Therapeutic hypothermia is associated with a decrease in urine output in acute stroke patients

Abstract Aims It is unclear what effect therapeutic hypothermia may have on renal function, because its effect has so far been primarily evaluated in settings in which there may be possible confounding perturbations in cardiovascular and renal physiology, such deep intraoperative hypothermia, genera...

Full description

Saved in:
Bibliographic Details
Published in:Resuscitation 2010-12, Vol.81 (12), p.1642-1647
Main Authors: Guluma, Kama Z, Liu, Lin, Hemmen, Thomas M, Acharya, Aninda B, Rapp, Karen S, Raman, Rema, Lyden, Patrick D
Format: Article
Language:English
Subjects:
Acute
Acute renal insufficiency
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood Urea Nitrogen
Body temperature
Creatinine - blood
Emergency
Female
Fluid balance
Hematocrit
Humans
Hypothermia
Hypothermia, Induced - adverse effects
Induced
Intensive care medicine
Kidney - physiology
Kidney function tests
Male
Medical sciences
Middle Aged
Neurology
Stroke
Stroke - physiopathology
Stroke - therapy
Urine
Vascular diseases and vascular malformations of the nervous system
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Aims It is unclear what effect therapeutic hypothermia may have on renal function, because its effect has so far been primarily evaluated in settings in which there may be possible confounding perturbations in cardiovascular and renal physiology, such deep intraoperative hypothermia, general anesthesia, and post-cardiac arrest. We sought to determine if therapeutic hypothermia affects renal function in awake patients with normal renal function who were enrolled into a clinical trial of hypothermia plus intravenous thrombolysis for acute ischemic stroke. Methods Eleven patients with normal renal function were cooled to 33 °C for 24 h using an endovascular catheter, and then re-warmed over 12 h to 36.5 °C, while hourly temperature, blood pressure, and fluid status data was recorded. Blood samples for blood urea nitrogen (BUN), creatinine, and hematocrit were drawn prior to treatment (baseline), immediately after hypothermia and re-warming (day 2), and again at day 7 or discharge, and values compared. Results On initiation of cooling, temperatures dropped from a median pre-treatment value of 36.1 °C (IQR: 35.8–36.4 °C) to 33.1 °C (IQR: 33.1–33.4 °C). Urine output decreased 5.1 ml/h for every 1 °C decrease in body temperature ( p -value = 0.001), with no associated serious adverse events. There were no statistically significant changes in BUN, creatinine, or hematocrit in the hypothermia patients. Conclusion Inducing hypothermia in patients with relatively unperturbed renal physiology results in a decrease in urine output that is linearly correlated with the decrease in core temperature. This has important implications for fluid management in patients undergoing therapeutic hypothermia.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2010.08.003