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- In patients with moderate to severe hypothermia, avoid drugs that alter sympathetic vascular tone or inhibit homeostatic reflexes, or modify their dosages.
- Consider limited administration of inotropes and vasopressors to support cardiac and vascular stability in patients with reperfusion injury.
- Be alert to the increased risk of ventricular arrhythmias in hypothermic patients, and initiate treatment to restore adequate circulation and respiration.
- Consider administering antimicrobial agents for selected patients.
| | Drug Treatment For Ventricular Dysrhythmias and Hypotension in Hypothermia (table)
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In patients with moderate to severe hypothermia, avoid drugs that alter sympathetic vascular tone or inhibit homeostatic reflexes, or modify their dosages.  |
- Follow the basic principles of drug intervention:
- Avoid excessive drug intervention of the hypothermic patient with a marked temperature gradient between the shell and core temperatures until core temperature is rewarmed to 33 to 35°C (91.4 to 95°F) and normal pharmacokinetic pathway is reestablished.
- Avoid levothyroxine to correct perceived hypothyroidism in the hypothermic patient, because aggressive treatment for sick euthyroid is potentially hazardous.
- Avoid vasoactive drugs as a first-line strategy; however:
- If vasoactive drugs are given, re-dose at an increased interval
- If vasoactive drugs are required to treat refractory hypotension, slowly titrate drug infusions
- Avoid drugs with a negative inotropic effect (e.g., lidocaine, procainamide, β-adrenergic antagonists, or local anesthetics).
- Avoid drugs that decrease vascular tone (e.g., sedatives, meperidine, vasodilators, or alcohol).
- Be aware that the use of nonsteroidal anti-inflammatory drugs, such as ibuprofen, for treatment of frostbite to prevent the release of inflammatory mediators associated with partial freezing and thawing may be contraindicated due to renal toxicity.
- See table Drug Treatment For Ventricular Dysrhythmias and Hypotension in Hypothermia.
| Background | Back to top
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Consider limited administration of inotropes and vasopressors to support cardiac and vascular stability in patients with reperfusion injury. |
- Avoid intravenous drugs in patients whose core body temperature is <30°C (86°F)).
- Increase the dose interval in patients whose core body temperature is >30°C (86°F).
- Recognize that the metabolic demand of hypothermic patients is significantly decreased, and that they would most likely require a lower perfusion pressure than at normothermia.
- See table Drug Treatment For Ventricular Dysrhythmias and Hypotension in Hypothermia.
| Background | Back to top
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Be alert to the increased risk of ventricular arrhythmias in hypothermic patients, and initiate treatment to restore adequate circulation and respiration.  |
- Do the following in the case of cardiovascular collapse:
- Initiate CPR, including controlled ventilation, until the patient becomes hemodynamically stable or is rewarmed to 35°C (95°F)
- If the patient's core temperature is <30°C (86°F), withhold vasoactive drugs and limit attempts of cardiac defibrillation to three shocks
- In the event of refractory cardiovascular collapse/malignant arrhythmia, provide hemodynamic support by instituting extracorporeal circulatory bypass
- Once the patient's temperature has reached >30°C (86°F), consider administering vasoactive drugs and antiarrhythmics, such as amiodarone
- Correct acidosis and electrolyte abnormalities to increase the success of cardioversion and to promote hemodynamic stability
- Replace potassium cautiously in the hypothermic, hypokalemic patient
- See table Drug Treatment For Ventricular Dysrhythmias and Hypotension in Hypothermia.
| Background | Back to top
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Consider administering antimicrobial agents for selected patients.  |
- Consider broad-spectrum antimicrobial agents for patients with concomitant traumatic injuries, risk of aspiration, dermatologic pathology, or for patients who may be immunocompromised, such as neonates or elderly patients.
- Avoid nephrotoxic antibiotics, or adjust dosage regimens in patients with apparent renal dysfunction.
| Background | Back to top
| | | FAQs |
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| Albert Cheung, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Dmitri Guvakov, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Stuart Weiss, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Wenjun Zhou Martini, PhD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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Hypothermia
