia is a dysregulated, detrimental phenomenon in sepsis. However, there is an increasing understanding that the association between hypothermia and adverse outcome does not imply that hypothermia directly effects outcome, but that this association may be the result of increased illness severity in patients with hypothermia compared to nonhypothermic patients. 3 The notion that septic hypothermia reflects dysfunction has also been challenged by the finding that hypothermia in septic patients not subjected to active rewarming is a transient, self-limiting response that becomes rare when organ dysfunction is at a maximum in the hours preceding death. 2 The same finding also raises the question as to whether it is necessary to actively rewarm those septic patients who develop hypothermia. It is currently unknown how these scientific lines of evidence relate to the perceptions of health care professionals regarding septic hypothermia, as is unknown how such perceptions drive clinical conduct concerning the use of active rewarming in these cases. We conducted an online survey on septic hypothermia to address these questions. Using this survey, we aimed to characterize differences in definition and rewarming practices of spontaneous hypothermia during sepsis and determine to what extent these practices are protocolized. Second, we aimed to assess current opinion on the effect of spontaneous hypothermia and rewarming patients with spontaneous hypothermia during sepsis. We hypothesized that rewarming practices and opinions regarding spontaneous hypothermia would be highly variable. Methods Survey A survey containing questions about opinions and management of hypothermic sepsis was developed for this study (Supplementary Data S1). The survey was tested several times for unambiguous interpretation of questions by distributing the survey among intensivists in the ICU of the Academic Medical Center in Amsterdam and was revised according to specific comments of respondents.