Trauma and Body Temperature Management In Tropical Regions Trauma and Temperature
Keywords:
Hypothermia, Trauma Patients, Body Temperature, Management TraumaAbstract
Trauma patients are exposed to hypothermia. Mortality of trauma patients with hypothermia is multiplied by four or five. Interactions of hypothermia with hemostasis and cardiovascular system are deleterious. The effects on coagulation are multiple and directly contribute to increase mortality, making hypothermia a major component of the "lethal triad". Causes of hypothermia in the trauma patient are multiple, (1) environmental, the risk increases when the ambient temperature decreases, (2) clinical, the risk increases with severity and also (3) therapeutic, for example by the infusion of solutes at room temperature. Optimal management is, first, based on early measurement and continuous monitoring of body temperature. The therapeutic objective is to maintain a body temperature at least equal to 36°C. Limiting the undressing of the patient, protecting him from the cold with a survival blanket, installing him quickly in a heated ambulance, using patient rewarming devices, infusing warmed fluids are the fundamental elements of the management of a traumatized patient, at risk of hypothermia. These guidelines should be applied worldwide, including in tropical regions.
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Perlman R, Callum J, Laflamme C, et al (2016) A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients. Crit Care 20:107
2. Waibel BH (2012) Hypothermia in trauma patients: predicting the big chill. Crit Care 16:155
3. Cannon JW (2018) Hemorrhagic Shock. N Engl J Med 378:1852–3
4. Gilbert M, Busund R, Skagseth A, et al (2000) Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet 355:375–76
5. Rösli D, Schnüriger B, Candinas D, et al (2020) The impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury specifically: a systematic review and meta-analysis. World J Surg 44:4106–17
6. Andrews PJD, Sinclair HL, Rodriguez A, et al (2015) Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med 373:2403–12
7. Gentilello LM, Jurkovich GJ, Stark MS, et al (1997) Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg 226:439–47
8. Luna GK, Maier RV, Pavlin EG, et al (1987) Incidence and effect of hypothermia in seriously injured patients. J Trauma 27:1014–8
9. Jurkovich GJ, Greiser WB, Luterman A, et al (1987) Hypothermia in trauma victims: an ominous predictor of survival. J Trauma 27:1019–24
10. Aitken LM, Hendrikz JK, Dulhunty JM, et al (2009) Hypothermia and associated outcomes in seriously injured trauma patients in a predominantly sub-tropical climate. Resuscitation 80:217–23
11. Balmer JC, Hieb N, Daley BJ, et al (2021) Continued relevance of initial temperature measurement in trauma patients. Am Surg 2022;88:424-8
12. Mize J, Koziol-McLain J, Lowenstein SR (1993) The forgotten vital sign: temperature patterns and associations in 642 trauma patients at an urban level I trauma center. J Emerg Nurs 19:303–5
13. Langhelle A, Lockey D, Harris T, et al (2012) Body temperature of trauma patients on admission to hospital: a comparison of anaesthetised and non-anaesthetised patients. Emerg Med J 29:239–42
14. Lapostolle F, Sebbah JL, Couvreur J, et al (2012) Risk factors for onset of hypothermia in trauma victims: the HypoTraum study. Crit Care 16:R142
15. Lapostolle F, Couvreur J, Koch FX, et al (2017) Hypothermia in trauma victims at first arrival of ambulance personnel: an observational study with assessment of risk factors. Scand J Trauma Resusc Emerg Med 25:43
16. Hsieh T-M, Kuo P-J, Hsu S-Y, et al (2018) Effect of hypothermia in the emergency department on the outcome of trauma patients: a cross-sectional analysis. Int J Environ Res Public Health 15:E1769
17. Lapostolle F, Garrigue B, Richard O, et al (2021) Prevention of hypothermia in trauma victims - the HYPOTRAUM 2 study. J Adv Nurs 77:2908–15
18. Williams GR, Spencer FC (1958) The clinical use of hypothermia following cardiac arrest. Ann Surg 148:462–8
19. Yenari MA, Han HS (2012) Neuroprotective mechanisms of hypothermia in brain ischaemia. Nat Rev Neurosci 13:267–78
20. Shrestha DB, Sedhai YR, Budhathoki P, et al (2022) Hypothermia versus normothermia after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. Ann Med Surg 74:103327
21. Chen H, Wu F, Yang P, et al (2019) A meta-analysis of the effects of therapeutic hypothermia in adult patients with traumatic brain injury. Crit Care 23:396
22. Rohrer MJ, Natale AM (1992) Effect of hypothermia on the coagulation cascade. Crit Care Med 20:1402–5
23. Wolberg AS, Meng ZH, Monroe DM, et al (2004) A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma 56:1221–8
24. Brohi K, Cohen MJ, Ganter MT, et al (2008) Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma 64:1211–17
25. Moore EE, Moore HB, Kornblith LZ, et al (2021) Trauma-induced coagulopathy. Nat Rev Dis Primer 7:30
26. Lester ELW, Fox EE, Holcomb JB, et al (2019) The impact of hypothermia on outcomes in massively transfused patients. J Trauma Acute Care Surg 86:458–63
27. Klauke N, Gräff I, Fleischer A, et al (2016) Effects of prehospital hypothermia on transfusion requirements and outcomes: a retrospective observatory trial. BMJ Open 6:e009913
28. Watts DD, Trask A, Soeken K, et al (1998) Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J Trauma 44:846–54
29. van Veelen MJ, Brodmann Maeder M (2021) Hypothermia in trauma. Int J Environ Res Public Health 18:8719
30. Tveita T, Ytrehus K, Myhre ES, et al (1998) Left ventricular dysfunction following rewarming from experimental hypothermia. J Appl Physiol Bethesda Md 85:2135–9
31. Paut O, Bissonnette B (2002) Effects of temperature and haematocrit on the relationships between blood flow velocity and blood flow in a vessel of fixed diameter. Br J Anaesth 88:277–9
32. Hasper D, Nee J, Schefold JC, et al (2011) Tympanic temperature during therapeutic hypothermia. Emerg Med J 28:483–85
33. Dankiewicz J, Cronberg T, Lilja G, et al (2021) Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med 384:2283–94
34. Henriksson O, Lundgren PJ, Kuklane K, et al (2015) Protection against cold in prehospital care: wet clothing removal or addition of a vapor barrier. Wilderness Environ Med 26:11–20
35. Henriksson O, Björnstig U, Saveman B-I, et al (2017) Protection against cold – a survey of available equipment in Swedish pre-hospital services. Acta Anaesthesiol Scand 61:1354–60
36. Nutbeam T, Fenwick R, Smith J, et al (2021) A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped. Scand J Trauma Resusc Emerg Med 29:17
37. Haverkamp FJC, Giesbrecht GG, Tan ECTH (2018) The prehospital management of hypothermia - An up-to-date overview. Injury 49:149–64
38. Webb P (1986) Afterdrop of body temperature during rewarming: an alternative explanation. J Appl Physiol 60:385–90
39. Savard GK, Cooper KE, Veale WL, et al (1985) Peripheral blood flow during rewarming from mild hypothermia in humans. J Appl Physiol 58:4–13
40. Mydske S, Thomassen Ø (2020) Is prehospital use of active external warming dangerous for patients with accidental hypothermia: a systematic review. Scand J Trauma Resusc Emerg Med 28:77
41. Ireland S, Endacott R, Cameron P, et al (2011) The incidence and significance of accidental hypothermia in major trauma--a prospective observational study. Resuscitation 82:300–6
42. Zafren K, Giesbrecht GG, Danzl DF, et al (2014) Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness Environ Med 25(4 Suppl):S66-85
43. Singleton W, McLean M, Smale M, et al (2017) An analysis of the temperature change in warmed intravenous fluids during administration in cold environments. Air Med J 36:127–30
44. Horowitz PE, Delagarza MA, Pulaski JJ, et al (2004) Flow rates and warming efficacy with Hotline and Ranger blood/fluid warmers. Anesth Analg 99:788–92
45. Piek R, Stein C (2013) Three insulation methods to minimize intravenous fluid administration set heat loss. Prehospital Emerg Care 17:68–72
46. Lapostolle F, Catineau J, Le Toumelin P, et al (2006) Intravenous fluid temperature management by infrared thermometer. Am J Emerg Med 24:174–6
47. Weatherall A, Gill M, Milligan J, et al (2019) Comparison of portable blood-warming devices under simulated pre-hospital conditions: a randomised in-vitro blood circuit study. Anaesthesia 74:1026–32
48. Sessler DI (2016) Perioperative thermoregulation and heat balance. Lancet 387:2655–64
49. Forristal C, Van Aarsen K, Columbus M, et al (2020) Predictors of hypothermia upon trauma center arrival in severe trauma patients transported to hospital via EMS. Prehospital Emerg Care 24:15–22
50. Lapostolle F, Debaty G, Slimani I, Siber-Tonne I, Ricard-Hibon A, Soulat L, Mazur V, Vicaut E. Prévention de l'hypothermie chez les victimes de traumatismes. Etude HYPOTRAUM 2. URGENCES 2024
51. Fremery A, Higel N, Ho-Kee-King D, Pujo J-M, Martin A, Lapostolle F. L’hypothermie en climat tropical est une réalité ! Elle multiplie par 8 la mortalité des traumatisés ! Etude HYPOTROP. URGENCES 2024
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Copyright (c) 2025 Frédéric Lapostolle, Dabor Resiere, Bruno Megarbane, Jean-Marc Pujo (Author)
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